Do not complete Part D if Line B5B is coded Y or if Line B13A is coded 6.

D1  Type of Contractor

D1A  Type of Entity ____(A) Small Disadvantaged Business (SDB) Performing in U.S.; (B) Other Small Business (SB) Performing in U.S.; (C) Large Business Performing in U.S.; (D) JWOD Participating Nonprofit Agency; (F) Hospital; (L) Foreign Concern or Entity; (M) Domestic Firm Performing Outside U.S.; (T) Historically Black College or University (HBCU); (U) Minority Institution (MI); (V) Other Educational or (Z) Other Nonprofit

D1B  Women-Owned Business  ___(Y) Yes; (N) No; or (U) Uncertified

D1C  HUBZone Representation  ___ (Y) Yes; or (N) No

D1D  Ethnic Group  ___ (A) Asian-Indian American; (B) Asian-Pacific American; (C) Black American; (D) Hispanic American; (E) Native American; (F) Other SDB Certified or Determined by SBA; or (Z) No Representation

D1E  Veteran-Owned Small Business  ___(A) Service-Disabled Veteran; or (B) Other Veteran

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  ________

D5-D6 Reserved

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 Included - 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  

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  Non-DoD Requesting Agency Code (FTPS 95)    __

E4  Requesting Activity Code           __

E5  Number of Actions

Fl  Name of Contracting Officer or Representative ____

F2  Signature _

F3  Telephone Number ____

F4  Date (yyyymmdd)  __