Form DD1921 Cost Data Summary Report

SECURITY CLASSIFICATION

Unclassified

COST DATA SUMMARY REPORT

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

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 whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. 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

a. NAME:

b. PHASE/MILESTONE

2. PRIME MISSION PRODUCT

3. REPORTING ORGANIZATION TYPE

4. NAME/ADDRESS (Include ZIP Code)

5. APPROVED PLAN NUMBER

Pre-A

B

C-FRP

PRIME / ASSOCIATE CONTRACTOR

DIRECT-REPORTING SUBCONTRACTOR

GOVERNMENT

a. PERFORMING ORGANIZATION

b. DIVISION

A

C-LRIP

O&S

6. CUSTOMER (Direct-reporting subcontractor use only)

7. CONTRACT TYPE

8. CONTRACT PRICE

9. CONTRACT CEILING

10. TYPE ACTION

a. CONTRACT NO.:

c. SOLICITATION NO.:

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

b. LATEST MODIFICATION:

d. NAME:

11. PERIOD OF PERFORMANCE

12. APPROPRIATION

13. REPORT CYCLE

14. SUBMISSION NUMBER

15. RESUBMISSION NUMBER

16. REPORT AS OF (YYYYMMDD)

a. START DATE (YYYYMMDD):

RDT&E

INITIAL

b. END DATE (YYYYMMDD):

PROCUREMENT

INTERIM

O&M

FINAL

17. NAME (Last, First, Middle Initial)

18. DEPARTMENT

19. TELEPHONE NUMBER (Include Area Code)

20. EMAIL ADDRESS

21. DATE PREPARED (YYYYMMDD)

WBS ELEMENT CODE

WBS REPORTING ELEMENTS

NUMBER OF UNITS TO DATE

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

NUMBER OF UNITS AT COMPLETION

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

NONRECURRING

RECURRING

TOTAL

NONRECURRING

RECURRING

TOTAL

A

B

C

D

E

F

G

H

I

J

22. REMARKS

DD FORM 1921, MAY 2011

PREVIOUS EDITION IS OBSOLETE.

SECURITY CLASSIFICATION

Unclassified