CDRL_CPP.pdf

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of Pages Adobe Professional 8.0

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

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 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION Draft

Final

Reg Repro

16. REMARKS

15. TOTAL 0

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

Block D: NIIN: 015714927; P/N: 23033661G1; Description: W2 Cable Assembly.

A Block 9: Data submittal shall be marked with the following on the cover page:

A DISTRIBUTION STATEMENT D: Distribution authorized to Department of Defense and U.S. DoD contractors only for administrative and operational use determined as of 04 MAY 2021. Other requests for this document shall be referred to MMIII Systems Directorate, Hill AFB, UT. 84056

WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. 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 Directive 5230.25.

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

Blocks 10, 11, 12 and 13: Contractor shall submit initial draft Counterfeit Prevention Plan within 60 days of contract award. Government approval/disapproval/comments will be provided to the contractor within 30 days after receipt, with contractor submittal of final counterfeit protection plan due 15 days after receipt of government comments.

Block 14: Document submission shall be made electronically using MS Office 2016 format. Those documents not compatible with MS Office 2016 shall be delivered in Adobe Acrobat.

NSP

$0

Bldg 1227

0002 BB

See Blk 16 PR# FD20202001175

A002 Counterfeit Prevention Plan

DI-MISC-81832 414 SCMS/GUEAA

DD

See Blk 16

See Blk 16 See Blk 16

A See Blk 16 See Blk 16

6031 Gum Lane

414 SCMS/GUEAA

Attn: James Jacques Hill AFB, UT 84056

Bldg 1227 6031 Gum Lane

11414 SCMS/GUMAC

Attn: Doug Eskelsen Hill AFB, UT 84056

Doug Eskelsen

04MAY21

Ray Dean Murrison

04MAY21

1 1

ESKELSEN.DOUGL

AS.R.1471568720

Digitally signed by

ESKELSEN.DOUGLAS.R.147156872

Date: 2021.05.04 12:55:32 -06'00'

MURRISON.RAY.D.J

R.1513506828

Digitally signed by

MURRISON.RAY.D.JR.1513506828

Date: 2021.05.04 17:02:23 -06'00'