Appendix D - DD Form 250 Material and Receiving Report.pdf

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Attached to
SATCOM Milstar Building Maintenance and Repair
Solicitation number
FA460026Q0101
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This is the DD Form 250, Material Inspection and Receiving Report (MIRR), a standard federal government form used to document the receipt and acceptance of contracted materials or supplies. The form serves as an official record of delivery, inspection, and quality assurance for items purchased under federal contracts.

The form captures essential procurement and logistics information including contract number, order number, shipment number, date shipped, bill of lading or transaction control number, invoice details, and discount terms. It identifies key parties involved in the transaction: the prime contractor, administering office, shipping origin and destination, payment office, and marked-for location, each referenced by organizational codes. The form includes line-item detail sections for recording stock/part numbers, item descriptions (including shipping container information), quantities shipped and received, units of measure, unit prices, and total amounts.

The form incorporates three critical certification sections: origin Contract Quality Assurance (CQA) acceptance, destination CQA acceptance, and receiver's use attestation. Each section requires an authorized government representative's signature, date, typed name, title, mailing address, and commercial telephone number. The receiver's section notes that quantities were received in apparent good condition except as noted, with specific instructions that matching quantities should be marked with an X, while differing quantities should be entered and encircled. Section 23 is reserved for contractor use only. The form is designed to be completed in accordance with DFARS Appendix F-401 instructions and has an estimated public reporting burden of three minutes per response.

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(Updated 20250912)

Page of

PREVIOUS EDITION IS OBSOLETE.

DD FORM 250, AUG 2000

MATERIAL INSPECTION AND RECEIVING REPORT

OMB No. 0704-0248

OMB approval expires:

20270131

The public reporting burden for this collection of information is estimated to average 3 minutes 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, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. 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 COMPLETED FORM TO THE ABOVE ORGANIZATION.

SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.

1. PROCUREMENT INSTRUMENT IDENTIFICATION

(CONTRACT) NO. ORDER NO. 2. SHIPMENT NO. 3. DATE SHIPPED

(YYYYMMDD)

4. B/L

TCN

5. DISCOUNT TERMS 6. INVOICE NO. DATE(YYYYMMDD)

7. PAGE OF

8. ACCEPTANCE POINT

9. PRIME CONTRACTOR CODE: 10. ADMINISTERED BY CODE:

11. SHIPPED FROM (If other than 9) CODE: FOB: 12. PAYMENT WILL BE MADE BY CODE:

13. SHIPPED TO CODE: 14. MARKED FOR CODE:

15.

ITEM NO.

16. STOCK/PART NUMBER AND DESCRIPTION

(Indicate number of shipping containers - type of container - container number.)

17. QUANTITY

SHIPPED/RECEIVED*

18.

UNIT

19.

UNIT PRICE

20.

AMOUNT

21. CONTRACT QUALITY ASSURANCE

a. ORIGIN

CQA ACCEPTANCE of listed items has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.

DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

TYPED NAME:

TITLE:

MAILING ADDRESS:

COMMERCIAL

TELEPHONE NUMBER:

b. DESTINATION CQA ACCEPTANCE of listed items has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.

DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

TYPED NAME:

TITLE:

MAILING ADDRESS:

COMMERCIAL

TELEPHONE NUMBER:

22. RECEIVER'S USE

Quantities shown in column 17 were received in apparent good condition except as noted.

DATE (YYYYMMDD) SIGNATURE OF AUTHORIZED

GOVERNMENT REPRESENTATIVE

TYPED NAME:

TITLE:

MAILING ADDRESS:

COMMERCIAL

TELEPHONE NUMBER:

* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.

23. CONTRACTOR USE ONLY

mailto:whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil

DRAFT

SAMPLE

PREVIOUS EDITION IS OBSOLETE.

DD FORM 250, AUG 2000

(Updated 20250912)

DRAFT

INSTRUCTIONS

PREVIOUS EDITION IS OBSOLETE.

DD FORM 250, AUG 2000

Page of (Updated 20250912)

MATERIAL INSPECTION AND RECEIVING REPORT

OMB No. 0704-0248 OMB approval expires: 20270131 The public reporting burden for this collection of information is estimated to average 3 minutes 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, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. 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 COMPLETED FORM TO THE ABOVE ORGANIZATION.

SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.

9. PRIME CONTRACTOR

10. ADMINISTERED BY

11. SHIPPED FROM (If other than 9)

12. PAYMENT WILL BE MADE BY

13. SHIPPED TO

14. MARKED FOR

15. ITEM NO.

16. STOCK/PART NUMBER AND DESCRIPTION

(Indicate number of shipping containers - type of container - container number.)

17. QUANTITY SHIPPED/RECEIVED*

18. UNIT

19. UNIT PRICE

20. AMOUNT

21. CONTRACT QUALITY ASSURANCE

a. ORIGIN has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.

b. DESTINATION has been made by me or under my supervision and they conform to contract, except as noted herein or on supporting documents.

22. RECEIVER'S USE

Quantities shown in column 17 were received in apparent good condition except as noted.

* If quantity received by the Government is the same as quantity shipped, indicate by (X) mark; if different, enter actual quantity received below quantity shipped and encircle.

9.0.0.2.20120627.2.874785

WHS

DD Form 250, "Material Inspection and Receiving Report"

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1. PROCUREMENT INSTRUMENT IDENTIFICATION (CONTRACT) NUMBER:
1. PROCUREMENT INSTRUMENT IDENTIFICATION (CONTRACT) NUMBER - Enter order number.:
2. SHIPMENT NUMBER:
3. DATE SHIPPED (YYYYMMDD):
4. B/L - bill of lading.:
4. B/L - Enter TCN.:
Enter discount terms.:
6. INVOICE NUMBER:
6. INVOICE DATE (YYYYMMDD):
7. Enter current page number:
7. Enter total number of pages.:
Enter acceptance point.:
9. PRIME CONTRACTOR - Enter code.:
9. PRIME CONTRACTOR:
10. ADMINISTERED BY - Enter code.:
10. ADMINISTERED BY:
11. SHIPPED FROM (If other than 9) - Enter code.:
11. SHIPPED FROM (If other than 9) - Enter F.O.B.:
11. SHIPPED FROM (If other than 9):
12. PAYMENT WILL BE MADE BY - Enter code.:
12. PAYMENT WILL BE MADE BY:
13. SHIPPED TO - Enter code.:
13. SHIPPED TO:
14. MARKED FOR - Enter code.:
14. MARKED FOR:
15. ITEM NUMBER (first part), row 1:
15. ITEM NUMBER (second part), row 1:
16. STOCK/PART NUMBER AND DESCRIPTION (Indicate number of shipping containers - type of container - container number.), row 1:
17. QUANTITY SHIPPED/RECEIVED* - If quantity received is different, enter on second line, row 1:
17. QUANTITY SHIPPED/RECEIVED* - Mark X if quantity received is same as quantity shipped, row 1: 0
18. UNIT, row 1:
19. UNIT PRICE, row 1:
20. AMOUNT, row 1:
15. ITEM NUMBER (first part), row 2:
15. ITEM NUMBER (second part), row 2:
16. STOCK/PART NUMBER AND DESCRIPTION (Indicate number of shipping containers - type of container - container number.), row 2:
17. QUANTITY SHIPPED/RECEIVED* - If quantity received is different, enter on second line, row 2:
17. QUANTITY SHIPPED/RECEIVED* - Mark X if quantity received is same as quantity shipped, row 2: 0
18. UNIT, row 2:
19. UNIT PRICE, row 2:
20. AMOUNT, row 2:
15. ITEM NUMBER (first part), row 3:
15. ITEM NUMBER (second part), row 3:
16. STOCK/PART NUMBER AND DESCRIPTION (Indicate number of shipping containers - type of container - container number.), row 3:
17. QUANTITY SHIPPED/RECEIVED* - If quantity received is different, enter on second line, row 3:
17. QUANTITY SHIPPED/RECEIVED* - Mark X if quantity received is same as quantity shipped, row 3: 0
18. UNIT, row 3:
19. UNIT PRICE, row 3:
20. AMOUNT, row 3:
15. ITEM NUMBER (first part), row 4:
15. ITEM NUMBER (second part), row 4:
16. STOCK/PART NUMBER AND DESCRIPTION (Indicate number of shipping containers - type of container - container number.), row 4:
17. QUANTITY SHIPPED/RECEIVED* - If quantity received is different, enter on second line, row 4:
17. QUANTITY SHIPPED/RECEIVED* - Mark X if quantity received is same as quantity shipped, row 4: 0
18. UNIT, row 4:
19. UNIT PRICE, row 4:
20. AMOUNT, row 4:
15. ITEM NUMBER (first part), row 5:
15. ITEM NUMBER (second part), row 5:
16. STOCK/PART NUMBER AND DESCRIPTION (Indicate number of shipping containers - type of container - container number.), row 5:
17. QUANTITY SHIPPED/RECEIVED* - If quantity received is different, enter on second line, row 5:
17. QUANTITY SHIPPED/RECEIVED* - Mark X if quantity received is same as quantity shipped, row 5: 0
18. UNIT, row 5:
19. UNIT PRICE, row 5:
20. AMOUNT, row 5:
15. ITEM NUMBER (first part), row 6:
15. ITEM NUMBER (second part), row 6:
16. STOCK/PART NUMBER AND DESCRIPTION (Indicate number of shipping containers - type of container - container number.), row 6:
17. QUANTITY SHIPPED/RECEIVED* - If quantity received is different, enter on second line, row 6:
17. QUANTITY SHIPPED/RECEIVED* - Mark X if quantity received is same as quantity shipped, row 6: 0
18. UNIT, row 6:
19. UNIT PRICE, row 6:
20. AMOUNT, row 6:
21. CONTRACT QUALITY ASSURANCE - a. ORIGIN - Mark X if CQA.: 0
21. CONTRACT QUALITY ASSURANCE - a. ORIGIN - Mark X if listed items are accepted.: 0
21. CONTRACT QUALITY ASSURANCE - a. ORIGIN - DATE (YYYYMMDD):
21. CONTRACT QUALITY ASSURANCE - a. ORIGIN - SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE :
21. CONTRACT QUALITY ASSURANCE - a. ORIGIN - TYPED NAME::
21. CONTRACT QUALITY ASSURANCE - a. ORIGIN - TITLE::
21. CONTRACT QUALITY ASSURANCE - a. ORIGIN - MAILING ADDRESS::
21. CONTRACT QUALITY ASSURANCE - a. ORIGIN - COMMERCIAL TELEPHONE NUMBER::
21. CONTRACT QUALITY ASSURANCE - b. DESTINATION - Mark X if CQA.: 0
21. CONTRACT QUALITY ASSURANCE - b. DESTINATION - Mark X if listed items are accepted.: 0
21. CONTRACT QUALITY ASSURANCE - b. DESTINATION - DATE (YYYYMMDD):
21. CONTRACT QUALITY ASSURANCE - b. DESTINATION - SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE :
21. CONTRACT QUALITY ASSURANCE - b. DESTINATION - TYPED NAME::
21. CONTRACT QUALITY ASSURANCE - b. DESTINATION - TITLE::
21. CONTRACT QUALITY ASSURANCE - b. DESTINATION - MAILING ADDRESS::
21. CONTRACT QUALITY ASSURANCE - b. DESTINATION - COMMERCIAL TELEPHONE NUMBER::
22. RECEIVER'S USE - DATE (YYYYMMDD):
22. RECEIVER'S USE - SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE :
22. RECEIVER'S USE - TYPED NAME::
22. RECEIVER'S USE - TITLE::
22. RECEIVER'S USE - MAILING ADDRESS::
22. RECEIVER'S USE - COMMERCIAL

TELEPHONE NUMBER::

twenty3:

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