A03 - DD1423.pdf

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.

0004, 0009, 0014

B. EXHIBIT

A

C. CATEGORY:

TDP_____ TM ______ OTHER: MISC

D. SYSTEM/ITEM

EQUIPMENT REPAIR SERVICES

E. CONTRACT/PR NO.

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

MONTHLY INSPECTION AND ACCEPTANCE REPORTS

3. SUBTITLE

STATUS REPORTS

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-80508A

5. CONTRACT REFERENCE

PWS C.6.6

6. REQUIRING OFFICE

FCDD-RLL-DAI

7. DD 250 REQ

N/A

9. DIST STATEMENT

REQUIRED

C

10. FREQUENCY

MONTHLY

12. DATE OF FIRST

SUBMISSION

NLT 40 Days ACA

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION See BLK 16

Draft Final

Reg Repro

16. REMARKS

BLK 4

REPORT SHALL BE DELIVERED ELECTRONICALLY IN A MEDIA SELECTED BY THE

GOVERNMENT AT TIME OF DELIVERY. SOME MEDIA TYPES WHICH CAN BE

ACCEPTED INCLUDE: FTP (FILE TRANSFER PROTOCOL), E-MAIL, CD-ROM AND DVD-

ROM.

BLK 13

SUBSEQUENT SUBMISSIONS SHALL BE MADE NLT THE 10TH DAY OF THE MONTH

FOLLOWING THE MONTH BEING REPORTED ON.

CONTRACTOR FORMAT ACCEPTABLE.

AMOUNT: THIS ITEM WILL BE NSP (NOT SEPERATELY PRICED)

FCDD-RLL-DAI 1 1

15. TOTAL 1 1 0

G. PREPARED BY

TBD

H. DATE

1/15/2020

I. APPROVED BY

J. DATE

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 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

DISTRIBUTION STATEMENT A

Approved for public release; distribution is unlimited.

All information generated from the performance of this contract shall be subject to the following distribution statement:

DISTRIBUTION STATEMENT A

Approved for public release; distribution is unlimited

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.