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CONTRACT DATA REQUIREMENTS LIST (CDRL)
(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 ___________X_____________ |
| D. SYSTEM/ITEM |
| E. CONTRACT/PR NO. |
| F. CONTRACTOR |
| HCU-6/E 463L PALLETS |
| FD2060-12-00211 |
| 1. DATA ITEM NO. |
| 2. TITLE OF DATA ITEM |
| 3. SUBTITLE |
17. PRICE GROUP
| A007 |
| MISHAP NOTIFICATION AND REPORTING |
| 4. AUTHORITY (Data Acquisition Document No.) |
| 5. CONTRACT REFERENCE |
| 6. REQUIRING OFFICE |
18. ESTIMATED
TOTAL PRICE
| DI-SAFT-81563 |
| SOW para 3.10.2 |
| 78 ABW/SE |
| 7. DD 250 REQ |
| 9. DIST STATEMENT |
| 10. FREQUENCY |
| 12. DATE OF FIRST SUBMISSION |
| 14. DISTRIBUTION |
| DD |
| REQUIRED |
| AS REQ |
| AS REQ |
| a. ADDRESSEE |
| b. COPIES |
| 8. APP CODE |
| B |
| 11. AS OF DATE |
| 13. DATE IF SUBSEQUENT SUBM. |
N/A
BLOCKS 4 AND 11: CONTRACTOR SHALL SUBMIT A REPORT ON ALL MISHAPS, DAMAGE TO DOD PROPERTY, AND EMPLOYEE INJURY, TO THE INSTALLATION SAFETY OFFICE TELEPHONICALLY WITHIN FOUR (4) HOURS AFTER INITIAL NOTIFICATION. WRITTEN REPORT SHALL BE SUBMITTED WITHIN THREE (3) CALENDAR DAYS OF MISHAP. ELECTRONIC SUBMISSIONS ARE ACCEPTABLE. INFORMATION THAT IS NOT AVAILABLE AT THE TIME OF THE INITIAL NOTIFICATION SHALL BE PROVIDED WITHIN 20 CALENDAR DAYS AFTER THE MISHAP.
BLOCK 7: WAWF ACCEPTOR: THE GOVERNMENT WILL ACCEPT THE RECEIVING REPORT THROUGH WAWF. CONTRACTOR SHALL SUBMIT RECEIVING REPORT UPON EACH SUBMISSION BLOCK 9: DISTRIBUTION AUTHORIZED TO US GOVERNMENT AGENCIES ONLY. OTHER REQUESTS FOR THIS DOCUMENT SHALL BE REFERRED TO 78 ABW/SE.
| G. PREPARED BY |
| H. DATE |
| I. APPROVED BY |
| J. DATE |
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 1 of 1 Pages
