CONTRACT DATA REQUIRMENTS LISTS.pdf

' CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) 0MB No. 070+0188

Public reporting burden for this collection of information Is estimated to average 11 o 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 thus burden estimate or any other aspect of this collection o f 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 comDleted form to the Government lssuin!I Contracting Officer for the Contract/PR No. listed In Block E.

A. CONTRACT LINE ITEM NO.

D. SYSTEMIITEM

0002AA

B. EXHIBIT

1. DATA ITEM NO. 2. TITLE OF DATA ITEM

PA C. CATEGORY:

TOP

E. CONTRACT/PR NO.

A001 WARRANTY PERFORMANCE REPORT

4. AUTHORITY (DIii• Acqul•IIIGn Ooc11111.,,I No.) I. CONTRACT REFERENCE

DI-SESS-81639A PER CONTRACT

TM OTHER

SESS

F. CONTRACTOR

3. SUBTITLE

WARRANTY DOCUMENTATION

&. REQUIRING OFFICE

PURCHASING ACTIVITY

7. DD250REQ 9 DIST STATEMENT 10, FREQUENCY 12. DATE OF FIRST SUBMISSION 14, DISTRIBUTION

REQUIRED

DD ONE/R SEE BLOCK 16 b. COPIES

B APP CODE D 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE DRAFT FINAL

SUBMISSION

NIA NIA N/A

16. REMARKS

Block 4 - Tailored to allow vendor to provide only 3.1.1 (a, c, d, e), 3, 1.2 (a, b, c, d, e. f, g, h, j, k, I, m).

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 5/20/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12- Certification/Data Report documentation shall be attached in the Wide Area Workflow rt-JAWF) e-Business Suite.

Upon submission in WAWF send email notifications to:

PSNS.WAWFQACertificalions.FCM@navy.mil. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0040-3850

G. PREPARED BY H.DATE I. APPROVED BY

/s/ Derek Dunlap 5/20/2D20 /s/ Malvin Dolnog

DD FORM 1423-1, JUN 90 IEG)

N4523A

1�. Total

Page

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0 1 0

J. DATE

5/20/2020 of 2 Pages

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' CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item} 0MB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the lime for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding thus burden estimate or any other aspect of this collection o f 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 lo 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. B. EXHIBIT

B

C. CATEGORY:

0002AB TOP TM OTHER

TMSS

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. Z. TITLE OF DATA ITEM 3.SUBTITLE

B001

EQUIPMENT TECHNICAL MANUAL (SANITIZED)

4, AUTHORITY {Dall! Ar:qu/sltlon Dor:umenl No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-TMSS-81675 PER CONTRACT PURCHASING ACTIVITY

7. DD250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

REQUIRED

DD ONE/R SEE BLOCK 16

8.APPCOOE D

11, AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

NIA NIA NIA

18 REMARKS

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 5/20/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow rt-JAWF) a-Business Suite.

Upon submission in WAWF send email notifications to:

PSNS.WAWFQACertifications.FCM@navy.mil. Acceptance/Rejection of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.: 0040-3850

G. PREPARED BY H.DATE I. APPROVED BY

Is/ Derek Dunlap 5/20/2020 /s/ Malvin Dolnog

DD FORM 1423-1, JUN 90 (EG)

14. DISTRIBUTION

a. ADDRESSEE

N4523A

15. Tolal

Pa9e

b. COPIES

DRAFT FIN.'.L

Reg Ropr

0 1 0

0 1 0

J.DATE

5/20/2020 of 2 Pages

OtJfJ'M'!.

lf.PIIICI

11.HTIIIA'IG

TOTAl.,tOCI

. CONTRACT DATA REQUIREMENTS UST Form Approved

(1 Data Item} 0MB No. 07()4.0188

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the lime for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding thus burden estimate or any other aspect of this collection o f 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◄302, 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 comcleted form to the Government lssuinQ Contractini, Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT

C

C. CATEGORY:

0006 AA

TOP TM OTHER

MISC

D. SYSTEMIITEM E. CONTRACT/PR NO. F. CONTRACTOR

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

CERTIFICATION/DATA REPORT NATIONAL RECOGNIZED TESTING

C001 LABORATORY (NRTL) CERTIFICATION

<I. AUTHORITY (Data Acqul•lllon Documenl No.} 5. CONTRACT REFERENCE

DI-MISC-80678 (DD) PER CONTRACT

7. DD250REO 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

REQUIRED

DD ONE/R SEE BLOCK 16

B.APP COOE D

11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

NIA NIA NIA

16. REMARKS

Block 4: Tailored to allow the vendor to only provide: 10.1, 10.2, 10.2.4, 10.3, 10.3.1-Provide actual values IAW procurement specification. Ensure certs provided are traceable to material via unique markings, 10.5.

Block 9: Distribution Statement D. Distribution authorized to DoD and DoD contractors only.

Administration and operations only, effective 5/20/2020. Other U.S. requests shall be referred to COMNAVSEASYSCOM.

Block 12 - Certification/Data Report documentation shall be attached in the Wide Area Workflow �AWF) e-Business Suite.

Upon submission In WAWF send email notifications to:

PSNS.WAWFOACertifications.FCM@navy.mil. Acceptance/Rejedion of Certification/Data Report documentation will be accomplished with the corresponding material and will not be accomplished prior to shipment of material.

Document No.:0040-3853

G. PREPARED BY H.DATE I. APPROVED BY

/s/ Derek Dunlap 5/20/2020 /s/ Malvin Dolnog

DD FORM 1423-1, JUN 90 (EG)

8. REQUIRING OFFICE

PURCHASING ACTIVITY

14. DISTRIBUTION

a. ADDRESSEE

N4523A

15. Total

Page b.COPIES

DAAFT FINAi.

Rog Flop-

0 1 0

0 1 0

J. DATE

5/20/2020 of 2 Pages tLUTNAff:D

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