prtCDRLdocx.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 NDTI

D. SYSTEM/ITEM

Egress Testing

E. CONTRACT/PR NO.

FD2020-20-50157

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW para 2.7

6. REQUIRING OFFICE

AFLCMC/EBHJ

7. DD 250 REQ

DD

9. DIST STATEMENT

REQUIRED

B

10. FREQUENCY

ANNLY

12. DATE OF FIRST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

O

13. DATE OF SUBSEQUENT

SUBMISSION

BLK 16

Draft

Final

Reg Repro

16. REMARKS

BLK 4: Contractor's format is acceptable. Follow preparation and content instructions per the Data Item Description.

BLK 7: The electronic receiving report shall be annotated with the Lot Number, National Stock Number and Nomenclature. Electronic receiving report required via internet Wide Area Work Flow (WAWF) at:

https://wawf.eb.mil. The electronic receiving report shall be used only for that data item; do not combine other data item submittals with this requirement.

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

Government agencies only (Administrative/Operational Use) (Date of Contract Award). Other requests for this document shall be referred to AFLCMC/EBHJ.

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec.

2751, et seq.) or the Export Administration Act of 1979 (Title 50, U.S.C, App. 2401 et seq.), as amended Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE--Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

BLK 10,12,13: Report shall be submitted annually and not later than 30 calendar days after start of the new fiscal year. The contractor shall notify Hill AFB engineering (AFLCMC/EBHJ) of any anomalies and suspected CAD/PAD performance issues within 3 working days.

BLK 14: Report shall be in Microsoft Office software or PDF format.

Submit via WAWF, using DoDAAC, FA8213.

FOB DESTINATION

EBH 20-029-002

Terry McCurdy/AFLCMC/EBHTC/586-0535

WAWF 0 1 0

DoDAAC, FA8213

15. TOTAL 0 1 0

G. PREPARED BY

mccurdy.terry.d.1075978215

H. DATE

2020/01/29

I. APPROVED BY

hargrove.eric.v.1167016843

J. DATE

2020/01/30

18. ESTIMATED

TOTAL PRICE

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

17. PRICE GROUP