CDRL A004.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 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 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

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

A004 A

X - MGMT

MK44 System Safety Objective N0017820Q6956

A004 Status Report Monthly Status Report

DI-MGMT-80368A (SEE BLK 16) SOW 3.3 NSWCDD/E30

LT

N/A D(SEE BLK 16)

MTHLY

N/A

SEE BLK 16

SEE BLK 16

TPOC 0 1

SEE BLK 16

0 1 0

BLK 4: DID is tailored to remove paragraph 3.2.3.

BLK 9: Distribution Statement D: Distribution authorized to Department of Defense and U.S. DoD contractors only for administrative and operational use [July 2020]. Other requests for this document shall be referred to Command, Naval Surface Warfare Center, Dahlgren Division (NSWCDD), 4045 Higley Road, Dahlgren, VA 22448-5110.

BLK 10, 12, 13: Initial and subsequent reports shall be required on the first Friday of every month during the Period of Performance (PoP).

BLK 14: Electronic Media: Submission may be sent via electronic mail (email) to the Technical Points of Contact (TPOC) identified in the Statement of Work.

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