CDRL_FATR.pdf

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:

A TDP ____ TM _____ OTHER X________________________

D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR

ICBM/ NIIN 016719796

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

TEST/INSPECTION REPORT CYLINDER, ACTUATOR

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICEDI-NDTI-80809B 414 SCMS/GUEA

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

DD REQUIRED ASREQ SEE BLK 16

a. ADDRESSEE

b. COPIES

8. APP CODE

D

11. AS OF DATE 13. DATE IF SUBSEQUENT SUBM.

Draft

Final A SEE BLK 16 SEE BLK 16 Reg Repro

16. REMARKS ORG 1 (SEE BLOCK 16) 1 0

BLOCK 4: PARAGRAPH 10.2 OF DI-NDTI-80809B CLARIFIED AS FOLLOWS:

ALL DIMENSIONS AND TOLERANCES SPECIFIED ON THE MANUFACTURING DATA SHALL BE

LIST IN ONE COLUMN, WITH THE ACTUAL CORRESPONDING READING OBTAINED FROM THE

INSPECTION OF THE PART LISTED IN ANOTHER COLUMN.

MATERIALS USED IN THE MANUFACTURE OF THE “FIRST ARTICLE” SHALL BE IDENTIFIED AND

CERTIFIED ALONG WITH A COPY OF MATERIALS PURCHASE REQUIREMENTS AS CONFORMING

TO APPLICABLE DATA REQUIREMENTS.

MATERIAL PROCESSING, INCLUDING FINISH REQUIREMENTS (PLATING, HEAT TREATMENT,

WELDING ANODIZING, PAINTING, ETC.) UTILIZED IN THE MANUFACTURE OF “FIRST ARTICLE”

ITEMS SHALL BE IDENTIFIED, AND CERTIFIED AS CONFORMING TO APPLICABLE

REQUIREMENTS. A COPY OF THE PURCHASE ORDER CERTIFYING THE PROCESS

ACCOMPLISHED AT OTHER THAN CONTRACTOR FACILITY SHALL BE INCLUDED.

BLOCK 9:

DISTRIBUTION STATEMENT D: DISTRIBUTION AUTHORIZED TO DEPARTMENT OF DEFENSE AND

U.S. DOD CONTRACTORS ONLY FOR ADMINISTRATIVE AND OPERATIONAL USE DETERMINED

[DATE OF DOCUMENT]. OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED TO ICBM

SYSTEMS DIRECTORATE, 6014 DOGWOOD AVE BLDG 1258, HILL AFB, UT 84056-5826.

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

ADMINISTRATIVE 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 DODD 5230.25 AND AFI 61-204.

DESTRUCTION NOTICE: FOR CLASSIFIED DOCUMENTS, FOLLOW THE PROCEDURES IN DOD

5220.22-M, NATIONAL INDUSTRIAL SECURITY PROGRAM OPERATING MANUAL (NISPOM),

SECTION 5-705, OR DOD 5200.1-R, INFORMATION SECURITY PROGRAM REGULATIONS, CHAPTER

VI. FOR UNCLASSIFIED, LIMITED DOCUMENTS, DESTROY BY ANY METHOD THAT WILL PREVENT

DISCLOSURE OF CONTENTS OR RECONSTRUCTION OF THE DOCUMENT.

BLOCK 10, 11, 12 & 13

INITIAL SUBMITTAL:

CONTRACTOR SHALL SUBMIT QUALIFICATION TEST REPORT NLT 45 DAYS AFTER COMPLETION

OF TEST. GOVERNMENT WILL BE ALLOWED 30 DAYS AFTER RECEIPT FROM CONTRACTOR TO

REVIEW FOR APPROVAL/ DISAPPROVAL/COMMENTS. CONTRACTOR SHALL SUBMIT REVISED

QUALIFICATION TEST REPORT INCORPORATING GOVERNMENT COMMENTS, IF APPLICABLE, NLT

15 DAYS AFTER RECEIPT FROM GOVERNMENT.

BLOCK 14: COMPLETE MAILING ADDRESS IS:

809 MXSS/MXDEB (DODAAC: FB2029)

BLDG 849, ATTN: NON-ACCOUNTABLE BAY

MARK FOR: FIRST ARTICLE DO NOT POST

HILL AFB, UT 84056-5713

NOMENCLATURE:

P/N 25-66930-3 CYLINDER, ACTUATOR

NSN: 1440-01-671-9796

15. TOTAL ▬▬▬▬► 0 1 0

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

26 Feb 2020 26 Feb 2020

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

HOWE.RICHARD

.W.1574025490

Digitally signed by

HOWE.RICHARD.W.1574025490

Date: 2020.02.26 09:10:36 -07'00'

SHUPE.KARL.M

.1514874944

Digitally signed by

SHUPE.KARL.M.1514874944

Date: 2020.02.26 09:32:15 -07'00'

0001AB

NSP

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