A03 - DD1423.pdf
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- Attached to
- Technician Range Services
- Solicitation number
- W911QX20R0006
About this file
This Contract Data Requirements List outlines seven required data items for a federal contract to provide Experimental Facilities Technician Support Services. The contractor will be required to submit a Management Plan within 30 days of award, followed by monthly Funds and Man-Hours Expenditure Reports, Status Reports, and Personnel Certifications. Quarterly Safety Reports are also required, along with incident-specific Accident Reports. The Army Research Laboratory at Aberdeen Proving Ground is the requiring office. All submissions must be provided electronically and in hard copy, with distribution lists and delivery due dates specified for each data item.
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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, 0008, 0012
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER: MGMT
D. SYSTEM/ITEM
EXPERIMENTAL FACILITIES
TECHNICIAN SUPPORT SERVICES
E. CONTRACT/PR NO.
0010947607
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A001
2. TITLE OF DATA ITEM
MANAGEMENT PLAN
3. SUBTITLE
PROGRAM MANAGEMENT PLAN
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-81797
5. CONTRACT REFERENCE
PWS C.4.3
6. REQUIRING OFFICE
RDRL-WM-G
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
C
10. FREQUENCY
SEMIA
12. DATE OF FIRST SUBMISSION
No Later Than (NLT) 30 days After
Contract Award (ACA)
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
SEE BLK 16
13. DATE OF SUBSEQUENT
SUBMISSION SEE BLK 16
Draft Final
Reg Repro
16. REMARKS
BLK 4: EACH 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), CD-ROM
AND DVD-ROM.
BLK 13: SUBSEQUENT SUBMISSIONS SHALL BE MADE NLT SEVEN (7) MONTHS ACA.
RDRL-WMP-G 1 1
15. TOTAL 1 1
G. PREPARED BY
COR
H. DATE
10/22/2019
I. APPROVED BY
PHILLIP J. AMADOR
J. DATE
10/22/2019
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, 0008, 0012
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER: MGMT
D. SYSTEM/ITEM
EXPERIMENTAL FACILITIES
TECHNICIAN SUPPORT SERVICES
E. CONTRACT/PR NO.
TBD
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A002
2. TITLE OF DATA ITEM
FUNDS AND MAN-HOURS EXPENDITURE REPORT
3. SUBTITLE
FINANCIAL REPORTS AND EXPENDITURE
REPORTS
4. AUTHORITY (Data Acquisition Document No.)
DI-FNCL-80331
5. CONTRACT REFERENCE
PWS C.8
6. REQUIRING OFFICE
RDRL-WM-G
7. DD 250 REQ
LT
A & F
MTHLY
12. DATE OF FIRST SUBMISSION
NLT 30 DAYS ACA
8. APP CODE
N/A
11. AS OF DATE
SEE BLK 16
13. DATE OF SUBSEQUENT
SUBMISSION SEE BLK 16
Draft Final
Reg Repro
16. REMARKS
BLK 4: IN ADDITION TO PAPER COPIES, EACH REPORT SHALL BE DELIVERED
ELECTRONICALLY IN A MEDIA SELECTED BY THE GOVERNMENT AT TIME OF
DELIVERY. MEDIA TYPES WHICH CAN BE ACCEPTED INCLUDE: FTP (FILE TRANSFER
PROTOCOL), CD-ROM, AND DVD-ROM.
BLK 11 AND 13: SUBSEQUENT SUBMISSIONS SHALL BE MADE NLT THE 10TH DAY OF
THE MONTH FOLLOWING THE PERIOD OF PERFORMANCE REPORTING ON.
RDRL-WMP-G 0 1
15. TOTAL 0 1
COR
H. DATE
10/22/2019
I. APPROVED BY
PHILLIP J. AMADOR
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, 0008, 0012
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER: MGMT
D. SYSTEM/ITEM
EXPERIMENTAL FACILITIES
TECHNICIAN SUPPORT SERVICES
E. CONTRACT/PR NO.
TBD
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A003
2. TITLE OF DATA ITEM
STATUS REPORT
3. SUBTITLE
MONTHLY STATUS REPORT
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-80368A
5. CONTRACT REFERENCE
PWS C.2.26.2
6. REQUIRING OFFICE
RDRL-WM
7. DD 250 REQ
LT
MTHLY
12. DATE OF FIRST
SUBMISSION
NLT 30 DAY ACA
8. APP CODE
N/A
11. AS OF DATE
SEE BLK 16
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLK 16
Draft Final
Reg Repro
16. REMARKS
BLK 4: IN ADDITION TO PAPER COPIES, EACH REPORT SHALL BE DELIVERED
ELECTRONICALLY IN A MEDIA SELECTED BY THE GOVERNMENT AT TIME OF
DELIVERY. MEDIA TYPES WHICH CAN BE ACCEPTED INCLUDE: FTP (FILE TRANSFER
PROTOCOL), CD-ROM, AND DVD-ROM.
BLK 11, 12 AND 13: SUBSEQUENT SUBMISSIONS SHALL BE MADE NLT THE 10TH DAY OF
RDRL-WMP-G 0 1 0
15. TOTAL 0 1 0
COR
H. DATE
10/22/2019
I. APPROVED BY
PHILLIP J. AMADOR
J. DATE
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of Pages
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, 0008, 0012
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER: MGMT
D. SYSTEM/ITEM
EXPERIMENTAL FACILITIES
TECHNICIAN SUPPORT SERVICES
E. CONTRACT/PR NO.
0010947607
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A004
2. TITLE OF DATA ITEM
SAFETY REPORT
3. SUBTITLE
SAFETY PLAN
4. AUTHORITY (Data Acquisition Document No.)
DI-ENVR-81375
5. CONTRACT REFERENCE
PWS C.11.7
6. REQUIRING OFFICE
RDRL-WM
7. DD 250 REQ
LT
QRTLY
12. DATE OF FIRST
SUBMISSION
NLT 120 DAYS ACA
8. APP CODE
N/A
11. AS OF DATE
SEE BLK 16
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLK 16
Draft Final
BLK 4: IN ADDITION TO PAPER COPIES, EACH REPORT SHALL BE DELIVERED
ELECTRONICALLY IN A MEDIA SELECTED BY THE GOVERNMENT AT TIME OF
DELIVERY. MEDIA TYPES WHICH CAN BE ACCEPTED INCLUDE: FTP (FILE TRANSFER
PROTOCOL), CD-ROM, AND DVD-ROM.
BLK 11 AND 13: SUBSEQUENT SUBMISSIONS SHALL BE MADE NLT THE 10TH DAY OF
THE MONTH FOLLOWING EACH QUARTER DURING THE PERIOD OF PERFORMANCE
REPORTING ON.
COR
H. DATE
10/22/2019
I. APPROVED BY
PHILLIP J. AMADOR
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, 0008, 0012
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER: MGMT
D. SYSTEM/ITEM
EXPERIMENTAL FACILITIES
TECHNICIAN SUPPORT SERVICES
E. CONTRACT/PR NO.
TBD
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A005
2. TITLE OF DATA ITEM
PERSONNEL MANAGEMENT PLAN
3. SUBTITLE
PERSONNEL PLAN
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-80096
5. CONTRACT REFERENCE
PWS C.9.4
6. REQUIRING OFFICE
RDRL-WM
7. DD 250 REQ
LT
OTIME/R
12. DATE OF FIRST
SUBMISSION
8. APP CODE
N/A
11. AS OF DATE
SEE BLK 16
13. DATE OF SUBSEQUENT
SUBMISSION
ASREQ
Draft Final
DELIVERY. MEDIA TYPES WHICH CAN BE ACCEPTED INCLUDE: FTP (FILE TRANSFER
PROTOCOL), CD-ROM, AND DVD-ROM.
BLK 11 AND 13: SUBSEQUENT SUBMISSIONS SHALL BE MADE WITHIN 24 HOURS OF
ANY CHANGES DURING THE PERIOD OF PERFORMANCE REPORTING ON.
COR
H. DATE
10/22/2019
I. APPROVED BY
PHILLIP J. AMADOR
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, 0008, 0012
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER: MGMT
D. SYSTEM/ITEM
EXPERIMENTAL FACILITIES
TECHNICIAN SUPPORT SERVICES
E. CONTRACT/PR NO.
TBD
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A006
2. TITLE OF DATA ITEM
RECORD OF ACCIDENTS OR INCIDENTS
3. SUBTITLE
ACCIDENT REPORT
4. AUTHORITY (Data Acquisition Document No.)
DI-SAFT-81563
5. CONTRACT REFERENCE
PWS C.19.1
6. REQUIRING OFFICE
RDRL-WM
7. DD 250 REQ
LT
AS REQ
12. DATE OF FIRST
SUBMISSION
SEE BLK 16
8. APP CODE
N/A
11. AS OF DATE
SEE BLK 16
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLK 16
Draft Final
DELIVERY. MEDIA TYPES WHICH CAN BE ACCEPTED INCLUDE: FTP (FILE TRANSFER
PROTOCOL), CD-ROM, AND DVD-ROM.
BLK 11, 12 AND 13: ALL SUBMISSIONS SHALL BE MADE WITHIN 72 HOURS OF THE
INCIDENT.
RDRL-WMP-G 0 1
15. TOTAL 0 1
COR
H. DATE
10/22/2019
I. APPROVED BY
PHILLIP J. AMADOR
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, 0008, 0012
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER: MGMT
D. SYSTEM/ITEM
EXPERIMENTAL FACILITIES
TECHNICIAN SUPPORT SERVICES
E. CONTRACT/PR NO.
TBD
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A007
2. TITLE OF DATA ITEM
EMPLOYEE CERTIFICATIONS
3. SUBTITLE
CERTIFICATIONS
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-80368
5. CONTRACT REFERENCE
PWS C.19.2
6. REQUIRING OFFICE
RDRL-WM
7. DD 250 REQ
LT
MTHLY
12. DATE OF FIRST
SUBMISSION
8. APP CODE
N/A
11. AS OF DATE
SEE BLK 16
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLK 16
Draft Final
DELIVERY. MEDIA TYPES WHICH CAN BE ACCEPTED INCLUDE: FTP (FILE TRANSFER
PROTOCOL), CD-ROM, AND DVD-ROM.
BLK 11 AND 13: SUBSEQUENT SUBMISSIONS SHALL BE MADE NLT THE 10TH DAY OF
COR
H. DATE
10/22/2019
I. APPROVED BY
PHILLIP J. AMADOR
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.
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