A0002_DR_81535_for_FD2030_212_31022_signed.pdf

CONTRACT DATA REQUIREMENTS LIST

Form Approved

CMB 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

Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, 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.

B. Exhibit A

C. Category

D. System/Item.

F100-PW-220 Convergent Nozzle Segment Assembly

E. Contract/PR NO.

FD2030-22-31022

F. Contractor

1. Data Item No.

A0002

2. Title of Data Item:

Deficiency Report (DR)

3. Subtitle:

None

4. Authority (Data Acquisition Document No.)

DI-ALSS-81535

5. Contract Reference 6. Requiring Office

AFLCMC/LPSIB

7. DD 250 Req

N/A

1. Dist Statement Required

10. Frequency

As Required

12. Date of First Submission

See Block 16

14. Distribution

8. APP Code

11. As of Date

13. Date of Subsequent Submission

See Block 16

a. Addressee b. Copies

D r a f t

Final

Reg Re pr o

16. REMARKS

As defined by T.O. 00-35D-54, submit a report whenever a material or a quality deficiency occurs utilizing SF Form 368.

Ref: Block 14a: Complete address for distribution:

FOR E-MAIL ADDRESS & ADDITIONAL PHONE NUMBERS CALL ATUEAYU WILSON

AT 405-582-5308 OR E-MAIL atueayu.wilson.2@us.af.mil

AFLCMC/LPSIB POCs RECEIVING REPORT:

beverly.hawkins@us.af.mil lateasha.lawrence.2@us.af.mil guy.bierwirth@us.af.mil

AFLCMC/LPSIB

3001 Staff Dr., Ste. 2AE1/107B

Tinker AFB, OK. 73145-3031

DCMA/ACO (See the face contract)

AFLCMC/LPSIB 4

AFSC/PCO 1

DCMA/ACO 1

15. TOTAL 6

G. PREPARED BY

H. DATE

11 March 22

I. APPROVED BY

J. DATE

mailto:atueayu.wilson.2@us.af.mil mailto:beverly.hawkins@us.af.mil mailto:lateasha.lawrence.2@us.af.mil mailto:guy.bierwirth@us.af.mil

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1 Pages