DD 1423 - A006 Test Inspection Report.pdf

CONTRACT DATA REQUIREMENTS LIST

(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:

TDP TM OTHER __X__

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

1. DATA ITEM NO. 3. SUBTITLE

5. CONTRACT REFERENCE

PD para 1.5.1.3

6. REQUIRING OFFICE:

402 CMXG/MXDEF

7. DD 250 REQ

NA

9. DIST

STATEMENT

REQUIRED

n/a

10. FREQUENCY

SEE BLOCK 16

12. DATE OF 1ST SUBMISSION

SEE BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

SEE BLK 16

13. DATE OF SUBSEQUENT

SUBMISSION

N/A Draft

Final

Reg Repro

15. TOTAL 0 1 0

J. DATE

PREVIOUS EDITION MAY BE USED

Page _ _ of __Pages

18. ESTIMATED

TOTAL PRICE

17. PRICE

GROUP

A006

1 1

G. PREPARED BY

DD Form 1423-1, FEB 2001

2. TITLE OF

Test/Inspection Report

SEE BLK 16

Christine L. Clark Christine L. Clark27 May 2021 27 May 2021

Die & Mold

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

H. DATE

E-mail:

Send to Technical POC stated on each call

A test report containing the results of the testing in accordance with the test plan shall be issued to the technical focal point stated in the call no later than 14 calendat days after completion of testing.

1230481071C Inserted Text