9_Contract_Data_Requirements_List.pdf

CONTRACT DAT A REQUIREMENTS LIST Form Approved

(1 Data Item) 0MB 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 instructK>ns, 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 b urden, 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 0MB control number. Please do not return your form to the above organization. Send compMlted form to the Government Issuing Contracting Officer for the Contract/PR No. lilted in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY: MISC TOP TM OTHER -- --

D. SYSTEM/ITEM

I E. coNTRAcTtPR No. F. CONTRACTOR

13360 l l l84637ES* FD20Z0-20-50084

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

AOOl Ammunition Data Card (ADC)

4. AUTHORITY /Data Acquisition Document No./

6. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MISC-80043B Airmunitions Specification AFLCMC/EBHJ

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

SD REQUIRED ASREQ BLK 16 b. COPIES B. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final

A B SUBMISSION Draft NIA ASREQ Reg Repro

16. REMARKS WAWF 0 1 0

BLK 7: The electronic receiving report shall be annotated with the Lot Number, DoDAAC, FA8213 National Stock Number and Nomenclature. The electronic receiving report shall Included with 0 1 0 also be annotated to reflect if additional submittals are to be furnished or if this is item( s) shipped the final submittal of data. The electronic receiving report shall be used only for Sample ADC via 0 1 0 this data item; do not combine other data item submittals with this requirement.

Electronic receiving report required via internet Wide Area Work Flow (WA WF)

WARP system only at: https://wawf.eb.mil.

BLK 9: DISTRIBUTION ST A TEMENT B. Distribution authorized to U.S.

Government agencies only, (Administrative/Operational Use) (Date of Contract Award). Other requests for this document shall be referred to AFLCMC/EBHJ.

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 in accordance with provisions of DoD Directives 5230.25.

DESTRUCTION NOTICE - Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

IBLK 10,12,13: Submit after successful Lot Acceptance Test and prior to delivery of each production lot.

BLK 14: A sample ADC or "draft" will be generated and submitted using the Worldwide Ammunition-data Repository Program (WARP) system to ensure general format and content is acceptable. For the final submittals, three hard copies of ADCs shall be generated from the WARP. One copy shall accompany items shipped, and the second copy submitted with the electronic receiving report via WA WF to AFLCMC/ EBHJ. The final ammo data card shall be uploaded in WAWF under DoDAAC FA8213.

*1336011184636ES, 1336011259400ES, 1336015197203ES,

1336015197200ES, 1336015195719ES.

FOB DESTINATION r--__J

EBH 19-160-001

Terry McCurdy, AFLCMC/EBHTC, 586-0535

15. TOTAL 0 3 0

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

MCCUROY.TERRY.0.1075978215 �1�1�J��v1>.,o7597t.2u HARGROVE.ERIC.V.1 Digitally signed by

10 JUN 19 HARGROVE.ERIC.V.1167016843 10 JUN 19

167016843 Date: 2019.06.12 06:16:20 -06'00'

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

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117. PRICE GROUP

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18. ESTIMATED

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TOTAL PRICE

(1 Data Item) 0MB 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 reviewtng 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 0MB 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. fisted in Block E.

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

SESS

TOP TM OTHER

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

1336011184637ES* FD2020-20-50084

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

A002 Engineering Change Proposal (ECP)

4. AUTHORITY (Data Acquisition Document No.) 16. CONTRACT REFERENCE 6. REQUIRING OFFICE

D1-SESS-80639D Airmunitions Specification AFLCMC/EBHJ

7. DD 260 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASREQ ASREQ b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final A

B

NIA

SUBMISSION Draft ASREQ Reg Repro

16. REMARKS AFLCMC/EBHJ l I 0

BLK 4: Format shall be in accordance with paragraph 2 of Data Item Description. AFLCMC/EBHTC 2 2 0 Data delivery description for content of Engineering Change Proposal AFLCMC/EBHKB I 1 0 (via DD Form 1692) shall be in accordance with EIA-649-1 and EIA-649. DCMA/QAR 1 I 0

DCMA/ACO 1 1 0

BLK 7: The Letter of Transmittal shall be annotated to reflect if additional submittals are to be furnished or if this is the final submittal of data. The Letter of Transmittal shall be used only for this data item; do not combine other data item submittals with this requirement.

BLK 8: Within 30 days of receipt, the Government engineer thru the Government contracting officer will respond with notification of approval/disapproval. If disapproved, Government engineer response thru the Government contracting officer will include instruction for remediation. Notification of approval of the proposed engineering change shall be by signed contract modification.

BLK 9: DISTRIBUTION STATEMENT B. Distribution authorized to U.S.

Government agencies only, (Administrative/Operational Use)(Date of Contract Award). Other requests for this document shall be referred to AFLCMC/EBHJ.

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 in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE - Destroy by any method that will prevent disclosure of contents or reconstmction of the document.

BLK 14: Submit reports electronically via e-mail in Microsoft Office or PDF format to the following e-mail recipients listed below. Refer to contract for e-mail address of the government contracting officer (AFLCMC/EBHKB).

robert.morgan.27@us.af.mil {AFLCMC/EBHTC)

*1336011184636ES, 1336011259400ES,1336015197203ES, 1336015197200ES,

1336015195719ES.

FOB DESTINATION

EBH 19-160-001

Terry McCurdy, AFLCMC/EBHTC, 586-0535

15. TOTAL 6 6 0

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

MCCURDY.lERRY.D.1075978215 ���':,,,.,,,,.,,.

HARGROVE.ERIC.V.1 Digitally �gned by

10 JUN 19 HARGROVE.ERIC.V.1167016843 10 JUN 19

D1tt:2019D6.111J:2bi2«i'OO' 167016843 Oate:2019.06.12 06:17:21-06'00'

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

I 11. PRICE GROUP

18. ESTIMATED

( 1 Date Item) 0MB 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 0MB control number. Please do not return your form to the above organization. Send completed form to the Government la,uing Contracting Officer for the Contract/PR No. listed in Block E;

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

TOP TM OTHER

D. SYSTEM/ITEM

I

E. CONTRACT/PR N0. F. CONTRACTOR

1336011184637ES* FD2020-20-50084

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

A003 Request for Variance (RFV)

4. AUTHORITY ID•t• Acquisition Document No.)

5. CONTRACT REFERENCE 6. REQUIRING OFFICE

D1-SESS-80640D Ainnunitions Specification AFLCMC/EBHJ

7. DD 260 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASREQ ASREQ b. COPIES

B. APP COOE 11. AS OF DATE 13. DATE Of SUBSEQUENT a. ADDRESSEE Final B SUBMISSION Draft A NIA ASREQ A•g Repro

AFLCMC/EBHTC 1 1 0

(refblk 16) DCMA/OAR 1 l 0 (LT only) DCMA/ACO l .1 0 (LT only) AFLCMC/EBHKB l l 0 (refblk 16) AFLCMC/EBHJ l l 0 (refblk 16)

16. REMARKS

BLK 4: Fonnat shall be in accordance with paragraph 2 of Data Item Description.

Data delivery description for content of Request for Variance (via DD Form 1694) shall be in accordance with EIA-649-1 and EIA-649.

BLK 7: The Letter of Transmittal shall be annotated to reflect if additional submittals are to be furnished or if this is the final submittal of data. The Letter of Transmittal shall be used only for this data item; do not combine other data item submittals with this requirement

BLK 8: Government engineer will perfonn review of the RFV. Within 30 days of receipt, the Government engineer thru the Government contracting officer will respond with notification of approval/disapproval. If disapproved, Government engineer response thru the Government contracting officer will include instruction for remediation. Notification of approval shall be signed contract modification

(AFLCMC/EBHKB).

BLK 9: DISTRIBUTION STATEMENT B. Distribution authorized to U.S.

Government agencies only, (Administrative/Operational Use) (Date of Contract Award). Other requests for this document shall be referred to AFLCMC/EBHJ.

WARNING - This document contains technical data whose export is restricted by �he 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 in accordance with provisions ofDoD Directive 5230.25.

DESTRUCTION NOTICE - Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

IBLK 14: Submit reports electronically via e-mail in Microsoft Office or PDF fonnat to the following e-mail recipients listed below. Refer to contract for e-mail address of the government contracting officer (AFLCMC/EBHKB).

robert.morgan.27@us.af.mil (AFLCMC/EBHTC)

*1336011184636ES, 1336011259400ES,

1336015197203ES, 1336015 l 97200ES, 1336015 l 95719ES.

FOB DESTINATION

EBH 19-160-001

Terry McCurdy, AFLCMC/EBHTC, 586-0535

15. TOTAL 5 5 0

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

HARGROVE.ERIC.V.1 Digitally signed by MCCURDY.TERRY.D.1075978215 �II)' "9r'* by MCCUROV.ltMYD.107S97121S 10 JUN 19 HARGROVE.ERIC.V.1167016843 10 JUN 19 o.tr.2019.o6.111U2:34�'00' 167016843 Date: 2019.06.12 06: 18:16 -06"00"

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

18. ESTIMATED

CONTRACT DA TA REQUIREMENTS LIST Form Approved

( 1 Data Item) 0MB No. 0704-0188

The public reporting burden for this collecttOn of information is estimated to average 110 hours per response, including the time for reviewing instructtons, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of informatton. 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 08fense, Executive Services and Communications Oireeto-rate (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 0MB control number. Please do not return your form to the above organization. Send completed form to the

I

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I Government IHuing Contracting Officer for the Contract/PR No. listed in Block E.

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

TOP TM 'OTHER I

D. SYSTEM/ITEM

I

E. CONTRACT/PR F. CONTRACTOR

1336011184637ES* FD2020-20-50084

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

I

I 17. PRICE GROUP

A004 Notice of Revision (NOR) I

4. AUTHORITY /Data Acquisition Document No.I

6, CONT

ACT REFERENCE 6. REQUIRING OFFICE

D1-SESS-80642D �irmunitions Specification AFLCMC/EBHJ I

18. ESTIMATED

TOTAL PRICE

7. DD 260 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASREQ ASREQ b. COPIES I

6. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final

A B

NIA

SUBMISSION Draft ASREQ Reg Repro I

16. REMARKS AFLCMC/EBHJ 1 1 0

BLK 4: Format shall be in accordance with paragraph 2 of Data Item Description. (refblk 16) !Data delivery description for content of Engineering Change Proposal (via DD AFLCMC/EBHTC 1 1 0 Form 1695) shall be in accordance with EIA-649-1 and EIA-649. (refblk 16)

I I

IAFLCMC/EBHKB 1 1 0

IBLK 7: The Letter of Transmittal shall be annotated to reflect if additional (refblk 16) submittals are to be furnished or if this is the final submittal of data. The Letter DCMA/QAR 1 I 0 of Transmittal shall be used only for this data item; do not combine other data item (LT only)

DCMA ACO 1 1 0

(LT only)

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I submittals with this requirement

BLK 8: Within 30 days of receipt, Government engineer thru the Government contracting officer will respond with notice of approval/disapproval. If disapproved, Government engineer response thru the Government contracting officer will include instruction for remediation. Notification of approval of the proposed notice of revision shall be by signed contract modification.

BLK 9: DISTRIBUTION STATEMENT B. Distribution authorized to U.S.

Government agencies only, (Administrative/Operational Use) (Date of Contract Award). Other requests for this document shall be referred to AFLCMC/EBHJ.

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 in accordance with provisions ofDoD Directive 5230.25.

DESTRUCTION NOTICE--Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

BLK 14: Submit reports electronically via e-mail in Microsoft Office or PDF format to the following e-mail recipients listed below. Refer to contract for e-mail address of the contracting officer (AFLCMC/EBHKB).

robert.morgan.27@ us.af.mil (AFLCMC/EBHTC)

*1336011184636ES, 1336011259400ES, 1336015197203ES,

1336015197200ES, 1336015195719ES.

FOB DESTINATION

EBH 19-160-001

Terry McCurdy, AFLCMC/EBHTC 586-0535 16. TOTAL 0 3 0

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

I I

I HARGROVE.ERIC.V. Digitally signed by

MCCUROY.TERRY.0.107597821 S �1�1�J�=;!!.IWIVD.io 5tnm 10 JUN 19 HARGROVE.ERIC.V.1167016843 10 JUN 19

1167016843 Date: 2019.06.12 06:19:14-06'00' I DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

( 1 Data Item) 0MB No. 0704-0188

The public reporting burden for this collection of informatton 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 informatk>n. 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 p,rovision 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 0MB control number. Please do not return your form to the above organization. Send completed form to the Government l11uing Contracting Officer for the Contract/PR No. listed in Block E.

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

QCIC

TOP TM OTHER

D. SYSTEM/ITEM

I E. CONTRACT /PR F. CONTRACTOR

1336011184637ES* FD2020-20-50084

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

A005 Lot Acceptance Test Plan

4. AUTHORITY /Data Acquisition Document No.) 6. REQUIRING OFFICE

D1-QCIC-80553A

6. CONTRACT REFERENCE

Airmunitions Specification AFLCMC/EBHJ

7. OD 260 REQ 9. DIST STATEMENT 10.FREQUENCY 12. DATE OF FIRST SUBMISSION

DD

REQUIRED ASREQ ASREQ

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

B SUBMISSION

A ASREQ ASREQ

16. REMARKS

IBLK 7: The electronic receiving report shall be annotated with the Lot Number, National Stock Number and Nomenclature. Electronic receiving report required via internet Wide Area Work Flow (WA WF) at: https://wawf.eb.mil. The electronic receiving report shall be used only for this data item, do not combine other data item submittals with this requirement.

BLK 8: Comments/approval/disapproval will be submitted within 30 working days ofreceipt by AFLCMC/EBHJ.

BLK 9: DISTRIBUTION STATEMENT B. Distribution authorized to U.S.

Government agencies (Administrative/Operational Use) (Date of Contract Award).

Other requests for this document shall be referred to AFLCMC/EBHJ.

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 in accordance with provisions ofDoD Directive 5230.25.

DESTRUCTION NOTICE - Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

BLK 10,11, 12, 13: The contractor shall provide a Acceptance Test Plan after contract award and at least 90 days prior to Lot Acceptance Testing allowing for 30 day approval time. No changes to previously approved government Acceptance Test Plans shall be made without prior notification of AFLCMC/EBHJ.

!Engineering approval in accordance with Airmunitions Specification.

BLK 14: Report shall be in Microsoft Office software or PDF format.

Submit through WA WF, DoDAAC, F A8213.

*1336011184636ES, 1336011259400ES, 1336015197203ES, 1336015197200ES,

1336015195719ES.

FOB DESTINATION

EBH 19-160-00 l Terry McCurdy, AFLCMC/EBHTC 586-0535

G. PREPARED BY

MCCURDY.TERRY.D.107597821 o,,,..,� '�""' "1

MCCURDY.TfRRYD.1075978215 D•t•:2019.06.1113:24:2.2�'00'

DD FORM 1423-1, FEB 2001

H. DATE I. APPROVED BY

HARGROVE.ERIC.V.

10 JUN 19

1167016843

PREVIOUS EDITION MAY BE USED.

14. DISTRIBUTION

b. COPIES

1. ADDRESSEE Final Draft

Reg Repro

WAWF 0 1 0

DoDAAC FA8213 AFLCMC/EBHJ l 1 0 (refblk 16)

15. TOTAL 1 2 0

J. DATE

Digitally signed by

HARGROVE.ERIC.V.1167016843 10 JUN 19

Date: 2019.06.12 06:19:56 -06'00'

Page of 1 Pages

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(1 Data Item) 0MB 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 instrucdons, 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 I currently valid 0MB control number. Please do not return your form to the above organization. Send completed form to the

I

I

I Government laauing Contracting Officer for the Contract/PR No. Hated in Block E.

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

TDP TM OTHER I -- --

D. SYSTEM/ITEM

I

E. CONTRACT/PR N0. F. CONTRACTOR

133601 l 184637ES* FD2020-20-50084

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

I

I 17. PRICE GROUP

A006 Test/Inspection Report Lot Acceptance Test I

4. AUTHORITY /Data Acquisition Document No.)

5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-NDTI-80809B Airmunitions Specification AFLCMC/EBHJ I

18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

DD

REQUIRED ASREQ BLK 16 b. COPIES I

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final B SUBMISSION Draft A NIA ASREQ Reg Repro I

16. REMARKS WAWF 0 1 0

DoDAAC, FA8213

AFLCMC/EBHJ 1 1 0

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IBLK 4: Contractor's format is acceptable.

IBLK 7: The electronic receiving report shall be annotated with the Lot Number, National Stock Number and Nomenclature. Electronic receiving report required rvia internet Wide Area Work Flow (WA WF) at: https://wawf.eb.mil. The electronic receiving report shall be used only for that data item; do not combine other data item submittals with this requirement.

BLK 9: DISTRIBUTION STATEMENT B. Distribution authorized to U.S.

Government agencies only (Administrative/Operational Use) (Date of Contract Award). Other requests for this document shall be referred to AFLCMC/EBHJ.

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 in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE--Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

BLK 10, 12, 13: Submit within 30 calendar days after completion of each Lot Acceptance Test.

BLK 14: Test plan shall be in Microsoft Office software or PDF format.

Submit through WAWF, DoDAAC, FA8213.

*1336011184636ES, 1336011259400ES, 1336015197203ES, 1336015197200ES,

1336015195719ES.

FOB DESTINATION

IEBH 19-160-001

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G. PREPARED SY H. DATE I. APPROVED BY J. DATE

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15 �;

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10 JUN 19

167016843

HARGROVE.ERIC.V.1167016843 10 JUN 19

Date: 2019.06.12 06:20:54 -06'00" I

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of l Pages

CONTRACT DAT A REQUIREMENTS LIST

(1 Data Item)

Form Approved

0MB 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 0MB 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.

TOP __

C. CATEGORY:

TM __ oTHER _s_E_s_s __________ _

A. CONTRACT LINE ITEM NO. B. EXHIBIT

D. SYSTEM/ITEM

13360 l l l 84637ES*

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

FD2020-20-50084IE. CONTRACT/PR N0 F. CONTRACTOR

3. SUBTITLE

A007 Failure Summary & Analysis Report

4. AUTHORITY (Data Acquisition Document No./

7. DD 260 REQ

LT

8. APP CODE

DI-SESS-80255A

9. DIST STATEMENT

REQUIRED

B

5. CONTRACT REFERENCE

Airmunitions Specification

10. FREQUENCY ASREQ

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

BLK 16

13. DATE OF SUBSEQUENT

SUBMISSION

6. REQUIRING OFFICE

AFLCMC/EBHJ

14. DISTRIBUTION

b. COPIES

a. ADDRESSEE Final Draft A NIA ASREQ Rag Aepro

16. REMARKS

IBLK 4: Contractor's format required for both the Preliminary and Final report.

BLK submittals 7: The are to Letter be of furnished Transmittal or if shall this is be the annotated final to submittal reflect of if data. additional The submittals Letter of with shall this be used requirement. only for this data item; do not combine other data item days BLK 8: after receipt by Comments/approval/disapproval AFLCMC/EBHJ. will be submitted within 30 calendar BLK 9: DISTRIBUTION STATEMENT B. Distribution authorized to U.S.

(Date Government of Contract agencies Award). only Other requests (Administrative/Operational shall be referred Use) to AFLCMC/EBHJ.

of contents DESTRUCTION or reconstruction NOTICE - of Destroy the by document. any method that will prevent disclosure the WARNING Arms -Export This Control document Act (Tile contains 22, U.S.C., technical Sec. data 2751, whose et seq.) export or is the restricted Export by Administration Act of 1979, (Title 50, U.S.C. App. 2401 et seq.), as amended.Violations Dissemination of in these export accordance laws with are subject provisions to severe ofDoD criminal Directive penalties. 5230.25.

BLK calendar 10, 12, days 13: after Submit receipt within of 7 calendar AFLCMC/EBHJ days of comments. each failure. Final with 15

BLK Submit 14: via Report e-mail shall to be cognizant in Microsoft Hill AFB Office Contracting software or Officer. PDF format.

*1336011184636ES, 1336011259400ES, 1336015197203ES, 1336015197200ES,

1336015195719ES.

FOB DESTINATION EBH 19-160-00 I

. .,. ........... enr ,,.._ e

Contracting Officer 0

Hill AFB UT 84056

16. TOTAL 0

•• -, --- -- A. DATE I. APPROVED BY J. DATE

HARGRQVE.ERIC.V Digitally signed by

10 JUN 19 HAAGROVE.ERJC.V.1167016843 IO JUN 19

.1167016843 Date:2019.06.1206:26:09-06'00"

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