Maintainer Training Report

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

TBD

C. CATEGORY:

C

D. SYSTEM/ITEM

Mercedes-Benz Dump Truck
1. DATA ITEM NO.

A006

E. CONTRACT/PR NO.

F. CONTRACTOR

TBD

TBD

2. TITLE OF DATA ITEM

17. PRICE GROUP

3. SUBTITLE

Maintenance Training Report

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE

DI-ILSS-80872/Training Report

7. DD 250 REQ

N/A

9. DIST STATEMENT

REQUIRED

8. APP CODE

Section C.5.3.2

10. FREQUENCY

12. DATE OF FIRST SUBMISSION

One Time

AMSTA-MSS-A

14.

DISTRIBUTION

See Remarks

11. AS OF DATE

See Remarks

18. ESTIMATED

TOTAL PRICE

6. REQUIRING OFFICE

13. DATE OF SUBSEQUENT

SUBMISSION

b. COPIES

a. ADDRESSEE

N/A

Final

Draft

Reg

AMSTA-MSS_A

16. REMARKS

Repro

Data Item Description (Block 2)
Contractor shall provide SAMD the Final training report and assessment upon completion of the training.
The report shall contain: students name, location of training, training dates, list of students trained, students achieving passing grade and proposed training dates for future classes.
Report shall be completed within 15 days after completion of the class. Contractor shall provide copy of each student completed “Student Critique” forms with each training report submission. Forms shall be submitted in English. Training report shall be in the contractor"s format.
Distribution (Block 9)
a. Army Contracting Command-Warren, Mr. Antonio Smith
[email protected]
b. SAMD Weapon System Manager, Mr. David Tipp
[email protected]

15. TOTAL

G. PREPARED BY

David Tipp

DD FORM 1423-1, FEB 2001