Dd Form 350 - Individual Contracting Action Report Page 4
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4INDIVIDUAL CONTRACTING ACTION REPORT
DD-AT&L(M)1014
Report Control Symbol
D2
Reason Not Awarded to SDB ____ (A) No Known SDB Source; (B) SDB Not Solicited;
(C) SDB Solicited and No Offer Received; (D) SDB Solicited and Offer Was Not Low;
or (Z) Other Reason
D3
Reason Not Awarded to SB ____ (A) No Known SB Source; (B) SB Not Solicited; (C)
SB Solicited and No Offer Received; (D) SB Solicited and Offer Was Not Low; or (Z)
Other Reason
D4
Set-Aside or Preference Program
D4A
Type of Set-Aside ____ (A) None; (B) Total SB Set-Aside; (C) Partial SB Set-Aside;
(D) Section 8(a) Set-Aside or Sole Source; (E) Total SDB Set-Aside; (F) HBCU or MI –
Total Set-Aside; (G) HBCU or MI – Partial Set-Aside; (H) Very Small Business Set-
Aside; (J) Emerging Small Business Set-Aside; (K) HUBZone Set-Aside or Sole Source;
(L) Combination HUBZone and 8(a)
D4B
Type of Preference ____ (A) None; (B) SDB Price Evaluation Adjustment –
Unrestricted; (C) SDB Preferential Consideration - Partial SB Set-Aside; (D) HUBZone
Price Evaluation Preference; or (E) Combination HUBZone Price Evaluation Preference
and SDB Price Evaluation Adjustment
D4C
Premium Percent __________
D7
Small Business Innovation Research (SBIR) Program ___(A) Not a SBIR Program
Phase I, II, or III; (B) SBIR Program Phase I Action; (C) SBIR Program Phase II Action;
or (D) SBIR Program Phase III Action
D8
Subcontracting Plan - SB, SDB, HBCU, or MI ____ (A) Plan Not Inc luded – No
Subcontracting Possibilities; (B) Plan Not Required; (C) Plan Required – Incentive Not
Included; or (D) Plan Required – Incentive Included
D9
Small Business Competitiveness Demonstration Program ____ (Y) Yes; or (N) No
D10
Size of Small Business ____
Employees
(A) 50 or fewer
Annual Gross Revenues
(B) 51 - 100
(M) $1 million or less
(C) 101 - 250
(N) Over $1 million - $2 million
(D) 251 - 500
(P) Over $2 million - $3.5 million
(E) 501 - 750
(R) Over $3.5 million - $5 million
(F) 751 - 1000
(S) Over $5 million - $10 million
(G) Over 1000
(T) Over $10 million - $17 million
(U) Over $17 million.
D11
Emerging Small Business ____ (Y) Yes; or (N) No
E1
Contingency, Humanitarian, or Peacekeeping Operation ____ (Y) Yes; or Leave Blank
E2
Cost Accounting Standards Clause ____ (Y) Yes; or Leave Blank
E3
Requesting Agency Code (FIPS 95) _________
E4
Requesting Activity Code _________
E5
Number of Actions ________
E6
Payment by Governmentwide Purchase Card ____ (Y) Yes; or Leave Blank
F1
Name of Contracting Officer or Representative _________________________________
F2
Signature _____________________________________________________
F3
Telephone Number ____________________
F4
Date (yyyymmdd) _____________________
Reset
DD FORM 350, OCT 2003
4
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