CDRL A002 - FILTER TEST REPORT - HEPA FILTER.pdf
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- Attached to
- HEPA FILTER
- Solicitation number
- N4523A26Q4045
About this file
This is a Contract Data Requirements List (CDRL) Form DD 1423-1 documenting a single data item requirement for a federal contract.
The requirement specifies an Acceptance Test Report (ATR) for filter testing under contract number 2370-1944 REV F, with contract reference DI-QCIC-81891. The contractor must provide test data associated with document DI-QCIC-81891 in conjunction with the contract. The data item is categorized as "QCIC" (Quality and Configuration Item Control) and is required under authority DI-QCIC-81891. The requiring office is PSNS & IMF with code 2305.3. The submission frequency is "AS REQUIRED" with the date of first submission to coincide with the first shipment of material. The contractor shall provide a hard copy of the filter test report with each material shipment under this contract. Only acceptable test articles meeting the filter specification in drawing 2370-1944, REV F (paragraph 2A of DI-QCIC-81891) are permissible. The distribution requires one copy in both draft and final formats to PSNS & IMF Code 2305.3. The form was prepared on 6/9/26 and indicates no estimated total price is specified in Block 18. The document reference number is DOC NO.: 6159VL00.
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CONTRACT DATA REQUIREMENTS LIST (CDRL)
(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
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED
TOTAL PRICE
7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION
REQUIRED
a. ADDRESSEE
b. COPIES
8. APP CODE
11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.
Draft
Final
Reg Repro
16. REMARKS
15. TOTAL ▬▬▬▬►
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page of Pages
| A CONTRACT LINE ITEM NO: TBD | |
| B EXHIBIT: A | |
| D SYSTEMITEM: HEPA FILTER | |
| E CONTRACTPR NO: TBD | |
| F CONTRACTOR: TBD | |
| 1 DATA ITEM NO: A002 | |
| 2 TITLE OF DATA ITEM: ACCEPTANCE TEST REPORT (ATR) | |
| 3 SUBTITLE: FILTER TEST REPORT | |
| 17 PRICE GROUP: | |
| 4 AUTHORITY Data Acquisition Document No: DI-QCIC-81891 | |
| 5 CONTRACT REFERENCE: 2370-1944 REV F* | |
| 6 REQUIRING OFFICE: PSNS & IMF Code 2305.3 | |
| 7 DD 250 REQ: DD | |
| 8 APP CODE: N/A | |
| 9 DIST STATEMENT REQUIRED: A | |
| 10 FREQUENCY: ASREQ* | |
| 12 DATE OF FIRST SUBMISSION: ASREQ* | |
| 11 AS OF DATE: N/A | |
| H DATE: 6/9/26 | |
| a ADDRESSEE16 REMARKS: PSNS & IMF CODE 2305.3 | |
| Draft16 REMARKS: 0 | |
| Reg16 REMARKS: 1 | |
| Repro16 REMARKS: 0 | |
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| Draft15 TOTAL: 0 | |
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| J DATE: | |
| 18 ESTIMATED TOTAL PRICE: | |
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| Pages: | |
| Page: 1 | |
| 2026-06-09T06:24:19-0700 | |
| CULP.JAYME.RAE.1467997668 |
| 13 DATE IF SUBSEQUENT SUBM: N/A |
| Remarks: BLOCK 2: ONLY ACCEPTABLE TEST ARTICLE FOR PARAGRAPH 2A OF DID (DI-QCIC-81891) IS FILTER SPECIFICATION (DRAWING: 2370-1944, REV F). |
THE CONTRACTOR SHALL PROVIDE DATA ASSOCIATED WITHDI-QCIC-81891 IN CONJUNCTION WITH THE CONTRACT.
BLOCK 4: TAILORED DATA ITEM DESCRIPTION (DID) SHALL BE PROVIDED BY THE GOVERNMENT.
BLOCK 5: 2370-1944 REV F, SECTION 9 (A) APPLIES TO
SECTIONS 2, 3, 6 (A), & 6 (B).
BLOCK 10: A FILTER TEST REPORT SHALL BE INCLUDED WITH EACH MATERIAL SHIPMENT ASSOCIATED WITH THIS
CONTRACT.
BLOCK 12: DATE OF FIRST SUBMISSION UPON PROVIDING GOVERNMENT WITH FIRST SHIPMENT OF MATERIAL.
BLOCK 14: A HARD COPY OF THE FILTER TEST REPORT SHALL BE PROVIDED TO THE GOVERNMENT WITH EACH SHIPMENT OF MATERIAL UNDER THIS CONTRACT.
DOC NO.: 6159VL00
| C CATEGORY TDP TM OTHER: QCIC |
| TM: |
| TDP: |
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