A01_-_DD1423.doc

Template last updated 09/29/2017

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item) Form Approved

OMB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-1088). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. Listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A

C. CATEGORY:

TDP_____ TM ______ OTHER: MGMT

D. SYSTEM/ITEM

Contract Administration and Acquisition Methodologies Support

E. CONTRACT/PR NO.

TBD

F. CONTRACTOR

TD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Management Report

3. SUBTITLE

Quarterly Status Reports

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80368-A

5. CONTRACT REFERENCE

6. REQUIRING OFFICE

CCAP-SCA

7. DD 250 REQ

LT

9. DIST STATEMENT

REQUIRED

B

10. FREQUENCY

QRTLY

12. DATE OF FIRST SUBMISSION

NLT 90 days ACA 14.

DISTRIBUTION

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION QRTLY

16. REMARKS

BLOCK 1: ALL REPORTS SHALL BE EMAILED AND IN MICROSOFT WORD, MICROSOFT OFFICE, MICROSOFT EXCEL, OR PDF FORMAT.

FORMAT TEMPLATE PROVIDED IN ATTACHMENT 1.

BLOCK 14: CCAP-SCA REPORT COPY TO BE SENT TO:

BETHANY LIMMER, CONTRACTING OFFICER’S REPRESENTATIVE

bethany.m.limmer.civ@mail.mil

(301) 394-3379

COR

15. TOTAL

G. PREPARED BY

Brittany Smith

H. DATE

10/16/2018

I. APPROVED BY

Dan Dougherty

J. DATE

10/18/2018

DD FORM 1423-1, FEB 2001

PREVIOUS EDITION MAY BE USED.

Page 1 of 1 Pages

EXHIBIT A – ATTACHMENT 1

ARMY RESEARCH LABORATORY

Report Title Goes Here

Any Subtitles Go Here

By Some Author and Another Author

Month XXXX

Prepared by

Whatever Technology Corporation

0000 Research Drive

Anywhere, ST 20006-1000

Under contract

W911QX-XX-C-XXXX

DISTRIBUTION STATEMENT GOES HERE

EXHIBIT A – ATTACHMENT 2

The findings in this report are not to be construed as an official Department of the Army position unless so designated by other authorized documents.

Citation of manufacturer's or trade names does not constitute an official endorsement or approval of the use thereof.

DESTRUCTION NOTICE: For classified documents, follow the procedures in DoD 5220.22-M, National Industrial Security Program Operating Manual, Chapter 5, Section 7. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.