CDRLS.pdf

For the best experience, open this PDF portfolio in

Acrobat X or Adobe Reader X, or later.

Get Adobe Reader Now!

http://www.adobe.com/go/reader

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 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

16. REMARKS (Continued)

DD FORM 1423-1, FEB 2001 Page of Pages

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package;

TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optional entry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15.

Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.

DD FORM 1423-1 (BACK), FEB 2001

data_item: A/B/C/D/E001 title: Contract Depot Maintenance Monthly Production Report sub: CDM Production Report auth: DI-PSSS-81995A ref: PWS Paragraph 4.3.12 req_ofc: AFSC/PZABB dd250: DD appcode: N/A dist: D freq: Monthly asof: N/A firstsub: See Block16 subsub: See Block16 addressee1: 408 SCMS/GULB draft1: 0 reg1: 1 repro1: 0 addressee2: 235 Byron St. STE 19A draft2:

reg2:

repro2:

addressee3: Robins AFB, GA 31098 draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks:

Block 4: Contractor format acceptable. This is a two-part report for which the Contractor shall report by contract delivery order on all applicable categories, totals and on-hand balances, IAW DI-PSSS-81995, providing TABLE I for EACH repair location, including subcontractor facilities, for the contracts maintenance occurrence actions during the reporting period.

Contractor shall report on production, providing TABLE I for EACH repair location, including subcontractor facilities, for which the contractor produced assets during the reporting period. If required, this portion of the table will be in narrative format.

The report following the final reporting period on contract will be annotated "Final Report."

The contractor's CAV AF reporting shall reflect their inventory property control management system data records which shall represent timely and accurate accountability of AF inventory assets at the physical location(s) of the contractor's repair facility (including subcontractor facilities); shop floor, bond room and/or receiving/shipping docks, etc. for each repair.

Block 9: Distribution authorized to Department of Defense and U.S. DoD contractors only (Administrative or Operational Use, 11Feb2020). Other request for this document shall be referred to the 408th Supply Chain Management Squadron, 408SCMS/GULB, 235 Byron St. STE 19A, Robins AFB, GA 31098.

BLKS 8,12,13: This monthly report shall be provided within 10 days of the previous month's end. Government will provide comments/concurrence within 30 days of receipt. Contractor shall submit corrections within 15 days of receipt of government comments.

Blocks 14: Submit electronically via email to the Program Manager and Supply Planner. Contractor shall request point of contact names and email addresses prior to submission.

group:

total_price:

prep_name:

line_item:

exhibit: A/B/C/D/E xtdp: Off xtm: Off othercat: X system: ALQ-172 ctr_no: FD2060-25-00073 contr: L3HARRIS remarksb:

Page2:

Reset:

2025-03-19T10:49:18-0400

DUCKWORTH.CHARLES.EDWARD.1186564398

prep_date:

app_by:

2025-06-18T09:07:29-0400

POWELL-SMITH.VALINE.A.1064795194

app_date: 18 Jun 25

Page:

of_pages:

app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A/B/C/D/E002 title: Commercial Asset Visibility Air Force (CAVAF) Reporting sub: CFM End Item Reporting auth: DI-MGMT-81838 ref: PWS Paragraph 4.3.13 req_ofc: 408 SCMS/GULB dd250: DD appcode: N/A dist:

freq: See BLK 16 asof: See BLK 16 firstsub: See BLK 16 subsub: See BLK 16 addressee1: See Block 16 draft1: 0 reg1: 1 repro1: 0 addressee2:

draft2:

reg2:

repro2:

addressee3:

draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks: NOTE: Changes to office symbols and/or e-mail addresses, when necessary shall be made by letter through the Government CO/ACO without further revision to this CDRL.

Block 7: The contractor shall report End Item transactional data through electronic submission in CAV AF using the CAV AF website or CICA XML.

The contractor shall submit a DD Form 250 (Material Inspection and Receiving Report) electronically via the Internet to iRAPT (WAWF) website address: https://wawf.eb.mil, using DODAAC FA8522. MARK FOR: Address in block 14A.

Block 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only due to operational use as of Nov. 30th 2020. Other requests shall be referred to 408 SCMS/GUEA or higher DoD authority.

Block 10: Date of first submission shall be within 24 hours following a supply or maintenance transaction, after the contract award date.

Block 11: Contractor reporting requirements to CAV AF shall be submitted daily and/or within 24 hours of a supply or maintenance action occurrence IAW the CAV AF Reporting Requirements Document.

Blocks 12, 13: Data shall be current within 24 hours of the last End Item maintenance occurrence.

Block 14: Reports shall be delivered within the CAV AF reporting system.

group:

total_price:

prep_name:

line_item:

exhibit: A/B/C/D/E xtdp: Off xtm: Off othercat: x system: AN/ALQ-172 ctr_no: FD2060-25-00073 contr: L3 Harris remarksb:

Page2:

Reset:

2025-03-19T10:49:02-0400

DUCKWORTH.CHARLES.EDWARD.1186564398

prep_date:

app_by:

2025-06-18T09:08:03-0400

POWELL-SMITH.VALINE.A.1064795194

app_date: 18 Jun 25

Page:

of_pages:

app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A/B/C/D/E003 title: Government Property Inventory Report sub: Government Property Inventory Report auth: DI-MGMT 80441D ref: PWS Paragraph 4.3.14 req_ofc: 408 SCMS/GULB dd250: DD appcode: N/A dist: D freq: Annually asof: N/A firstsub: See Block16 subsub: See Block16 addressee1: 408 SCMS/GULB draft1: 0 reg1: 1 repro1: 0 addressee2: 235 Byron St. STE 19A draft2:

reg2:

repro2:

addressee3: Robins AFB, GA 31098 draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks:

Block 4: Government Property Inventory Report prescribes the format, content, and preparation instructions for the data product required to meet this requirement. Report shall be formatted using Microsoft Excel and may utilize Adobe PDF. Submission shall be delivered electronically via email. The Contractor shall conduct an annual 100% physical inventory over the course of a year's time of each NIIN as not to impede maintenance operations. Upon completion of each NIIN's physical inventory, the contractor shall provide the AF Government an inventory listing of the result of all AF Government Furnished Property (GFP) in the contractor's possession, by contract, and by National Stock Number (NSN). The Contractor shall submit a Table for each designated repair facility / DODAAC location for which the contractor has received inventory during the reporting period, including Subcontractor facilities. The report should include all AF GFP in possession of the Contractor.

The Contractor's CAVAF Reporting shall reflect their inventory property control management system data records which shall represent timely and accurate accountability of AF inventory assets at the physical location(s) of the contractor's repair facility (including subcontractor facilities), shop floor, bond room, and/or receiving/shipping docks, etc. for each NIIN.

BLK 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only due to operational use as of Nov. 30th 2020. Other requests shall be referred to 408 SCMS/GUEA or higher DoD authority.

Block 10: This report shall be provided annually, at a minimum, but shall also be provided upon request of the Government.

Block 11: The data is representative of the Contractor's Internal Property Control

Blocks 12-13: The report shall be delivered within seven (7) calendar days of the end of the first reporting period and annually thereafter, or within seven (7) calendar days of Government request.

Blocks 14: Submit electronically via email to the Program Manager and Supply Planner Contractor shall request point of contact names and email addresses prior to submission.

group:

total_price:

prep_name:

line_item:

exhibit: A/B/C/D/E xtdp: Off xtm: Off othercat: x system: AN/ALQ-172 ctr_no: FD2060-25-00073 contr: L3 Harris remarksb:

Page2:

Reset:

2025-03-19T10:48:51-0400

DUCKWORTH.CHARLES.EDWARD.1186564398

prep_date:

app_by:

2025-06-18T09:08:59-0400

POWELL-SMITH.VALINE.A.1064795194

app_date: 18 Jun 25

Page:

of_pages:

app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A/B/C/D/E004 title: Counterfeit Prevention Plan sub: CPP auth: DI-MGMT-81832 ref: PWS Paragraph 4.3.15 req_ofc: 408 SCMS/GULB dd250: DD appcode: A dist: D freq: ONE/R asof: N/A firstsub: See Block16 subsub: See Block16 addressee1: 408 SCMS/GULB draft1: 0 reg1: 1 repro1: 0 addressee2: 235 Byron St. STE 19A draft2:

reg2:

repro2:

addressee3: Robins AFB, GA 31098 draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks:

Block 9: Distribution authorized to Department of Defense and U.S. DoD contractors only (Administrative or Operational Use 15 March 2019) due to critical technology. Other request for this document shall be referred to AFLCMC/WNYEBA.

Block 8,12,13: The Government shall provide approval/comments/corrections no later than 45 business days after receipt of document from the contractor. The contractor has 30 days to correct and submit the corrected document for approval.

Block 14: Submissions shall be made electronically to the Contracting Officer, Program Manager, and Program Engineer. Contractor shall request point of contact names and email addresses prior to submission.

group:

total_price:

prep_name:

line_item:

exhibit: A/B/C/D/E xtdp: Off xtm: Off othercat: x system: AN/ALQ-172 ctr_no: FD2060-25-00073 contr: L3 Harris remarksb:

Page2:

Reset:

2025-03-19T10:48:24-0400

DUCKWORTH.CHARLES.EDWARD.1186564398

prep_date:

app_by:

2025-06-18T09:09:28-0400

POWELL-SMITH.VALINE.A.1064795194

app_date: 18 Jun 25

Page:

of_pages:

app: Adobe Professional 8.0

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 conformance with Government requirements, and the required to perform additional work to conform to Government without conforming to Government requirements, and the contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any data_item: A/B/C/D/E005 title: Accident/Incident Report sub:

auth: DI-SAFT-81563 ref: PWS Paragraph 5.6 req_ofc: 408 SCMS/GULB dd250: DD appcode: N/A dist: C freq: AS REQ asof: See Block16 firstsub: See Block16 subsub: See Block16 addressee1: 408 SCMS/GULB draft1: 0 reg1: 1 repro1: 0 addressee2: 235 Byron St. STE 19A draft2:

reg2:

repro2:

addressee3: Robins AFB, GA 31098 draft3:

reg3:

repro3:

addressee4:

draft4:

reg4:

repro4:

addressee5:

draft5:

reg5:

repro5:

addressee6:

draft6:

reg6:

repro6:

addressee7:

draft7:

reg7:

repro7:

addressee8:

draft8:

reg8:

repro8:

addressee9:

draft9:

reg9:

repro9:

addressee10:

draft10:

reg10:

repro10:

addressee11:

draft11:

reg11:

repro11:

addressee12:

draft12:

reg12:

repro12:

addressee13:

draft13:

reg13:

repro13:

addressee14:

draft14:

reg14:

repro14:

addressee15:

draft15:

reg15:

repro15:

addressee16:

draft16:

reg16:

repro16:

addressee17:

draft17:

reg17:

repro17:

addressee18:

draft18:

reg18:

repro18:

addressee19:

draft19:

reg19:

repro19:

addressee20:

draft20:

reg20:

repro20:

addressee21:

draft21:

reg21:

repro21:

addressee22:

draft22:

reg22:

repro22:

addressee23:

draft23:

reg23:

repro23:

addressee24:

draft24:

reg24:

repro24:

addressee25:

draft25:

reg25:

repro25:

addressee26:

draft26:

reg26:

repro26:

addressee27:

draft27:

reg27:

repro27:

addressee28:

draft28:

reg28:

repro28:

addressee29:

draft29:

reg29:

repro29:

addressee30:

draft30:

reg30:

repro30:

addressee31:

draft31:

reg31:

repro31:

addressee32:

draft32:

reg32:

repro32:

addressee33:

draft33:

reg33:

repro33:

addressee34:

draft34:

reg34:

repro34:

addressee35:

draft35:

reg35:

repro35:

addressee36:

draft36:

reg36:

repro36:

addressee37:

draft37:

reg37:

repro37:

addressee38:

draft38:

reg38x:

repro38:

total_draft: 0 total_reg: 1 total_repro: 0 remarks:

Block 7: The Contractor shall submit each report with a letter of transmittal. Submit invoice in WAWF after submittal of final report to account for all previously submitted.

Block 9: Distribution C. Distribution authorized to U.S. Government agencies and their contractors Administration and Operational use (12 February 2019). Other requests for this document shall be referred to 408 SCMS/GUEA or higher DoD authority.

Blocks 10-13: Contractor shall submit a safety and health plan within 10 working days after contract award. Written Government approval/comments/disapproval will be within 10 working days after receipt of data. Contractor's final submission shall be submitted within 10 working days of receiving Government comments. Contractor shall notify PCO/ACO prior to assuming acceptance. Acceptance by the Government is required prior to formal distribution. If, during the performance of this contract, changes to the safety and health plan are required, submit the revised safety and health plan IAW Block 14.

Block 14: Reports shall be delivered electronically via E-mail to the Contracting Officer, Program Manager, and Program Engineer. Contractor shall request point of contact names and email addresses prior to submission.

group:

total_price:

prep_name:

line_item:

exhibit: A/B/C/D/E xtdp: Off xtm: Off othercat: x system: AN/ALQ-172 ctr_no: FD2060-25-00073 contr: L3 Harris remarksb:

Page2:

Reset:

2025-03-19T10:48:07-0400

DUCKWORTH.CHARLES.EDWARD.1186564398

prep_date:

app_by:

2025-06-18T09:09:58-0400

POWELL-SMITH.VALINE.A.1064795194

app_date: 18 Jun 25

Page:

of_pages:

app: Adobe Professional 8.0