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DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The 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 the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No.

listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP ________ TM _______ OTHER

D. SYSTEM/ITEM: E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

G. PREPARED BY: (Data Manager) H. DATE I. APPROVED BY: (Engineer) J. DATE

Page of Pages

DD FORM 1423-1, AUG 96

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s right to use the data shall be governed by the pertinent provisions of the contract.

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4;

Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

16. REMARKS (Continued)

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT:

xTDP: Off xTM: Off

OTHER:

DSYSTEMITEM:

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued: s. Original drawings are not required. If applicable, reproducible stable base copies of unidimensional drawings and master pattern drawings are required. See Block 14.

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1_DATA_ITEM_NO: A001

2_TITLE_OF_DATA_ITEM: Counterfeit Prevention Plan

3_SUBTITLE: CPP

4_AUTHORITY_Data_Acquisit: DI-MISC-81832

5_CONTRACT_REFERENCE: CLIN for Data

6_REQUIRING_OFFICE: 416 SCMS/GUEAA

7_DID_250_REQ: LT

8_APP_CODE: A

DIST_STATEMENT: D

10_FREQUENCY: ONE/R

11_AS_OF_DATE: SEE BLK 16

12_DATE_OF_FIRST_SUBMISSI: SEE BLK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLK 16

addressee1: 416 SCMS/ draft1:

reg1: 1 repro1:

addressee2: GUEAA draft2:

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addressee3: 6070 Gum LN draft3:

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addressee4: Bldg. 1213 draft4:

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16_REMARKS: NOTE: Changes to office symbols and/or e-mail addresses when necessary shall be made by letter through the Government CO/ACO without further revision to this CDRL.

1. Block 4: Contractor Format Acceptable.

2. Blocks 7, 8, 14: The contractor shall submit a Letter of Transmittal and send the Contractors Counterfeit Protection Plan (CPP) via e-mail to: javad.refahiyat@us.af.mil

3. Blocks 8, 10, 11, 12, 13: The contractor shall deliver the Counterfeit prevention Plan (CPP) NLT thirty (30) calendar days after contract award. The Government comments will be provided to the contractor within fourteen (14) calendar days after receipt. The contractor shall resubmit the CPP NLT seven (7) calendar days after receipt of Government comments.

4. Block 9: Distribution Statement, Export Control Warning and Destruction Notice shall be IAW DoD Instruction 5230.24

The following Distribution Statement shall be placed on the first sheet of each document and/or associated lists.

DISTRIBUTION STATEMENT "D": Distribution authorized to the Department of Defense and U.S. DoD contractors only (Administration or Operational Use). (March 2021). Other requests for this document shall be referred to (416 SCMS/GUEAA, Hill AFB, UT 84056-5826).

EXPORT CONTROL WARNING: All printed and electronic, including digital, technical documents that determined to contain export-controlled technical data shall be marked with the following statement:

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 (Title 50, U.S.C., App. 2401 et seq.), as amended. Violations of these export laws are subject to severe criminal penalties. Disseminate IAW provisions of DoD Directive 5230.25.

17_PRICE_GROUP: NSP

ESTIMATED_TOTAL_PRICE: 0.00

G_PREPARED_BY:

H_DATE: 10 Mar 2021

1_APPROVED_BY:

J_DATE: 10 Mar 2021

Page: 1 reg38t: 1

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: A

xTDP: Off

OTHER: MISC

DSYSTEMITEM: Amplifier, Radio Fre

E_CONTRACTPR_NO: FD2020-21-00604

FCONTRACTOR:

of_pages: 2

Reset:

xTM: Off

16_REMARKS_Continued: DESTRUCTION NOTICE: For classified documents, follow the procedures, in DoD 5220.22-M, National Industrial Security Program Operating Manual (NISPOM), Section 5-705, or DoD 5200.1-R, Information Security Program Chapter VI. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

Page2: 2

2021-03-10T13:10:41-0700

PINNEGAR.STEPHANIE.A.1102660737

2021-03-10T13:54:00-0700

REFAHIYAT.JAVAD.1251906323

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The 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 the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No.

listed in Block E.

D. SYSTEM/ITEM: E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

G. PREPARED BY: (Data Manager) H. DATE I. APPROVED BY: (Engineer) J. DATE

DD FORM 1423-1, AUG 96

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor’s performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data. These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government’s right to use the data shall be governed by the pertinent provisions of the contract.

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package; TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15. Examples are: Tailoring of documents cited in Item 4;

Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FD2020-20-00663 FAT 6150015559783WF

3rd page CDRL

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT:

xTDP: Off xTM: Off

OTHER:

DSYSTEMITEM:

E_CONTRACTPR_NO:

FCONTRACTOR:

16_REMARKS_Continued: s. Original drawings are not required. If applicable, reproducible stable base copies of unidimensional drawings and master pattern drawings are required. See Block 14.

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xtm: Off

1_DATA_ITEM_NO: B001

2_TITLE_OF_DATA_ITEM: Test/Inspection Report

3_SUBTITLE: First Article Test Report

4_AUTHORITY_Data_Acquisit: DI-NDTI-80809B/T

5_CONTRACT_REFERENCE: CLIN for Data

6_REQUIRING_OFFICE: 416 SCMS/GUEAA

7_DID_250_REQ: DD

8_APP_CODE: A

DIST_STATEMENT: B

10_FREQUENCY: OTIME

11_AS_OF_DATE: SEE BLK 16

12_DATE_OF_FIRST_SUBMISSI: SEE BLK 16

13_DATE_OF_SUBSEQUENT_SUB: SEE BLK 16

addressee1: 416 SCMS/ draft1:

reg1: 1 repro1:

addressee2: GUEAA draft2:

reg2:

repro2:

addressee3: 6071 Gum LN draft3:

reg3:

repro3:

addressee4: Bldg. 1213 draft4:

reg4:

repro4:

addressee5: Hill AFB, UT draft5:

reg5:

repro5:

addressee6: 84056-5825 draft6:

reg6:

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16_REMARKS: NOTE: Changes to office symbols and/or e-mail addresses, when necessary shall be made by letter through the CO/ACO without further revision to this CDRL.

NSN: 5960-01-464-4836WF

1. Block 4: Contractor's format is acceptable. Paragraph 10.2 of DI-NDTI-80809B is clarified as follows:

a. All dimensions and tolerances specified on the manufacturing data shall be listed in one column, with the actual corresponding reading obtained from the inspection of the part listed in another column.

b. Materials utilized in the manufacture of "First Article" item shall be identified and certified along with a copy of material purchase requests as conforming to applicable data requirements.

c. Material processing, including finish requirements (plating, heat treatment, welding, inspecting, anodize, painting, etc.) utilized in the manufacture of "First Article" item shall be identified and certified as conforming to applicable requirements. A copy of the purchase order certifying the process accomplished at other than contractor facility shall be included.

d. Other requirements as called out on Engineering Data Requirement (OO-ALC Form 462).

2. Block 9: Distribution Statement, Export Control Warning and Destruction Notice shall be IAW DoD Instruction 5230.24.

The following Distribution Statement shall be placed on the first sheet of each document and/or Associated Lists.

DISTRIBUTION STATEMENT "B"" Distribution authorized to U.S. Government agencies only. (Test & Evaluation) (March 2021). Other requests for this document shall be referred to (416 SCMS/GUEAA, Hill AFB, UT 84056-5825).

17_PRICE_GROUP: NSP

ESTIMATED_TOTAL_PRICE: 0.00

G_PREPARED_BY:

H_DATE: 10 Mar 2021

1_APPROVED_BY:

J_DATE: 10 Mar 2021

Page: 1

2021-03-10T13:27:42-0700

PINNEGAR.STEPHANIE.A.1102660737

2021-03-10T13:55:29-0700

REFAHIYAT.JAVAD.1251906323

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: B

xTDP: Off xTM: Off

OTHER: NDTI

DSYSTEMITEM: Amplifier, Radio Fre

E_CONTRACTPR_NO: FD2020-21-00604

FCONTRACTOR:

16_REMARKS_Continued: EXPORT CONTROL WARNING: All printed and electronic, including digital, technical documents that are determined to contain export-controlled technical data shall be marked with the following statement:

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 (Title 50, U.S.C., App. 2401 et seq.), as amended. Violations of these export laws are subject to severe criminal penalties. Disseminate IAW provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE: For classified documents, follow the procedures in DoD 5220.22-M, National Industrial Security Program Operating Manual (NISPOM), Section 5-705, or DoD 5200.1-R, Information Security Program Chapter VI. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

3. Blocks 10, 11, 12, 13, 14:

a. For Contractor Testing - submit IAW the current delivery schedule.

b. For Government Testing - Report to assist in "First Article" testing by the Air Force shall be submitted concurrently with the "First Article" item either in the packaging of the shipping container or separately if the report will not fit within the container packaging unfolded. When shipped in the "First Article" container, the report shall be enclosed in a paper or plastic envelope.

c. SHIP TO: Non-Accountable Bay Transportation Officer Building 849 West Hill AFB, UT 84056-5999

MARK FOR: 809 MXSS/MXDEB

7278 4th Street (Bldg. 100, Bay D) Hill AFB, UT 84056-5205

NOTE: If report is shipped separate from "First Article" item, send report to "MARK FOR" address listed above.

d. Contractor shall deliver the Test/Inspection Report via e-mail to the following e-mail address: javad.refahiyat@us.af.mil

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