Attachment_5_ExhibitA_CDRLS.pdf

PDF 1 MB Posted May 21, 2021

Attached to: C-17 Arm-Fire Initator Federal contract opportunity
Solicitation number: FA8213-21-R-3040-Solicitation
Issued by: Department of the Air Force Materiel Command Lifecycle Management Center Hill Air Force Base

About this file

Written by GovTribe AI · Dec 28, 2023

This document contains a Contract Data Requirements List (CDRL) with eight data items required under a federal contract for the production of C-17 arm-fire initiators.

The CDRL includes requirements for the contractor to submit an Ammunition Data Card, Acceptance Test Plan, Test/Inspection Report, Failure Summary and Analysis Report, Report of Receipts and Inventory, Engineering Change Proposal, Notice of Revision, and Request for Variance. Required data submissions include item acceptance testing documentation, inventory reports, engineering change documentation, and failure analysis reports. The contracting agency is the Department of the Air Force Materiel Command Lifecycle Management Center. The anticipated contractor is Pacific Scientific Energetic Materials Company. Submittals shall be made through the Wide Area Workflow system or email using specified distribution statements, delivery methods, and recipients.

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Attachment_2_QALI.pdf	PDF	May 21, 2021
Attachment_3_REPSHIP.pdf	PDF	May 21, 2021
Attachment_4_SOW_Appendix_A_29April21.pdf	PDF	May 21, 2021
FA821321R3040.pdf	PDF	May 21, 2021
Attachment_9_AFMC_Form_158.pdf	PDF	May 21, 2021
Attachment_6_Special_Packaging_Instructions.pdf	PDF	May 21, 2021
Attachment_7_SOW_SPI.pdf	PDF	May 21, 2021
Attachment_8_Transportation_Instructions.pdf	PDF	May 21, 2021
Attachment_1_Item_Marking_Instr_Ver1_5-20190501.pdf	PDF	May 21, 2021

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CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

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 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 MISC

D. SYSTEM/ITEM

1377-01-382-0670ES

E. CONTRACT/PR NO.

FD2020-21-51271

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Ammunition Data Card (ADC)

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-80043B

5. CONTRACT REFERENCE

APPENDIX A

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

Draft

Final

Reg Repro

16. REMARKS

BLK 7: The electronic receiving report shall be annotated with the Lot Number, National Stock Number and Nomenclature. The electronic receiving report shall also be annotated to reflect if additional submittals are to be furnished or if this is the final submittal of data. The electronic receiving report shall be used only for this data item; do not combine other data item submittals with this requirement. Electronic receiving report required via internet Wide Area Work Flow (WAWF) at: https://wawf.eb.mil.

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

Government agencies only, (Administrative/Operational Use)(Date of Contract Award). Other requests 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 as amended, Title 50, U.S.C, App. 2401 et seq. Violation of these export-control laws is subject to severe criminal penalties. Dissemination of this document is controlled under DoD Directives 5230.25.

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

BLK 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 for each part number/NSN produced under this contract using the Worldwide Ammunition-data Repository Program (WARP) system to ensure general format and content is acceptable prior to final ADC submittals.

Sufficient hard copies of final version ADCs shall be generated for each individual production lot from the Worldwide Ammunition-data Repository Program (WARP) such that at least one hard copy per production lot shall be provided with each individual CLIN shipment/destination. An electronic copy for each production lot shall be submitted/uploaded with the electronic receiving report through WAWF to AFLCMC/EBHJ using DoDAAC FA8213.

FOB DESTINATION

EBH 21-096-005

Robert W. Morgan, Jr., AFLCMC/EBHEC, 777-5126

WAWF 0 1 0

DoDAAC, FA8213

Included with item(s) shipped

Sample ADC via

WARP system onl

15. TOTAL 0 1 0

G. PREPARED BY

morgan.robert.wesley.jr.1158190040

H. DATE

2021/05/04

I. APPROVED BY

blanch.teresa.m.1260787809

J. DATE

2021/05/04

18. ESTIMATED

TOTAL PRICE

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

17. PRICE GROUP

Pacific Scientific Energetic Materials Company

Form Approved OMB No. 0704-0188

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

TDP TM OTHER QCIC

D. SYSTEM/ITEM

1377-01-382-0670ES

E. CONTRACT/PR NO.

FD2020-21-51271

F. CONTRACTOR

1. DATA ITEM NO.

A002

2. TITLE OF DATA ITEM

Acceptance Test Plan

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-QCIC-80553A

5. CONTRACT REFERENCE

APPENDIX A

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

ASREQ

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

ASREQ

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

Draft

Final

Reg Repro

16. REMARKS

BLK 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 (WAWF) 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 of receipt by AFLCMC/EBHJ.

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

Government agencies only, (Administrative/Operational Use)(Date of Contract Award). Other requests 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. Violation of these export-control laws is subject to severe criminal penalties. Dissemination of this document is controlled under DoD Directives 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 WAWF, DoDAAC, FA8213.

FOB DESTINATION

EBH 21-096-005

Robert W. Morgan, Jr., AFLCMC/EBHEC, 777-5126

WAWF 0 1 0

DoDAAC FA8213

15. TOTAL 0 1 0

G. PREPARED BY

morgan.robert.wesley.jr.1158190040

H. DATE

2021/05/04

I. APPROVED BY

blanch.teresa.m.1260787809

J. DATE

2021/05/04

18. ESTIMATED

TOTAL PRICE

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

17. PRICE GROUP

Form Approved OMB No. 0704-0188

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

TDP TM OTHER NDTI

D. SYSTEM/ITEM

1377-01-382-0670ES

E. CONTRACT/PR NO.

FD2020-21-51271

F. CONTRACTOR

1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

APPENDIX A

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

Draft

Final

Reg Repro

16. REMARKS

BLK 4: Contractor format is acceptable.

BLK 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 (WAWF) 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 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, as amended, Title 50, U.S.C, App. 2401 et seq. Violation of these export-control laws is subject to severe criminal penalties. Dissemination of this document is controlled under DoD Directives 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.

FOB DESTINATION

EBH 21-096-005

Robert W. Morgan, Jr., AFLCMC/EBHEC, 777-5126

WAWF 0 1 0

DoDAAC, FA8213

15. TOTAL 0 1 0

G. PREPARED BY

morgan.robert.wesley.jr.1158190040

H. DATE

2021/05/04

I. APPROVED BY

blanch.teresa.m.1260787809

J. DATE

2021/05/04

18. ESTIMATED

TOTAL PRICE

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

17. PRICE GROUP

Form Approved OMB No. 0704-0188

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

TDP TM OTHER SESS

D. SYSTEM/ITEM

1377-01-382-0670ES

E. CONTRACT/PR NO.

FD2020-21-51271

F. CONTRACTOR

1. DATA ITEM NO.

A004

2. TITLE OF DATA ITEM

Failure Summary and Analysis Report

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-SESS-80255B

5. CONTRACT REFERENCE

APPENDIX A

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

Draft

Final

Reg Repro

16. REMARKS

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

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: Comments/approval/disapproval will be submitted within 30 calendar days after receipt by AFLCMC/EBHJ.

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

Government agencies only, (Administrative/Operational Use) (Date of Contract Award). Other requests 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, as amended, Title 50, U.S.C, App. 2401 et seq. Violation of these export-control laws is subject to severe criminal penalties. Dissemination of this document is controlled under DoD Directives 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 7 days of each failure. Final with 15 days after receipt of AFLCMC/EBHJ comments.

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

Submit via e-mail to cognizant Hill AFB Contracting Officer.

FOB DESTINATION

EBH 21-096-005

Robert W. Morgan, Jr., AFLCMC/EBHEC, 777-5126

Contracting Off 0 1 0

Hill AFB, UT

15. TOTAL 0 1 0

G. PREPARED BY

morgan.robert.wesley.jr.1158190040

H. DATE

2021/05/04

I. APPROVED BY

blanch.teresa.m.1260787809

J. DATE

2021/05/04

18. ESTIMATED

TOTAL PRICE

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

17. PRICE GROUP

Form Approved OMB No. 0704-0188

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

TDP TM OTHER MGMT

D. SYSTEM/ITEM

1377-01-382-0670ES

E. CONTRACT/PR NO.

FD2020-21-51271

F. CONTRACTOR

1. DATA ITEM NO.

A005

2. TITLE OF DATA ITEM

Report of Receipts, Inventory, Adjustments and

3. SUBTITLE

Contractor Possessed Munitions Report

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-80442

5. CONTRACT REFERENCE

APPENDIX A

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

BLK16

12. DATE OF FIRST SUBMISSION

BLK16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

BLK16

Draft

Final

Reg Repro

16. REMARKS

Blk 4: Data Item Description (DID) DI-MGMT-80442 will be used to report on-hand inventory only. In reference to DID para 10.1, format as follows:

Column 1(NSN Recd): Report the on-hand NSN Column 2(Related NSN): Report the CLIN Number of inventory being reported Column 3(Document Number): Report the Contract Number Column 4(Serial Number): Report CLIN quantity (not inventory quantity) Column 5(Qty Received): Report the quantity received to date on CLIN Column 6(Date Received): Report date received in MM/YYYY format Column 7(Balance On-Hand): Report the on-hand balance quantity Column 8(Condition Code): Report the condition code of the on-hand balance Column 9(NSN Shipped): Report the NIIN shipped Column 10(Qty Shipped): Report the quantity shipped Column 11(Date Shipped): Report the date shipped in MM/YYYY format Column 12(Shipment Number): Report the Lot number of refurbished A condition items or shipped quantity only. Leave blank for all others.

Column 13(Adjustment Qty): Report inventory changes resulting from transactions other than receipts or shipments. These include, but not limited to:

- Inductions

- Scrap (for testing or other)

- Condemnation

- Cannibalization

Column 14(Explanation): Report explanation for quantities in Column Column 15(Remarks): Report the DoDAAC of the contractor facility where inventory is located

DID para. 10.2.2.1: Only CAS reportable (stock listed) removed components need to be reported using the format outlined above for DID para 10.1

DID para. 10.2.2.2: Removed components that will be re-installed as part of maintenance or repair activities do not need to be reported.

BLK 7: Electronic receiving report required via internet WAWF 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 9: Distribution Statement B: Distribution authorized to the Department of Defense and U.S. government agencies only (Administrative/Operational Use)(Date of Contract Award). Other requests shall be referred to AFLCMC/EBHJ

WAWF 0 1 0

DoDAAC, FA8213

AFLCMC/EBHKA 0 1 0

(Ltr Only)

DCMA ACO 0 1 0

(Ltr Only)

AFLCMC/EBHJ 0 1 0

6044 Dogwood Av

Hill AFB UT

84056-5816

(ref BLK 16)

15. TOTAL 0 4 0

G. PREPARED BY

morgan.robert.wesley.jr.1158190040

H. DATE

2021/05/04

I. APPROVED BY

blanch.teresa.m.1260787809

J. DATE

2021/05/04

18. ESTIMATED

TOTAL PRICE

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 1 of 2 Pages

17. PRICE GROUP

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

TDP TM OTHER MGMT

D. SYSTEM/ITEM

1377-01-382-0670ES

E. CONTRACT/PR NO.

FD2020-21-51271

F. CONTRACTOR

16. REMARKS (Continued)

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

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Tile 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 is subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

Blk 10: Interim submission will be required to be within 5 days of identifying any discrepancies. This will allow for the Government and Contractor Team to evaluate if additional Government Furnished Property (GFP) is to be released, in order to fulfill contractual obligations.

Blk 12: First submission will be within 10 days of receipt of initial quantity of government assets or within 30 days of new contract if government assets are already on site.

Blk 13: Final submission will be within 10 days of Lot Acceptance.

Blk 14: Submittals shall be in .XML (preferred) or .CSV format in accordance with DID. Submit through WAWF, DoDAAC FA8213.

FOB DESTINATION

EBH 21-096-005

Robert W. Morgan, Jr., AFLCMC/EBHEC, 777-5126

DD FORM 1423-1, FEB 2001 Page 2 of 2 Pages

Form Approved OMB No. 0704-0188

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

TDP TM OTHER SESS

D. SYSTEM/ITEM

1377-01-382-0670ES

E. CONTRACT/PR NO.

FD2020-21-51271

F. CONTRACTOR

1. DATA ITEM NO.

A006

2. TITLE OF DATA ITEM

Engineering Change Proposal (ECP)

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-SESS-80639E

5. CONTRACT REFERENCE

APPENDIX A

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

ASREQ

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

Draft

Final

Reg Repro

16. REMARKS

BLK 4: Data delivery description for content of engineering change proposal via applicable DD Form 1692 shall be in accordance with para. 3.3.1(1) of EIA-649-1and the principles of EIA-649-B.

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 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, as amended (Title 50, U.S.C, App 2401 et seq.). Violations of these export laws are subject to severe criminal penalties. Dissemination of this document is controlled under DoD 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 Government Contracting Officer

(AFLCMC/EBHKB).

robert.morgan.27@us.af.mil (AFLCMC/EBHEC) kendra.reese.1@us.af.mil (AFLCMC/EBHEC)

FOB DESTINATION

EBH 21-096-005

Robert W. Morgan, Jr., AFLCMC/EBHEC, 777-5126

AFLCMC/EBHJ 1 1 0

AFLCMC/EBHEC 1 1 0

AFLCMC/EBHKB 1 1 0

DCMA/QAR 1 1 0

DCMA/ACO 1 1 0

15. TOTAL 5 5 0

G. PREPARED BY

morgan.robert.wesley.jr.1158190040

H. DATE

2021/05/04

I. APPROVED BY

blanch.teresa.m.1260787809

J. DATE

2021/05/04

18. ESTIMATED

TOTAL PRICE

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

17. PRICE GROUP

Form Approved OMB No. 0704-0188

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

TDP TM OTHER SESS

D. SYSTEM/ITEM

1377-01-382-0670ES

E. CONTRACT/PR NO.

FD2020-21-51271

F. CONTRACTOR

1. DATA ITEM NO.

A007

2. TITLE OF DATA ITEM

Notice of Revision (NOR)

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-SESS-80642E

5. CONTRACT REFERENCE

APPENDIX A

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

ASREQ

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

Draft

Final

Reg Repro

16. REMARKS

BLK 4: Data delivery description for content of Notice of Revision via applicable DD Form 1695 shall be in accordance with para.

3.3.4(2) of EIA-649-1 and principles of EIA-649-B.

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 notice of revision shall be by signed contract modification

(AFLCMC/EBHKA).

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

Government agencies only, (Administrative/Operational Use)(Date of Contract Award). Other requests 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, as amended (Title 50, U.S.C, App 2401 et seq.). Violations of these export laws are subject to severe criminal penalties. Dissemination of this document is controlled under DoD 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 email in Microsoft Office or PDF format to the email recipients listed below. Refer to contract for email address of the Government Contracting Officer

(AFLCMC/EBHKB).

robert.morgan.27@us.af.mil (AFLCMC/EBHEC) kendra.reese.1@us.af.mil (AFLCMC/EBHEC)

FOB DESTINATION

EBH 21-096-005

Robert W. Morgan, Jr., AFLCMC/EBHEC, 777-5126

AFLCMC/EBHEC 1 1 0

AFLCMC/EBHKB 1 1 0

DCMA/QAR 1 1 0

DCMA/ACO 1 1 0

15. TOTAL 4 4 0

G. PREPARED BY

morgan.robert.wesley.jr.1158190040

H. DATE

2021/05/04

I. APPROVED BY

blanch.teresa.m.1260787809

J. DATE

2021/05/04

18. ESTIMATED

TOTAL PRICE

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

17. PRICE GROUP

Form Approved OMB No. 0704-0188

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

TDP TM OTHER SESS

D. SYSTEM/ITEM

1377-01-382-0670ES

E. CONTRACT/PR NO.

FD2020-21-51271

F. CONTRACTOR

1. DATA ITEM NO.

A008

2. TITLE OF DATA ITEM

Request for Variance (RFV)

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-SESS-80640E

5. CONTRACT REFERENCE

APPENDIX A

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

ASREQ

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

ASREQ

Draft

Final

Reg Repro

16. REMARKS

BLK 4: Data delivery description for content of Request for Variance via applicable DD Form 1694 shall be in accordance with para.

3.3.2(1)-(6) of EIA-649-1 and the principles of EIA-649-B.

BLK 7: Government engineer will perform review of the RFV.

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 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, as amended (Title 50, U.S.C, App 2401 et seq.). Violations of these export laws are subject to severe criminal penalties. Dissemination of this document is controlled under DoD Directive 5230.25.

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

(AFLCMC/EBHKB).

robert.morgan.27@us.af.mil (AFLCMC/EBHEC) kendra.reese.1@us.af.mil (AFLCMC/EBHEC)

FOB DESTINATION

EBH 21-096-005

Robert W. Morgan, Jr., AFLCMC/EBHEC, 777-5126

AFLCMC/EBHEC 1 1 0

AFLCMC/EBHJ 1 1 0

DCMA/QAR 1 1 0

DCMA/ACO 1 1 0

15. TOTAL 4 4 0

G. PREPARED BY

morgan.robert.wesley.jr.1158190040

H. DATE

2021/05/04

I. APPROVED BY

blanch.teresa.m.1260787809

J. DATE

2021/05/04

18. ESTIMATED

TOTAL PRICE

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

17. PRICE GROUP

File details come from the government source that posted it. Updated May 21, 2021.