Attachment J-3 Contract Data Requirements List

SECTION J

ATTACHMENT J-3

Contract Data Requirement List (CDRL)

CONTRACT DATA REQUIREMENTS LIST

Form Approved

OMB No. 0704-0188

(1 Data Item)

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 (0704-0188). 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 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

C. CATEGORY:

TDP

D. SYSTEM/ITEM

1. DATA ITEM NO.

A010

TM

E. CONTRACT/PR NO.

OTHER

F. CONTRACTOR

2. TITLE OF DATA ITEM

3. SUBTITLE

Third Party Recoveries for Fiscal Year Report

Initial

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE

6. REQUIRING OFFICE

TOM C10 S4

7. DD 250 REQ

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

B

11. AS OF DATE

8. APP CODE

12. DATE OF FIRST SUBMISSION

See Block 16
See Block 16

OGC
14.

DISTRIBUTION

See Block 16

13. DATE OF SUBSEQUENT

SUBMISSION

b. COPIES

a. ADDRESSEE

16. REMARKS

Reg

Repro

Submit through the
DHA e-Commerce
Extranet.

(Per TOM C14)

AF
T

FIRST SUBMISSION:

Frequency: Annual (Fiscal Year)
Reporting Period Start Date: Start of service delivery
Due Date: November 1

SUBSEQUENT SUBMISSION: CONTINUE FROM FIRST SUBMISSION

Final
Draft

See Block 16

PHI/PII: No

FILE FORMAT: No specific file format required

R

CONTENT DETAILS:

The report shall include the following elements:
- Reporting Period (covering the 12 months of the previous Fiscal Year) - The Contractor’s Name and Region Name (if applicable) - The Uniformed Service that the report figures are associated with (i.e., Army, Air Force, Navy & Marine Corps, Coast Guard, United States Public Health Service (USPHS) and National Oceanic and Atmospheric Administration (NOAA)).

D

The contractor shall create a breakdown for each of the Uniformed Services listed above which includes the following categories: