USAFE_0056_CDRL_Updates_June_2016.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 11 O 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 Defence, Washington Headquarters Services, Directorate for information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704·0188), Washington, DC 20503. Please 00 NOT RETURN your form to either of these addresses, Send completed form to the GovermenHssuing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A I C. CATEGORY

TOP TM OTHER MGMT

D. SYSTEM I ITEM I F. CONTRACTOR

ENGINEERING SERVICE

WWM-15-038

E. CONTRACT PR NO.

FA8232-16-R-3030

1. DATA ITEM N0.12 . TITLE OF DATA ITEM

AOOl !In tegrated Master Schedule (IMS) r SUBTITLE

4. AUTHORITY (Data Acquisition Document N o . ) 5. CONTRACT REFERENCE PWS Paragraph: 1.5. 3

DI-MGMT-81650/T

7. DD 250 REO 9. DIST STATEMENT 10 FREQUENCY

LT

REQUIRED BLK16

12. DATE OF FIRST SUBMISSION

BLK 16

6. REQUIRING OFFICE

AFLCMC/WWMWD

14. DISTRIBUTION

c b. COPIES

8. APP CODE 11. AS OF DA TE

BLK 16

16. REMARKS

13. DATE OF SUBSEQUENT

SUBMISSION

BLK 16

1. Blocks: 10, 11, 12, 13: First Submission shall be delivered no later than 45 calendar days after contract award. Subsequent submissions shall be delivered every 3 months thereafter, through the life of the contract.

2. Block 9:

a. Distribution Statement B: Distribution authorized to U.S. Government Agencies only for Administrative or

Operational use. Date of Determination April 2015.

Other requests for this document shall be referred to

AFLCMC/WWMWD

b. Distribution Statement D: Distribution authorized to the Department of Defense and U.S. DoD contractors only, for Administrative or Operational Use. Date of

Determinaton: December 2012. Other request for this document shall be referred to AFLCMC/WWMWD.

c. Distribution D shall be used on all CDRL deliveries except for any contract data deliverable doucment that warrants data to be delivered with less than unlimited rights, "restricted", in accordance with DFARS 252. 227-7013 and will be delivered with an updated distribuiton code of "B". If the CDRL distribution code is changed, specific paragraphs or statements in the document which necessitate the restricted distribution will be underlined or highlighted so they may be redacted. Should secondary distribution be required by the Government then such

"restriction" must cite the appropriate assertion identified in the attachment to the contract, in accordance with DFARS 252.227-7013(e) (2)

Export Control Warning: All technical documents that

H. DATE I. APPROVED BY

a. ADDRESSEE Final Draft Reg Repro

AFLCMC/WWMWD 1

6061 GUM LN

HILL AFB UT

84056

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J. DATE

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05 Oct 15

DD Form 1423-1, JUN 90 0 Computer Generated Previous editions are obSOlete Page _1_ of� Pages

17. PRICE GROUP

1 8. ESTIMATED

TOTAL PRICE

1091129856C Typewritten Text

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) OMB No. 0704-0188

Publi<: reporting burden for this collection of information os estimated to average 110 hours per response, including the time for reviewing instructlons, searohing existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection ol information. Send comments regarding this burden estimate or any Other aspect ol th1s collection ol information, onciuding suggestions for reducing this burden, to: Department of Defence, Washington Headquarters Services, Directorate for information Operations a nd Reports . . 1215 Jefferson Davis Highway, Suite 1204, Mongton VA 22202·4302, and to the Offoce of Management and Budge1, Paperwotl< Reduction Project (0704-0168), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses, Send completed form to the GovermenHssuing Contracling Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT I c. CATEGORY

0056 A

D. SYSTEM I ITEM

ENGINEERING SERVICE

WWM-15-038

1 DATA ITEM NO. 2. TITLE OF DATA ITEM

AOOl Integrated Master

4. AUTHORITY (Data Acquisition Document No.)

DI-MGMT-81650/T

TDP

E. CONTRACT I PR NO.

FA8232-16-R-3030

Schedule (IMS)

5. CONTRACT REFERENCE

PWS Paragraph: 1. 5. 3

TM OTHER MGMT

F. CONTRACTOR

13. SUBTITLE

6. REQUIRING OFFICE

AFLCMC/WWMWD

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

REQUIRED 14. DISTRIBUTION

L T BLK16 BLK 16

c b. COPIES

8. APP CODE 11. AS OF DATE 13. DA TE OF SUBSEQUENT

SUBMISSION a. ADDRESSEE

BLK 16 BLK 16

16. REMARKS

are determined to contain export-controlled technical data shall be marked "WARNING - This document contains technical data whose export is restricted by the Arms Export Conrol Act (Title 22, u.s.c.' Sec 2751, et seq.

Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." When it is technically infeasible to use the entire statement, an abbreviated marking may be used, and a copy of the full statement added to the "Notice To Accompany

Release of Export-Controlled Data" required by DoD

Directive 5230.25 (reference (c)).

Handling and Destroying Unclassified/Limited

Distribution Documents. Unclassified/Limited

Distribution documents shall be handled using the same standard as "For Official use Only (FOUO)" material, and will be destroyed by any method that will prevent disclosure of contents or reconstruction of the document. When local circumstances or experience indicates that this destruction method is not suffciently protective of unclassified limited information, local authorities may prescribe other methods but must give due consideration to the additional expense balanced against the degree of sensitivity.

FOB DESTINATION

15. TOTAL -··>

G. PREPARED BY H.DATE I. APPROVED BY

D TA GE

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05 Oct 15 LT RHETT W� ----

PROGRAM MANA R

Final Draft Reg Repro

I

J. DATE

05 Oct 15

DD Form 1423·1, JUN 90 omputer Genera ted Previous ed�ion s are o bsolete Page� of --1_ Pages

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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 soun::es, gathering and maintaining the data needed, and completing and reviewi"il the c041ec:tion of information. Send comments regarding this burden estimate or any other aspect ol this collection of inlormation, Including suggestions for reducing this burden, to: Department of Defence, Washington Headquarters Services, Directorate for information Operations and Reports, 1215 Jellerson Davis Highway, Suite 1204, M ington VA 22202-4302, and to the Oflioe ol Management and Budget, Paperwor1< Reduction Project (0704·0188), Washington, DC 20503. Please 00 NOT RETURN your lorm to either ol these addresses, Send completed form to the GovermenHssuing Contracting Oflicer tor the ContracVPR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT I c. CATEGORY

0056 A TDP TM OTHER MGMT

D. SYSTEM/ ITEM I F. CONTRACTOR

ENGINEERING SERVICE

WWM-15-038

E. CONTRACT PR NO.

FA8232-16-R-3030

17. PRICE GROUP

1. DATA ITEM NOr- TITLE OF DATA ITEM 3. SUBTITLE

A002 Status Report onthly and Final Progress Report

4. AUTHORITY (Data Acquisition Documenl No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED PWS Paragraph: 1. 5. 4 TOTAL PRICE DI-MGMT-80368/T AFLCMC/WWMWD

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

REQU IRED 14. DISTRIBUTION

LT BLK16 BLK 16

b. COPIES

8. APPvuDE c 11. AS OF DATE 13. DA TE OF SUBSEQUENT SUBMISSION a. ADDRESSEE Final

Draft

BLK BLK 16 Reg Repro

16. REMARKS AFLCMC/WWMWD 1

1. Block 4: Contactor's format is acceptable. 6061 GUM LN

HILL AFB UT

2. Block 9: Distribution Statement C: Distribution 84056 authorized to U.S. Government Agencies and their contractors (Critical Technology) . Date of

Determination is April 2015. Other requests for this document shall be referred to AFLCMC/WWMWD. F-16

Depot Program Office.

Export Control Warning: All technical documents that are determined to contain export-controlled technical data shall be marked "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. as amended, Title 50, u.s.c. I App. 2401 et seq.

Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DoD Directive 5230.25." When it is technically infeasible to use the entire statement, an abbreviated marking may be used, and a copy of the full statement added to the "Notice To Accompany

Release of Export-Controlled Data" required by DoD

Directive 5230.25 (reference ( c) ) .

Handling and Destroying Unclassified/Limited

Distribution Documents. Unclassified/Limited

Distribution documents shall be handled using the same standard as "For Official Use Only (FOUO) " material, and will be destroyed by any method that will prevent disclosure of contents or reconstruction of the document. When local circumstances or experience indicates that this destruction method is not sufficiently protective of unclassified limited information, local authorties may prescribe other methods but must give due consideration to the

15. TOT AL --·-··> 0 1 0

G. �Ell AREDBY H.DATE I. APPROVED BY

/'] J.DATE

D$A �TANLE;JJt;� 05 Oct 15 LT """' - 05 Oct 15 �j '/ �ER . . O J !fT"'AG'ER J� �· bo Form 1423-1, JUNO Computer Generated Previous editions are obsolete Page _1_ of� Pages

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 intormation. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Department of Defence. Washington Headquarters Services, Directorate for information Operations and Reports, 1215 Jefferson Davis Highway, Suhe 1204. Mington VA 22202·4302, and to the Office of Management and Budget, Paperworl< Reduction Project (0704·0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses, Send completed form to the Gove<ment-fssuing Contracting Otticer for the ContracVPR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT I c. CATEGORY

0056 A TOP TM OTHER MGMT

D. SYSTEM / ITEM I F. CONTRACTOR

ENGINEERING SERVICE

WWM-15-038

E. CONTRACT PR NO.

FA8232-16-R-3030

1. DATA ITEM NO 2. TITLE OF DATA ITEM 3. SUBTITLE

A002 Status Report onthly and Final Progress Report

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-80368/T

PWS Paragraph: l. 5. 4

AFLCMC/WWMWD

7. DD250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

LT

REQUIRED

BLK16 BLK 16

14. DISTRIBUTION

c b. COPIES 8. APP CODE 11. AS OF DA TE 13. DA TE OF SUBSEQUENT

SUBMISSION

BLK 16 BLK 16

16 REMARKS

additional expense balanced against the degree of sensitivity.

3. Blocks: 10, 11, 12, 13: First report shall be submitted not later than 45 calendar days after first aircraft induction and the Form 290 has been signed.

Subsequent submissions shall be submitted every two

(2) weeks thereafter through the life of the contract.

H.DATE I. APPROVED BY

a.ADDRESSEE

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17. PRICE GROUP

18. ESTI MATED

TOT Al PRICE

(1 Data Item) OMB No. 07-04-0188

Public reporting burden for this collection of information Is estimated to average 110 hours per response. including the t ime 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 Defence, Washington Headquarters Services.

Directorate for information Operations and RepMs, 1215 Jellerson Davis Highway, Suite 1204, Artington VA 22202·4302, and to the Office of Management end 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 GovermenH$$uing Contracting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT I c. CATEGORY

0056 A TOP TM OTHER ADMN

0. SYSTEM/ ITEM F. CONTRACTOR

ENGINEERING SERVICE

WWM-15-038

E. CONTRACT I PR NO.

FA8232-16-R-3030

1. DATA ITEM NO. 2. TITLE OF DATA ITEM

A003 Conference Agenda 13.

SUBTITLE

4. AUTHORITY (Data Acquisition Document No. ) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-ADMN-81249A

PWS Paragraphs: 1.5.6.4

AFLCMC/WWMWD

7. DD250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

REQUIRED 14. DISTRIBUTION

LT BLK16 BLK 16

c b. COPIES

8. APP CODE 11. AS OF DATE 13. DA TE OF SUBSEQUENT

SUBMISSION a. ADDRESSEE Final Draft

BLK 16 BLK 16 Reg Repro

16. REMARKS

1. Block 9: DISTRBUTION STATEMENT C: Distribution authorized to the U.S. Government and their contractors only (Administrative and Operational)

(April 2015). Other requests shall be referred to

AFLCMC/WWMWD.

EXPORT CONTROL WARNING: All technical documents that are determined to contain export-controlled technical data, shall be marked with the following warning:

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. l or Executive

Order 12470. Violations of these export laws are subject to severe criminal penalties.

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

2. Blocks 10, 11, 12, 13: Contractor shall submit an agenda not later than 7 calendar days prior to every

Program Management Review.

H. DATE I. APPROVED BY )illiLEY 05 Oct 15

AFLCMC/WWMWD

6061 GUM LN

HILL AFB UT

84056

15. TOTAL····->

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J. DATE

05 Oct 15

DD Form 1423-1, JUN 90 cf' Computer Generated Previous edrtions are obsolete Page _1_ of __

1 Pages

17. PRICE GROUP

1 8 . ESTIMATED

(1 Data Item) OMB No. 0704·0188

Public reporting burden lor this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions. seatciling existing data sources. gathering and maintaining the data needed, and completing and reviewing the collect ion of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burclen, to: Oeparunent of Oefence. Washington HeaclquMers Services, Directorate for information Operations and Reports. 1215 Jefferson Davis Highway, Suite 1204, Mington VA 22202·4302, and to the Office of Management and Budget, Paperwor1< Reduction Project (0704·0188), WaShington. DC 20503. Please DO NOT RETURN your form to either of these addresses, Send completed form to the Goverment-lssuing Contract ing Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT I c. CATEGORY

0056 A TOP TM OTHER ADMN

0. SYSTEM / ITEM I F. CONTRACTOR

ENGINEERING SERVICE

WWM-15-038

E. CONTRACT PR NO.

FA8232-16-R-3030

17. PRICE GROUP

1 DATA ITEM NO 2. TITLE OF DATA ITEM

A004 Conference Minutes

13. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED PWS Paragraphs: 1. 5.6. 6 TOTAL PRICE DI-ADMN-81250A AFLCMC/WWMWD

7. DD 250 REO 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMIS SION

LT

REQUIRED

BLK16 BLK 16

14. DISTRIBUTION

b. COPIES 8. APP CODE c 11. AS OF DATE 13. DATE OF SUBSEQUENT SUB MISSION a. ADDRESSEE Fina l

Draft BLK 16 BLK 16 Reg Repro

16. REMARKS AFLCMC/WWMWD 1

1. Block 9: DISTRBUTION STATEMENT C: Distribution 6061 GUM LN authorized to the U.S. Government and their HILL AFB UT contractors only. (Administrative and Operational) 84056 (April 2015). Other requests shall be referred to

AFLCMC/WWMWD.

EXPORT CONTROL WARNING: All technical documents that are determined to contain export-controlled technical data, shall be marked with the following warning:

WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (title 22, u.s.c. I Sec 2751 et seq. ) or Executive Order 12470. Violations of these export laws are subject to severe criminal penalties.

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

2. Blocks 10, 11, 12, 13: Minutes shall be sumitted not later thank 30 calendar days after every Program Review.

15. TOTAL----> 0 1 0 l�AREDBY H.DATE I. APPROVED BY J . DATE S TANLEY J, I � 05 Oct 15 LT RHETT WALK�

� 05 Oct 15 'kT�

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DD Form 1423-1, JUN� Computer Generated Previous e ditions are obsolete Page _1_ of __ 1 Pages

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 Defence. Washington Headquarters Services.

Directorate for information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302, and to the Office of Management and Budget, Paperworl< Reduction Project (0704-0188). Washington, DC 20503. Please 00 NOT RETURN your form to 911her of these addresses. Send completed form to the GovermenHssulng Contr;icting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT I C. CATEGORY

0056 A TOP TM OTHER SAFT

D. SYSTEM/ ITEM N F. CONTRACTOR

ENGINEERING SERVICE

WWM-15-038

E. CONTRACT I PR O.

FA8232-16-R-3030

1 DATA ITEM NO 2. TITLE OF DATA ITEM

A005 Accident/Incident Report Mishap Report

1:3 . SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) S. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-SAFT-81563 SOW Paragraph: 1.9.6.1 AFLCMC/WWMWD

7. OD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

LT

REQUIRED

ASREQ BLK 16

14. DISTRIBUTION

b. COPIES

8. APP CODE D 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION a. ADDRESSEE Fina l Draft A BLK 16 BLK 16 Reg Repro

16. REMARKS

1. Block 4: Contractor format is acceptable.

2. Block 8: The government will review and approve/disapprove within 5 working days after receipt of a Mishap Report.

3. Block 9: Distribution Statement D: Distribution authorized to the Department of Defense and U. S. DoD contractors only, for Administrative/Operational Use.

Date of determination is January 2015. Other requests for this data shall be referred to AFLCMC/WWMAP.

Export Control warning: All technical documents that are determined to contain technical data shall be marked with the following warning:

"WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, u.s.c.' Sec 2751, et q. ) or the Export Administration Act of 1979, as amended, Title 50, u.s.c.' App 2401 et seq. Violations of these export laws are subject to severe criminal penalties.

Disseminate in accoradnce with provisions of DoD Directive 5230. 25."

When it is not technically feasible to use the entire statement, an abbrieviated marking may be used, and a copy of the full statement added to the "Notice To Accompany Release of Export Controlled Data" required by DoD Directive 5230.25 (reference (c) ) .

Handling and Destroying Unclassified/Limited Distribution documents:

Unclassified/Limited distribution documents shall be handled using the same standard as "For Official Use Only (FOUO) II material, disclosure of contents

H.OATE

lrANLEY

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05 Oct 15 or

I. APPROVED BY

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84056

15. TOTAL ... ->

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J. DATE

05 Oct 15

Computer Generated DD Form 1423-1, JUN 9 Pr8V!Ous editions are obsolete

Page _1_ of --1_ Pages

17. PRICE GROUP

18 . ESTIMATED

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 collectioo of Information. Send comments regarding this burden estimate or any other aspect of this collection of informatioo, including SUllQGSllons for reducing this burden, to: Department of Defence, Washington Headquarters Services, Directorate for information Operations and Reports. 1215 Jefferson Davis Highway, Suite 1204, Artington VA 22202-4302, and to the Office of Management and Budge1, Paperwork Reduction Project (0704·0188), Washlngtoo, DC 20503. Please DO NOT RETURN your form to ehher of these addresses, Send completed form to the Goverment-1ssu1ng Contracting Officer for the ContracVPR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT I c. CATEGORY

0056 A TOP TM OTHER SAFT

D. SYSTEM/ ITEM F. CONTRACTOR

ENGINEERING SERVICE

WWM-15-038

E. CONTRACT I PR NO.

FA8232-16-R-3030

1 DATA ITEM NO 2. TITLE OF DATA ITEM

A005 Accident/Incident Report Mishap Report

13. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-SAFT-81563 SOW Paragraph : 1.9.6.1 AFLCMC/WWMWD

7. DD250REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

REQUIRED 14. DISTRIBUTION

LT ASREQ BLK 16

D b. COPIES

8. APPCODE 1 1 . AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

A BLK 16 BLK 16

16. REMARKS

reconstruction of the document. When local circumstances or experience sufficiently protective or unclassified limited information, local authorities may prescribe other methods, but must give due consideration to the additional expense balanced against the degree of sensitivity.

3. Blocks 1 0 , 11, 12, 13: The contractor shall notify 75 ABW/SEG (801-777-3333) , or the Hill AFB

Command Post (801-777-3007) after normal hours, and the designated Government Representative (GR ) , i . e . , The ACO, PCO, or DCMA QAR (Quality Assurance

Representative) within one (1) hour of all mishaps or incidents at or exceeding $2000 (material & Labor) in damage to DoD property entrusted by this contract, even if the government is wholly or partially reimbursed. This notification requirement shall also include physiological mishaps/incidents. A written or email copy of the mishap/incident notification shall be sent wihtin three calendar days to the GR who will forward i t t o 7 5 ABW/SEG. For information not available at the time of initial notification, the contractor shall provide the remaining information no later than 20 calendar days after the mishap, unless extended by the ACO.

4: Block 14 :

a. Deliver one ( 1 ) Draft and one (1) Final Copy to each addressee indicated in block 1 4 of this DD Form 1423.

b. The submittal shall be delivered in a digital format compatible with Microsoft Office Professional 2003 (or newer ) . Final Delivery or submittal media of the specification shall be in editable MSWord 2003

H. DATE I. APPROVED BY G:.l1ARr=D BY

D A ST ['.NLEY h/ d D 'h '"'' /1 'A

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a. ADDRESSEE Final

Draft Reg Repro

15. TOT AL --··>

J. DATE

05 Oct 15

DD Form 1423·1� JUN 90

Computer Generated Previous editions are obsolete Page -1_ of� Pages

17. PRICE GROUP

Public reporting burdoo for this collection of information is estimated to average 1 t O hOIJrs per response. including the 1ime for reviewing instruciions, searching existing dala sources, gathering and malnlainlng 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, 10: Department of Defence, Washlnglon Headquarters Services.

Directorate for information Operations and Reports, 1215 Jefferson Davis Highway, Sulle 1204. Mington VA 22202-4302, and to the Office of M anagement and Budget, Paperwor1< Reduction Project (0704·0188), Wasllington. DC 20503. Please DO NOT RETURN yOIJr form to either of these addresses. Send completed lorm to the Govermoot-lssuing Contractln11 Officer for the ContracVPR No. llsled in Block E.

A CONTRACT LINE ITEM NO. B. EXHIBIT I C. CATEGORY

0056 A TOP TM OTHER SAFT

D. SYSTEM/ ITEM N F. CONTRACTOR

ENGINEERING SERVICE

WWM-15-038

E. CONTRACT I PR O.

FA8232-16-R-30 30

1. DATA ITEM NO. 2. TIT!-E OF DATA IT!=M 3. SUBTITLE

AOOS Accident/Incident Report ishap Report

4. AUTHORITY (Data Acquisition Document No.) 6. REQUIRING OFFICE

5 CONTRACT REFERENCE

SOW Paragraph ; 1 . 9 . 6 . 1DI-SAFT-81563 AFLCMC/WWMWD

7 DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION

LT REQUIRED

ASREQ BLK 16

14. DISTRIBUTION

D b. COPIES 8. APP1,;uDE 11. AS OF DATE 13. DA TE OF SUBSEQUENT SUBMISSION a. ADDRESSEE Final

A BLK 16

Draft

BLK 16 Reg Repro

16. REMARKS

files and Adobe PDF format via email for inclusion in

F-16 Weapon Systems Management Tool (WSMT ) database.

G:�ED BY

DE A ST llliLEY

J;;t;tM D ---� 7 ''-7J '- DD Form 1423-1, JUN 90 {/'

H. DATE

05 Oct

Computer Generated

15. TOT AL -····>

I. APPROVED BY J. DATE

L T R HETT "'"TJl"R"D 05 Oct 15 ��

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1 7. PRICE GROUP