CDRL_A007.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved (1 Data Item) OMB 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 thus burden estimate or any other aspect of this collection o f 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 22202-4302, 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 C. CATEGORY:

TDP TM OTHER

D. SYSTEM ITEM E. CONTRACT/PR NO. F. CONTRACTOR

MHU-196A

NSN: 1740-01-621-1713

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE

GROUP

A007 Prototype Test/Inspection Report Test Report

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

DI-NDTI-80809B PWS para 4.2.2, 4.2.4 AFLCMC/WNZEA

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

SD 1 TIME BLK 16 b. COPIES

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

SUBMISSION

a. ADDRESSEE DRAFT FINAL

A N/A N/A Reg Repr o

16. REMARKS See BLK.16 0 3 0

"The test report shall document all testing performed, including results of any unsuccessful test attempts. Failure reports generated as a result of the Failure Reporting and Corrective Action System (FRACAS) process shall be included with the results of unsuccessful test attempts."

BLK 8: The government will have 30 days after the receipt of the test report for approval or disapproval. The contractor shall have 10 days after the receipt of the Government comments to resubmit the report.

BLK 9: DISTRIBUTION STATEMENT D - Distribution authorized to the Department of Defense and U.S. DoD contractors only (Administrative or Operational Use) (1 June 2002). Other requests for this document shall be referred to 406 SCMS/GUEE, Robins AFB, GA 31098. Questions concerning technical content shall be referred to AFLCMC/WNZEA.

BLK 12: Test report shall be submitted electronically in Microsoft Word format no later than 45 days after the completion of testing. The Government will have 30 days after the receipt of test report to review and provide comments. The contractor shall have 10 days after the receipt of the Government comments to resubmit the test report.

BLK 14: Documents shall be provided via electronic media utilizing standard Microsoft Office applications to:

AFLCMC/WNZEA: e.shoman@us.af.mil (ENG) AFLCMC/WNKABA: Donna.Pallini@robins.af.mil (PCO) AFLCMC/WNZBB: Jacquelyn.Booze@us.af.mil (PM)

15. Total 3

G. PREPARED BY H. DATE I. APPROVED BY J. DATE

T. Shoman 01/12/2015

DD FORM 1423-1, Feb 2001 Previous editions are obsolete Page of Pages mailto:e.shoman@us.af.mil mailto:Donna.Pallini@robins.af.mil mailto:Jacquelyn.Booze@us.af.mil

BLK 16