FMSCDRLsDIDs.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved CMB No. 0704-0188

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, 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 completed form to the Government Issuing Contracting Officer for the Contract. PR No. listed in Block E.

A. Contract Line Item No.

B. Exhibit A

C. Category

D. System/Item.

F100-PW-229 Augmentor Fuel Control and Pump E. Contract/PR NO.

FD2030-19-30173

F. Contractor

1. Data Item No.

A007

2. Title of Data Item:

Deficiency Report (DR)

3. Subtitle:

None

4. Authority (Data Acquisition Document No.)

DI-ALSS-81535

5. Contract Reference

6. Requiring Office

AFLCMC/LPSIB

7. DD 250 Req N/A

1. Dist Statement Required

10. Frequency As Required

12. Date of First Submission See Block 16

14. Distribution

8. APP Code

11. As of Date

N/A

13. Date of Subsequent Submission See Block 16

a. Addressee b. Copies D r a f t

Final

Reg Re pr o

16. REMARKS

As defined by T.O. 00-35D-54, submit a report whenever a material or a quality deficiency occurs utilizing SF Form 368.

THIS CDRL WILL SERVE BASIC YEAR AND ALL OPTION YEARS

Ref: Block 14a: Complete address for distribution:

AFLCMC/LPSIB

3001 Staff Dr., Ste. 2AE1107B Tinker AFB, OK. 73145-3031

DCMA/ACO (See the face contract)

AFLCMC/LPSIB 1

DCMA/ACO 1

15. TOTAL 2 1 1

G. PREPARED BY

Mi Nguyen/736-3944

H. DATE

8/21/2018

I. APPROVED BY

Jennifer Brown/734-1532

J. DATE

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1 Pages

‘ATA ITEM DESCRIPTION ~ w~

OMBNO.07040188

I*mmmtil. oi!*!-ti tire.. ndwtld”-qllohn. pr,-~cmwml.+blmk -=Mq.im14t.li -@miqd-*iml y*-qy:g *.*-. w—-ti- . . . ..ti-d*tid t*ti~dk. *qi. -dk.—.q — .,- * a.9u mc+.,ul ,2,5Al,- hi w.”. m Km,am “, nm.m

—tib.”. -*. m-dti,. -w b*wlw14mti*i*

-d r’1-,-d b ti- i#q ,- ,idO~--. FIEASEOO ,0, Ml”R,,O”ti FORM ,0 ,“F,80,t IBDmSS.

TITLE I IDENTIFICATIONNUMBiR eficiency Repon (DR) DI-ALSS-81535 DESCfllPT!ONIPURFQSE

1 Provides complete and accurate deficiency idemificaiton on GFM in repair contracts by contractors to the government. llds formation is used by government to identify necessary corrective action lAW T O 00-35 D-54, USAF Deficiency Repocdng and vestigation System.

kPPROVAlDATE 5,OFFICEOFPRIMARYRESPONSIBIUTVIOPRI /rwlMfLTo/

6,. DTICAPPUCARLE 6h GIDEPAPPLICABLE

970124 F/AFMC-ENBP

bPPLICATIONNNTERRELATIONSHIP

1 This Data Item Description (DID) contains format and content preparation instructions for the data product generated by ecific and discrete task requirements as delineated in tfse contract.

2 This DID is applicable when contractors are responsible for maintaining cuslodhl records for government propecty being paired.

3 Referenced documents can be obtainstf as specified iEEthe contract. For an explanation contact AFMC/ENS, 937-257-3085 mmmnd Locamr 937-257-3231.

4 This DID interrelates with DI-MGMT-80258A and supersedes DI-L.3342.

\PPROVAlLIMITATION 9a.APPLICABLEFORMS 9b.AMSCNUMBER

F7227

PREPARATIONINSTRUCTIONS

.1 Format and content. Refmts &If provide the information descriked in Table 1. Contractor format is acceptable.

Table 1. Deficiency Report Contem

1. From: Address of origimting activity.

2. To: Office of Primsry Respcm.sibiiity for the equipment Refer to DO 43, or T O CO-25-115 for guidance

(Continued on Page 2)

DISTRIBUTIONSTATEMENT

STRIBUTION STATEMENT A: Approved for public release: distribution is uofimited.

.Umw IOU*, nub Yo (ttq .“,”,””, ,“,,,,. . . . m“St”, PW$~ of& Pq( Wi”..4.k h.+- % .Il!mm ,.. .

Block 10. Preparation Instmctions (Continuad)

Subjacf Fimt pS1l’t.8S af.)fslkable

a. Catago~ I Ctaficiency Report (CAT 10R)

b. Ca:agory II Dsticlency Rapwt (CAT II OR)

c. MISHAP Catsgory I Dsfklency Report (CAT 10R)

Second pan, source selaction sensitive Intormetion.

mkd part. resulfa of Initial acceptance Inepacfion of eircmtt, air craft engine, engine module.

I 3. Rapoti Control Number (RCN)

4. Date deficiency

I

I 5. National Stock Numbar (NSN) or Not Stock Listed (NSL)

I 6. Nomenclalura (NOM)

1 7. Manufacfura/Repair/Overhaul

I 7a. Manufactures’ Code

7b. Shipper/City/state

8. Manufacturers Part Number

(MFRPN)

1 9. Serfal. Lot Batch Number

(SER,LOT,NR)

I 10. Contract Number

I 10a. Purchase Order Number

10b. Requisition Number

10c. GBL Number

11. Item New. Repaird Overhauled (New, RPR.OVHL)

& Unique alpha numeric RCN

b. Contractor submittsd RCNS shall bagin with O followad by timmerclal and Government Entity code (CAGE), two dlglt calendar year, four digit saquence number.

Year, month, day defsct was discovered.

NSN and applicable Material Management Aggregsfion Code (MMAC) of item (saa D043 and Tachnlcal Oder (70) 00-25-115 for guidanca on MMAC codes)

Noun of item for which report Is submlffed. Soffwara DRs shall provide NOM of programmable herdwara.

Manufacturer name, maintenance contractor, Manutacfurer code, maintenance contractor, government activity which last repaired or over hauled Item.

ff ahlpper is differant than manufacfurar, shlppar or supplier name shall be included.

complete manufacfure~s pal number shall be Inclut%xi.

For sottwam DRs, if contractor identification number Is aaaoclatad with a computer program It shall be pnsvldad, along with tha version number and patches usad.

complete item serial numbar. Softwara DRa shall Identi?y batch madia, Computer Soffwara Identification Numbar (CSIN) or TO.

Obtain contract number from racords aarvice tag manufacturer/container label. etc. contract number Is critical to processing affotls.

Use these or any transpotitlon document number in Ileu of Government Bill of Lading (GBL).

If unknown. leave blank.

If unknown, leave blank.

Use one to identify item, as appropriate.

Page 2 of 5 Pages

810ck 10. Preparation Instructions (Continued)

Table 1. Deficiency Regort Content (Continued)

12 Date Manufactured, Repalmd, Overhauled (O MFo, RPR, OVHL)

13. Operating Time at Failure (OTF)

14. Government Furnished Materiel (GFM)

15. Quantify (Q7V)

1E-a. Received (RECP)

15b. Inspected (INSP)

15c. Oeficient (DEF)

15d. In stock

16. Oeticient item works on or with lea. End item

16b. Next Higher Assembly (NHA)

17. Unit Cost (UN CST)

18. Estimated Repair Cost (EST REP COST)

19. ffem Under Wamenty

19a. Expiration Date

20. Work Unit Cods (WUC)

21. Exhibit Disposition (EXH OISP)

Year, month. day

Time, events. cycles of materiel. For sottwam ORe, Ieet revlsiordversion. Engines. H component tracked by automated system. flight hour or cycies.

Yes/no

Sett-explanatory.

Disregard unit of Issue.

Number inspected and type of inspection.

Number deficient.

Quantify with same contract number. Air munitions, include lot number.

Self-exptsnatov.

CrltIcal information, major weapon system’s mission, design, serfes, type, model, &erial number. Vehicles, enter joint electronic type designator and special numb-er, model, nomenclature, contract number required for prime vehicles and equipment manufacture.

Critical information; netional etock number, psrf end serfal numbers. For software DRs, associate with programmable harttws= engines, serial number and flight hourdcycles.

tf known. dollar value per unit of issue.

Tofel estimate based on man-hours and materfal: other DRe leave blsnk.

Yes, no, unknown.

Provide, if known.

Refer to the applicabl~S TO. For software DRs, use NHA WUC if necee.sa~ indicate WU,C of programmable hsrdwaie. For vehicles, use appropriate system code prefixed with zem to complete five digit fietd.

Disposition will be one of following:

1. Hold pending receipt cd instructions (Refer to TO-00-35D-54, Chapter 6 and for guidance).

Required information for block 22j when using automated sysfem.

2. Release tor investigation: date name, organization of authorizing individual, and to whom released, along with circumstances.

Page 3 of 5 Pages

I

I

DI-ALsS-815~5

❑lock 10. Prapamtion Instructions (Continued)

Table L Deficlencv Report Content (Contlnuad)

3. Returned to stock or disposed ot information fmm 21.1 above.

4. Repaired.

5. Shipped [n Accordance With (lAwl WWIWNY plan or actionskupport point activity directions (use when block 19=yes).

22. Details

22a. Circumstances Prior to difficulty (cIR PRIOR OIFFI

33b. Description and Cause of Oifficutty (OESC and CAUSE of OIFF)

22c. Action Taken and or Recommendation (ACT TAKEN or RECM)

22d. Technical Information (TECH INFO)

Self-cxplanatoty.

1. Concise, chronological description of factc and circumstances.

2. Mishaps OR, provide narrctive (uaa AFI 91-104 for guidance). If local mishap is parl of Air Force mishapa, and no reporf aubmitfed, provide concise report.

NOTE Mishap-related report shall not directly quote conclusions and recommendations of mishap Investigator. All Information shall be scnitized through official safety messages.

1. Concise, chmnologid description of difficulty and cause.

z Satisfy requirements of 22c above.

3. Inltlal acceptance inspection of alrcraff engine, engine modula reporl teat and consecutively number detcctc under headings Critical Detects, Major Defccfs, Minor defccta will not respond to other agancies. (Use TO- 0&20-1 and chapter 1 of TO-00-350-54 for reference).

4. Software/fimnware DRs, need specific references, specifications and documentation. Indicate process type, idantify ayatems in axecution and Computer Software Configuration Item (CSCI) vercidn. All medial required to rameate problem and other information that confirm the failure cause.

Stcte ft condition is repeatable, and other, partinent Information.

5. If oil wetted include last five Jet Oil Analysis Program (JOAP) rssultc.

Decctfbe action Ccken to remedy, praclude cafafy hczard, and to prsvent racun’cnce. Recommend corrective action which will assist in the resolution of the identified problem.

1. For mishap, related reports, refer to AFI 91-104 ?or guidance.

2. Initial acceptance inspection airwaff, aircrcft engines, or engine model raport consecutively number action Ccken or rar.ommendation with defect racofdcd In 22b above. State if exhibits available.

TO figure and index of item.

Page 4 of 5 Pages

Block 10. Preparation Instructions (Continued)

TABLE I. Deficiency RePOrt Content (Continusd)

32e. Technical Data Deficiency (TECH DAT DEF)

22f. Supfmrf Data Mailed

22g.

221.

24.

System Program Director or Item Manager ALC Code (SM OR ALC CODE)

Standard Reporting Designator (SRD)

Command Code (CMD COOE)

Other pertinent Data

3X. Cognizant official (COGN OFF)

221. Certifying Official (CERT OFF)

NOTE For mishap DR. includes technical information as a subparagraph;

use AFI 91-104 for guidance.

lf mchnical data contributed to deficiency, use Air Fome Technical Order (AHO) Form 32, or Air Force Form 847 for guidance on reporffng information; also use publication control numbers, and TO references.

A list of suppon data such is photos, fags, iabels, etc. along with pertinent DR and mishap control numbers are includsd, If mailed under separate cover.

Rstersnce TO 00-35D-54 appendix F for guidance.

SRD using Rehabilitating Maintainability Information System (REMIS) SRD tale description.

Refersnce TO-00-35 D-54, appendix B for guidance.

Number 1 and 2, are used on all ORS, Number 3 for photogmphlc supplies only, if exhibit is AF Critical [tern or Mission Incapable Part (MICAAP), so indicate.

1. DR exhibit holding activity address and Dsfense Switchbowd Network (DSN), commercial, fax numbers, and Information Central (INFOCEN) user name of holding activity.

Z Pertinent Data (PERT DATA): When applicable, the opinion of initiator as to what the condition was attributed, including secondsfy damage, and possible futurs failures. State ft a sampling plan wee ussd, and item is part of a TCTO list. Software DRs, identity fecility end pmcassor.

3. Photographic Suppiies (PHOTO SUP) Included shali bs:

(a.) Processing clefs such as manufacturer, chemical, processor or equipment used, and speed during processing.

(L.) Chemical used: indicate data stamp: lot numbsr, manufacturer, etc.

(c.) Pertinent Information regarding the film end pspar Including environmental conditions.

0. Air crew flying datw Lfss AFI 91-104 for guidance for mishap DR.

Individuals end all communication information necesssry to address ell queries.

Individual within the originating actwity with primary responsibility.

Page 5 of 5 Pages

CONTRACT DATA REQUIREMENTS LIST Form Approved CMB No. 0704-0188

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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 222202-2302, 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 completed form to the Government Issuing Contracting Officer for the Contract. PR No. listed in Block E.

A. Contract Line Item No.

B. Exhibit A

C. Category

D. System/Item.

F100-PW-229 Augmentor Fuel Control and Pump E. Contract/PR NO.

FD2030-19-30173

F. Contractor

1. Data Item No.

A006

2. Title of Data Item:

Status Report for Contractor Receipt/Shipment of FMS R/R

3. Subtitle:

4. Authority (Data Acquisition Document No.)

DI-MISC-80915

5. Contract Reference

6. Requiring Office

AFLCMC/LPSIB

7. DD 250 Req N/A

1. Dist Statement Required N/A

10. Frequency Monthly

12. Date of First Submission See Block 16

14. Distribution

8. APP Code

11. As of Date See Block 16

13. Date of Subsequent Submission See Block 16

a. Addressee b. Copies D r a f t

Final

Reg Repro

16. REMARKS

BLOCK 4: DID IS TAILORED AS FOLLOWS:

THIS CDRL WILL SERVER FOR BASIC YEAR AND ALL OPTION YEARS

THE CONTRACTOR SHALL PREPARE AND FURNISH A MONTHLY CUMULATIVE

STATUS REPORT FOR ALL ITEMS THAT HAVE BEEN RECEIVED FOR REPAIR. THE

REPORT SHALL BE PREPARED AS OF THE LAST WORKING DAY OF EACH MONTH

AND FORWARDED BY E-MAIL OR FAXED NO LATER THAN THE 5TH WORKING DAY

OF THE FOLLOWING MONTH. THE INITIAL REPORT WILL BE PREPARED FOR THE

MONTH DURING WHICH THE CONTRACT ASSETS ARE RECEIVED. REPORTS WILL

CONTINUE TO BE FORWARDED UNTIL ALL END ITEMS ARE REPAIRED. THE LAST

REPORT WILL BE ANNOTATED “FINAL REPORT”. NEGATIVE REPORTS ARE

REQUIRED.

CONTRACTOR’S FORMAT IS ACCEPTABLE.

NOTE: THIS REPORT SHOULD REFLECT THE APPLICABLE COUNTRY, ITEM PART

NUMBER, NATIONAL STOCK NUMBER, SERIAL NUMBER, NOMENCLATURE, DATE

RECEIVED, DOCUMENT NUMBER, DATE INPUT INTO WORK, EXHIBIT LINE ITEM

NUMBER, FORECAST COMPLETION DATE AND SHIP DATE OF SERVICEABLE ASSET.

REPORT IS TO BE FURNISHED IN EITHER NATIONAL STOCK NUMBER OR PART

NUMBER SEQUENCE. SCRAPPED ITEMS REQUIRE REASON FOR SCRAP AND T.O.

REFERENCE.

CALL FOR E-MAIL ADDRESS: 405-736-3944 (LPSIB).

AFLCMC/LPSIB 1

DCMA/ACO

15. TOTAL 2 1 1

G. PREPARED BY

Mi Nguyen/736-3944

H. DATE

I. APPROVED BY

Jennifer Brown/734-1532

J. DATE

DD Form 1423-1, JUN 90 Previous editions are obsolete Page 1 of 1 Pages

Status Report DID