1300883133 CDRLs 09Nov21CC.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 110 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 this burden, to Department of Defense, Washington Headquarters Service, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP_________ TM___________ OTHER: MISC

D. SYSTEM/ITEM

Transient Generator

E. CONTRACT / PR NO.

1300883133

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM:

CERTIFICATE OF COMPLIANCE

3. SUBTITLE

N/A

17. PRICE GROUP

4. AUTHORITY (Date Acquisition Document No.)

DI-MISC-81356A

5. CONTRACT REFERENCE

SOW Para# 4.1

6. REQUIRING OFFICE

NUWCDIVNPT, Code 3422

18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMNT

REQUIRED

10. FREQUENCY

12. DATE OF FIRST

SUBMISSION 14. DISTRIBUTION *

LT D* ASREQ See Block 16* b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQNT

SUBMISSION

a. ADDRESSEE Draft Final

N/A See Block 16* N/A See Block 16* Reg Repro

16. REMARKS PI 0 1 0

Block 9: See BLOCK 16 ADDENDUM 3432 DM 0 1 0

Block 10: One (1) submission is anticipated.

Block 12 & 13: Contractor shall deliver a Certificate of Compliance with each unit that is delivered.

Block 14: Media Requirements: The report shall be delivered electronically in Microsoft 2016 format with email notification to all addressees.

Principal Investigator (PI): marion.m.lee@navy.mil 3432 DM: NUWC_NPT_3432DataMgt@navy.mil

15. TOTAL

______> 0 2 0

G. PREPARED BY:

Marion Lee

H. DATE

25 OCT 2021

I. APPROVED BY J. DATE

APPROVED

FOR RFQ

09 NOV 2021

DD Form 1423-1, Feb 2001 Previous Edition May be Used Page __1__ of __3 Pages

(1 Data Item)

Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 110 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 this burden, to Department of Defense, Washington Headquarters Service, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP_________ TM___________ OTHER: MISC

D. SYSTEM/ITEM

Transient Generator

E. CONTRACT / PR NO.

1300883133

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM:

ELECTROMAGNETIC INTERFERENCE TEST

REPORT (EMITR)

3. SUBTITLE

N/A

17. PRICE GROUP

4. AUTHORITY (Date Acquisition Document No.)

DI-EMCS-80200C

5. CONTRACT REFERENCE

SOW Para# 4.1

6. REQUIRING OFFICE

NUWCDIVNPT, Code 3422

18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMNT

REQUIRED

10. FREQUENCY

12. DATE OF FIRST

SUBMISSION 14. DISTRIBUTION *

LT D* ASREQ See Block 16* b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQNT

SUBMISSION

a. ADDRESSEE Draft Final

N/A See Block 16* N/A See Block 16* Reg Repro

16. REMARKS PI 0 1 0

Block 9: See BLOCK 16 ADDENDUM 3432 DM 0 1 0

Block 10: One (1) submission is anticipated.

Block 12 & 13: Contractor shall deliver a Electromagnetic Interference Test Report (EMITR) with each unit that is delivered.

Block 14: Media Requirements: The report shall be delivered electronically in Microsoft 2016 format with email notification to all addressees.

Principal Investigator (PI): marion.m.lee@navy.mil 3432 DM: NUWC_NPT_3432DataMgt@navy.mil

15. TOTAL

______> 0 2 0

G. PREPARED BY:

Marion Lee

H. DATE

25 OCT 2021

I. APPROVED BY J. DATE

APPROVED

FOR RFQ

09 NOV 2021

DD Form 1423-1, Feb 2001 Previous Edition May be Used Page __2__ of __3 Pages

DD FORM 1423

BLOCK 16 ADDENDUM

1300883133

BLOCK 9: The following information is provided in amplification of the Block 9 Distribution Statement shown on each DD FORM 1423.

Distribution Statement paragraphs are in addition to CLASSIFICATION markings of the data.

CDRLs A001 and A002

Distribution Statement D: Distribution authorized to Department of Defense and U.S. DoD contractors only Critical Technology (25 October 2021). Other requests shall be referred to NUWCDIVNPT, Code 349.

The following "EXPORT CONTROL WARNING NOTICE" must be used in conjunction with DISTRIBUTION STATEMENTS identified in the CDRL.

WARNING -This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. Sec. 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App.

2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DD Form 1423-2, AUG 96 (EG) PREVIOUS EDITION MAY BE USED Page 3 of 3 Pages