Cost Data Summary Report

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Unclassified

SECURITY CLASSIFICATION

OMB No. 0704-0671
Expires: X/XX/XXXX

COST DATA SUMMARY REPORT

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 the Department of Defense, Washington Headquarters Services, at [email protected]. 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. MAJOR PROGRAM
b. PHASE/MILESTONE
Pre-A
B
A
C-LRIP

a. NAME:

6. CUSTOMER (Direct-reporting
subcontractor use only)

7. CONTRACT TYPE

C-FRP
O&S

2. PRIME MISSION
PRODUCT

3. REPORTING ORGANIZATION TYPE
PRIME / ASSOCIATE
DIRECT-REPORTING
CONTRACTOR
SUBCONTRACTOR

8. CONTRACT PRICE

9. CONTRACT CEILING

GOVERNMENT

c. SOLICITATION NO.:

b. LATEST MODIFICATION:
12. APPROPRIATION
RDT&E
PROCUREMENT
O&M
18. DEPARTMENT

17. NAME (Last, First, Middle Initial)

WBS
ELEMENT
CODE

WBS REPORTING ELEMENTS

A

B

NUMBER OF
UNITS
TO DATE
C

5. APPROVED PLAN
NUMBER

b. DIVISION

10. TYPE ACTION
a. CONTRACT NO.:

11. PERIOD OF PERFORMANCE
a. START DATE (YYYYMMDD):
b. END DATE (YYYYMMDD):

4. NAME/ADDRESS (Include ZIP Code)
a. PERFORMING ORGANIZATION

COSTS INCURRED TO DATE (thousands of U.S. Dollars)
NONRECURRING
D

e. TASK ORDER/DELIVERY
ORDER/LOT NO.:

d. NAME:
13. REPORT CYCLE
14. SUBMISSION NUMBER
INITIAL
INTERIM
FINAL
19. TELEPHONE NUMBER (Include Area Code)

RECURRING
E

TOTAL
F

15. RESUBMISSION
NUMBER

21. DATE PREPARED (YYYYMMDD)

20. EMAIL ADDRESS
NUMBER OF
UNITS AT
COMPLETION
G

16. REPORT AS OF (YYYYMMDD)

COSTS INCURRED AT COMPLETION (thousands of U.S. Dollars)
NONRECURRING
H

RECURRING
I

22. REMARKS

DD FORM 1921, MAY 2011

PREVIOUS EDITION IS OBSOLETE.

SECURITY CLASSIFICATION

Unclassified

TOTAL
J