The public reporting burden for this collection of information is estimated to average 8 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 Department of Defense, Washington Headquarters Services, Executive Services Directorate (0704-0188). 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 COMPLETED FORM TO THE ABOVE ORGANIZATION.
1. PROGRAM
a. MDAP:
b. PHASE:
2. PRIME MISSION PRODUCT3. CONTRACTOR TYPE (X one)
PRIME/ASSOCIATE
DIRECT-REPORTING SUBCONTRACTOR
4. NAME/ADDRESS (Include ZIP Code)5. APPROVED PLAN NUMBER
6. CUSTOMER(Direct-Reporting Subcontractor Use Only)7. CONTRACT TYPE8. CONTRACT PRICE9. CONTRACT CEILING10. TYPE ACTION
a. CONTRACT NO.:
b. LATEST MODIFICATION:
c. SOLICITATION NO.:
d. NAME:
11. PERIOD OF PERFORMANCE
a. START DATE (YYYYMMDD):
b. END DATE (YYYYMMDD):
12. APPROPRIATION
RDT&E
PROCUREMENT
O&M
13. REPORT CYCLE (X one)
INITIAL
INTERIM
FINAL
14. SUBMISSION NUMBER15. RESUBMISSION NUMBER16. REPORT AS OF (YYYYMMDD)
17. NAME (Last, First, Middle Initial)18. DEPARTMENT19. TELEPHONE NUMBER (Include Area Code)20. EMAIL ADDRESS21. DATE PREPARED (YYYYMMDD)
