209F953_CDRL_A004_FA_Qual_Test_Report-9802.pdf

PDF 142 KB Posted Jun 25, 2026

Attached to: Request for Proposal - 20mm F-16 Ammunition Handling Set - NSN:1005-01-190-9802
Solicitation number: SPRWA1-26-R-0017
Issued by: Defense Logistics Agency Aviation

About this file

Written by GovTribe AI · Jun 25, 2026

This is a DD Form 1423-1, Contract Data Requirements List (CDRL), documenting a single data item requirement for an Air Force contract.

The contract concerns Test/Inspection Report (Data Item A004) deliverables for the F-16 Transfer of Housing Assembly, 20mm component under contract FD2060-23-00075 with the Air Force Space Command Security Group and Materiel Management (AFSC 409 SCMS/GUME). The requirement is based on authority DI-NDTI-80809B and references a Per Contract specification. The contractor must submit the test/inspection report one time, due 45 calendar days from completion of First Article Testing or 270 days after contract award, whichever occurs first. Electronic delivery in PDF format is required to five distribution recipients: the Procuring Contracting Officer (PCO), Program Manager (PM), Engineer, WAWF, and First Article Manager, with each receiving one draft copy and one final copy. Government approval of the CDRL is required within 45 calendar days. Changes to office symbols or email addresses require notification through the PCO/ACO without further revision. The form was prepared by Rickey C. Moore and approved by Scott B. Groves on June 29, 2022, with control number FISKE ROBER and a total of five copies required across all distribution categories.

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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 the Department of Defense, Executive Services and Communications Directorate (0704-0188). 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 organization. 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 H. DATE I. APPROVED BY J. DATE

Page of Pages

A_CONTRACT_LINE_ITEM_NO:

B_EXHIBIT: A

TDP:

TM:

OTHER: MGMT

DSYSTEMITEM: F-16 Transfer Unit Housing Assembly, 20mm

E_CONTRACTPR_NO: FD2060-23-00075

FCONTRACTOR:

1_DATA_ITEM_NO: A004

2_TITLE_OF_DATA_ITEM: Test / Inspection Report

3_SUBTITLE: (P/N 209F953)

4_AUTHORITY_Data_Acquisit: DI-NDTI-80809B

5_CONTRACT_REFERENCE: Per Contract

6_REQUIRING_OFFICE: AFSC 409 SCMS/GUME

7_DID_250_REQ: LT

8_APP_CODE: A

DIST_STATEMENT: C

10_FREQUENCY: 1 TIME

11_AS_OF_DATE: N/A

12_DATE_OF_FIRST_SUBMISSI: See Blk 16

13_DATE_OF_SUBSEQUENT_SUB: See Blk 16

addressee1: PCO

draft1: 1

reg1: 0

repro1: 1

addressee2: See BLK 16

draft2:

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repro2:

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addressee4: PM

draft4: 1

reg4: 0

repro4: 1

addressee5: See BLK 16

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addressee8: See BLK 16

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draft10: 1

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draft13: 1

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total_draft: 5

total_repro: 5

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

Block 8: The Government has 45 calendar days to approve.

Block 12: Test Report due 45 calendar days from completion of First Article Testing or 270 Days After Contract award.

BLK 14: Electronic delivery Draft copies via e-mail to the following Distribution Addresses shall be delivered in PDF format.

First Article Manager: David Lewis email: david.lewis.49@us.af.mil

PCO: Todd J. Stimus, Jr.

email: todd.stimus@us.af.mil

PM: Janet M. Harvey email: janet.harvey.3@us.af.mil

Engineer: Rickey C. Moore email: rickey.moore@us.af.mil

17_PRICE_GROUP:
ESTIMATED_TOTAL_PRICE:
G_PREPARED_BY:
H_DATE:
1_APPROVED_BY:
J_DATE:
Page: 1
of_pages: 1
Reset:
reg38t: 0
	2022-06-29T05:34:44-0400
MOORE.RICKEY.C.1249718579

	2022-06-29T10:38:54-0400
GROVES.SCOTT.B.1279744817

Text15: 6/29/2022
Text16: 29 Jun 22
Text10: Date
Text12: DMO Signature
	2022-06-29T09:40:43-0400
FISKE.ROBERT.R.1260632872

Text11: Control Number

Text6: 22.06.29.024

Text1: 29 June 2022

File details come from the government source that posted it. Updated Jun 25, 2026.