DD 1423 - FA Test Report.pdf

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of 2 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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:

NDTI

TDP TM OTHER

D. SYSTEM/ITEM

Power, Panel Dist

E. CONTRACT/PR NO.

FD2020-24-00216

F. CONTRACTOR

1. DATA ITEM NO.

B001

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

First Article Test Report

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B/T

5. CONTRACT REFERENCE

CLIN for Data

6. REQUIRING OFFICE

416 SCMS/GUEAA

7. DD 250 REQ

SD

9. DIST STATEMENT

REQUIRED

B

10. FREQUENCY

OTIME

12. DATE OF FIRST 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

SEE BLK 16

Draft Final

Reg Repro

16. REMARKS

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

NSN: 6110-01-204-3839WF

1. BLK 4: Contractor's format is acceptable. Paragraph 10.2 of DI-NDTI-80809B is clarified as follows:

a. All dimensions and tolerances specified on the manufacturing data shall be listed in one column, with the actual corresponding reading obtained from the inspection of the part listed in another column.

b. Materials utilized in the manufacture of "First Article" item shall be identified and certified along with a copy of material purchase requests as conforming to applicable data requirements.

c. Material processing, including finish requirements (plating, heat treatment, welding, inspecting, anodize, painting, etc.) utilized in the manufacture of "First Article" item 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.

d. Other requirements as called out on Engineering Data Requirement (HILL AFB Form 462).

2. The Distribution Statement and Export Control Warning shall be placed on the first sheet of each document and located in a conspicuous location.

BLK 9: DISTRIBUTION STATEMENT "B" Distribution authorized to U.S.

Government agencies. (Test & Evaluation) (Nov 2023). Other requests for this document shall be referred to 416 SCMS/GUEAB, Hill AFB, UT 84056-5825.

416 SCMS 1

GUEAA

6071 Gum LN Bldg. 1213 Hill AFB, UT 84056-5825

SEE BLK 16 1

15. TOTAL 0 2 0

G. PREPARED BY: (Data Manager) PINNEGAR.STEPHA Digitally signed by

PINNEGAR.STEPHANIE.A.1102660737

NIE.A.1102660737 Date: 2023.11.16 14:54:20 -07'00'

H. DATE

16 Nov 2023

I. APPROVED BY: (Engineer) ALLRED.JUSTIN.M Digitally signed by

ALLRED.JUSTIN.M.1545519786

.1545519786 Date: 2023.11.20 15:52:42 -07'00'

J. DATE

16 Nov 2023

0.00

NSP

Reset

0001AA

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT

B

C. CATEGORY:

NDTI

TDP TM OTHER

D. SYSTEM/ITEM

Power, Panel Dist

E. CONTRACT/PR NO.

FD2020-24-00216

F. CONTRACTOR

16. REMARKS (Continued)

EXPORT CONTROL WARNING: All technical documents/data (printed, digital/electronic) that are determined to contain export-controlled technical data, shall be marked with the following statement:

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Section 2751 of Title 22, United States Code) or the Export Control Reform Act of 2018 (Chapter 58 Sections 4801-4852 of Title 50, United States Code).

Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive

5230.25 and DoD Instruction 2040.02.

3. BLKs 10, 11, 12, 13, 14:

a. For Contractor Testing - submit IAW the current delivery schedule.

b. For Government Testing - Report to assist in "First Article" testing by the Air Force shall be submitted concurrently with the "First Article" item either in the packaging of the shipping container or separately if the report will not fit within the container packaging unfolded. When shipped in the "First Article" container, the report shall be enclosed in a paper or plastic envelope.

c. SHIP TO: Non-Accountable Bay Transportation Officer Building 849 West Hill AFB, UT 84056-5999

MARK FOR: 809 MXSS/MXDEB

7278 4th Street (Bldg. 100, Bay D) Hill AFB, UT 84056-5205

NOTE: If report is shipped separate from "First Article" item, send report to "MARK FOR" address listed above.

d. Contractor shall deliver a copy of the Test/Inspection Report via e-mail to the following e-mail: justin.allred.2@us.af.mil

DD FORM 1423-1, FEB 2001 Page 2 of 2 PagesReset

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 delivering such data item to the Government.

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, AUG 96