Page images
PDF
EPUB

Department of Transportation

CUMULATIVE CLAIM AND

RECONCILIATION STATEMENT

Pt. 1253, Subpt. 1253.3, App.

OMB Control No. 2105-0517

Expiration Date: 4/30/97

Public reporting burden for this collection of information is estimated to average 1 hour 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 this burden, to the FAR Secretariat (VRS), Office of Federal Acquisition and
Regulatory Policy, GSA, Washington, D.C. 20485; and to the Office of Management and Budget, Paperwork Reduction Project (2105-0517), Washington, D.C. 20503.

1. Name of Contractor

2. Address of Contractor

3. Contract No.

4. Delivery/Task Order No.

5. The total amount claimed under the above numbered contract, delivery order, or task order number is as follows:

[merged small][ocr errors][merged small][merged small][merged small][merged small][ocr errors][ocr errors][merged small][ocr errors]

6. Total amount due under the above numbered contract, delivery order, task order is as follows:

[merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small]

of the above named contractor, declare that the above statements are correct in accordance with the records of the contractor.

Form DOT # 4220.46 (REV. 2/97) (EXCEL)

PREVIOUS EDITION OBSOLETE

(Signature)

AUTHORIZED FOR LOCAL REPRODUCTION

[graphic][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][ocr errors][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed]

DD FORM 882 INSTRUCTIONS

GENERAL

This form is for use in submitting INTERIM and FINAL Invention reports to the Contracting Officer and for use in the prompt notification of the award of subcontracts containing a "Patent Rights" clause. If the form does not afford sufficient space, multiple forms may be used or plain sheets of paper with proper identification of information by Item Number may be attached.

An INTERIM report is due at least every 12 months from the date of contract award and shall include (a) a listing of "Subject Inventions" during the reporting period, (b) a certification of compliance with required invention identification and disclosure procedures together with a certification of reporting of all "Subject Inventions." and (c) any required information not previously reported on subcontracts awarded during the reporting period and containing a "Patent Rights" clause.

A FINAL report is due within 6 months if contractor is a small business firm or domestic nonprofit organization and within 3 months for all others after completion of the contract work and shall include (a) a listing of all "Subject Inventions" required by the contract to be reported, and (b) any required information not previously reported on subcontracts awarded during the course of or under the contract and containing a "Patent Rights" clause.

While the form may be used for simultaneously reporting inventions and subcontracts, it may also be used for reporting, promptly after award, subcontracts containing a "Patent Rights" clause.

Dates shall be entered where indicated in certain items on this form and shall be entered in four or six digit numbers in the order of year and month (YYMM) or year, month and day (YYMMDD). Example: April 1986 should be entered as 8604 and April 15, 1986 should be entered as 860415.

[blocks in formation]
[blocks in formation]

50251, Sept. 25, 1996; 62 FR 26421, May 14, 1997; 62 FR 67752, Dec. 30, 1997; 64 FR 2445, Jan. FR 40299, Aug. 8, 1994, as amended at 60 FR 55802, Nov. 3, 1995; 61 FR 393, Jan. 5, 1996; 61

1999]

190-192 D-01--20

(Word)

[blocks in formation]
« PreviousContinue »