CDRL_22-51259.pdf

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 NDTI

D. SYSTEM/ITEM

B-1 Mode Selector

E. CONTRACT/PR NO.

FD2020-22-51259

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

Root Cause Analysis Report Failure Investigation

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

DD

9. DIST STATEMENT

REQUIRED

B

10. FREQUENCY

BLK 16

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

BLK 16

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 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.

BLK 10,12,13: Report shall be submitted not later than 30 calendar days after completion of failure investigation identified in SOW.

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

Submit through WAWF, DoDAAC, FA8213.

FOB DESTINATION

EBH 22-160-001

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

WAWF 1 0 1

DoDAAC, FA8213

15. TOTAL 1 0 1

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

18. ESTIMATED

TOTAL PRICE

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

17. PRICE GROUP

A

Chemring Energetic Devices