White_Paper_Cover_Sheet.pdf

PART IV: APPENDIX B

NEEDIPEDIA WHITE PAPER COVERSHEET

WP Classification: Proprietary Data: Submission Date:

WP Title:

Offeror Organization:

Need or CALL Number: (Number Only)

Need or CALL Title: (Title Name Only)

DUNS Number: CAGE Code Number

2 Technical POC:

Name: Title:

Phone: Ext: Email:

3 Contracts POC:

Name: Title:

Phone: Ext: Email:

4 Mailing Address:

Street: City:

State: Country: Zip:

5 Physical Address:

(If different from above)

Street: City:

State: Country: Zip:

Organization

Descriptors

(Select more than one if applicable)

Large Business Federally Funded Research & Development Center (FFRDC)

Small Business IC CAE or Minority Servicing Institution (MSI)

(AANAPISI / HBCU / HSI / TCU) Non-Profit

8(a) Business Program Woman-Owned Small Business (WOSB)

HUBZone Service-Disabled Veteran-Owned Small Business (SDVOSB)

Academic Institution Foreign / Offeror not based in US o National Lab or UARC Other:

Requested Funding or

Contractual Instrument

BAA (FAR Based) Contract Type Requested:

CSO (FAR Based) Contract Type Requested:

Grant

Other Transaction Authority (OTA)

Cooperative Research and Development Agreement (CRADA)

Other / Not Known / Not Declared Note:

Estimated Cost of Effort: Estimate Duration of Effort (Months):

Estimate the percentage of effort to be performed by the offeror & percentage of work by other team members (e.g., prime, subcontractor) Offeror: %

Team

Members:

Is the submitter a non-traditional defense contractor? (if yes, explain below)

If yes, explain:

Was DoD-reimbursed IR&D technology a foundation for the proposed approach?

Does the proposed submission derive from, extend, or complete efforts from prior federally funded SBIR or STTR projects? (If yes, provide details below)

SIBR/STTR Topic Number:

SIBR/STTR Topic Name:

SIBR/STTR Agency:

SIBR/STTR Contract Number:

Have you ever done business previously with the DIA?

If “yes” – note how recently: Within the last 12 months 1 - 5 years ago Over 5 years ago

Additional Routing: Is there a US Government POC that is possibly interested in this submission or topic?

USG POC 1

(If Not Applicable, Leave blank)

Name: Title:

Phone: Email:

USG POC 2

(If Not Applicable, Leave blank)

Name: Title:

Phone: Email:

List keywords or phrases separated by commas for this submission to aid search and discovery (text will scale to fit):

13 Filename of Submitted White Paper:

DIA NeedipeDIA Form 002 Version 7.5 - White Paper Cover Sheet Page 1 of 1

Yes No

Yes No

Yes No

Yes No

Yes No

Note: Include this cover sheet form as a separate file when submitting white papers to ensure proper routing.