CDRL DD Form 1423-1 A001.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved OMB No. 0704-0188

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 this burden, to Department of Defense, Washington Headquarters Service, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP_________ TM___________ OTHER NDTI

D. SYSTEM/ITEM

Underwater Explosive Test Facility Report

E. CONTRACT / PR NO.

1301028303

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM:

Test/Inspection Report

3. SUBTITLE

Test Data Report

17. PRICE GROUP

GROUP 1

4. AUTHORITY (Date Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW 4.9

6. REQUIRING OFFICE

NUWCDIVNPT Code 1535

18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMNT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION N/C

LT OTIME SEE BLOCK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE Draft Final

N/A N/A N/A Reg Repro

16. REMARKS Code 1535 0 4 0 BLOCK 9: SEE BLOCK 16 ADDENDUM. See Blk 16

BLOCK 12: SUBMIT REPORT 15 DAYS AFTER TEST COMPLETION.

15. TOTAL

_____> 0 4 0

G. PREPARED BY: H. DATE

08 August 2022

I. APPROVED BY J. DATE

DD Form 1423-1, Feb 2001 Previous Edition May be Used Page __1__ of __1 Pages laina.ouellette Cross-Out

DD FORM 1423, CONTRACT DATA REQUIREMENTS LIST

BLOCK 16 ADDENDUM

PR 1301XXXXXX

BLOCK 9: The following information is specifically included in amplification of the Block 9 Distribution Statement selected:

Distribution Statement paragraphs are in addition to CLASSIFICATION markings of the data.

CDRL: A001

Distribution Statement D. Distribution authorized to Department of Defense (DoD) and U.S. DoD contractors only; Critical Technology (date data generated). Other requests for this document shall be referred to the controlling DoD office – NUWCDIVNPT Code 1535.

BLOCK 14:

NAVAL Undersea Warfare Center, Division Newport 1176 Howell Street Newport, RI 02481-1708

James Madden, Code 1535, Bldg 113, Room 114

The following 'EXPORT CONTROL WARNING NOTICE' must be used in conjunction with DISTRIBUTION STATEMENTS identified in all CDRL Items:

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. Disseminate in accordance with provisions of DoD Directive 5230.25.