Dd Form 1921 - Cost Data Summary Report - 2011

SECURITY CLASSIFICATION

Unclassified

Form Approved

COST DATA SUMMARY REPORT

OMB No. 0704-0188

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. MAJOR PROGRAM

a. NAME:

b. PHASE/MILESTONE

3. REPORTING ORGANIZATION TYPE

4. NAME/ADDRESS (Include ZIP Code)

2. PRIME MISSION

5. APPROVED PLAN

Pre-A

B

C-FRP

PRODUCT

PRIME / ASSOCIATE

DIRECT-REPORTING

GOVERNMENT

a. PERFORMING ORGANIZATION

b. DIVISION

NUMBER

CONTRACTOR

SUBCONTRACTOR

A

C-LRIP

O&S

6. CUSTOMER (Direct-reporting

7. CONTRACT TYPE

8. CONTRACT PRICE

9. CONTRACT CEILING

10. TYPE ACTION

subcontractor use only)

a. CONTRACT NO.:

c. SOLICITATION NO.:

e. TASK ORDER/DELIVERY

ORDER/LOT NO.:

b. LATEST MODIFICATION:

d. NAME:

15. RESUBMISSION

11. PERIOD OF PERFORMANCE

12. APPROPRIATION

13. REPORT CYCLE

14. SUBMISSION NUMBER

16. REPORT AS OF (YYYYMMDD)

NUMBER

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

NUMBER OF

NUMBER OF

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

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

ELEMENT

WBS REPORTING ELEMENTS

UNITS

UNITS AT

CODE

TO DATE

COMPLETION

NONRECURRING

RECURRING

TOTAL

NONRECURRING

RECURRING

TOTAL

A

B

C

D

E

G

H

I

J

F

22. REMARKS

Unclassified

DD FORM 1921, MAY 2011

PREVIOUS EDITION IS OBSOLETE.

SECURITY CLASSIFICATION