Contract Data Requirements List.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 440 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 Services, 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 complete 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

0004 A TDP____ ___ TM ______________________ OTHER _____See Blk 16__________________________

D. SYSTEM / ITEM

P/N 5385-0101 and P/N 1002-0074

E. CONTRACT / PR NO.

1300900467

F. CONTRACTOR

TBD

1. DATA ITEM

NO.

A001

2. TITLE OF DATA ITEM

CERTIFICATE OF COMPLIANCE

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-81356A

5. CONTRACT REFERENCE

N/A

6. REQUIRING OFFICE

NUWCDIVNPT CODE 4512

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

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

LT See Blk 16 See Blk 16 b. COPIES

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

SUBMISSION a. ADDRESSEE Draft

Final

N/A See Blk 16 N/A N/A Reg Repro

NUWC Code 4512 0 1 016. REMARKS

Blk C (Other): MISC

Blk. 4: Contractor format is acceptable.

BLk. 9: See Block 16 Distribution Statement Addendum

Blks 10&12: At the time of material delivery, a Certificate of Compliance shall be submitted to NUWCDIVNPT for each of the two part numbers being ordered.

15. TOTAL -------------- 0 1 0

1. DATA ITEM

NO.

2. TITLE OF DATA ITEM 3. SUBTITLE

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

7. DD250 REQ 9. DIST STATEMENT

REQUIRED

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

b. COPIES

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

SUBMISSION a. ADDRESSEE

Draft Final

Reg Repro

16. REMARKS

****************INTENTIONALLY BLANK****************

15. TOTAL -------------

G. PREPARED BY

Robert M. Waleyko

H. DATE

12/28/2020

I. APPROVED BY J. DATE

DD Form 1423-2, AUG 96 (EG) Previous Edition May be Used Page ___1_of 1_Page

PR # 1300900467

DD FORM 1423

CONTRACT DATA REQUIREMENTS LIST

BLOCK 16 ADDENDUM

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.

Distribution Statement D. Applies to CDRL Item No. A001. Distribution authorized to the DoD and U.S. DoD contractors only; Critical Technology. Dated when data generated. Other requests for this document shall be referred to Naval Undersea Warfare Center Division, Newport, RI, Code 4512.

The following “EXPORT CONTROL WARNING NOTICE” must be used in conjunction with DISTRIBUTION STATEMENTS identified in the above CDRL item:

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.

Text2: 2/9/21