DD1423_FATR_(A002).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

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

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

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

7. DD 250 REQ

8. APP CODE

16. REMARKS

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE Draft

b. COPIES

Final

Reg Repro

15. TOTAL

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

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of Pages Adobe Professional 8.0

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

A

C17/PSE/17G

A002 Acceptance Test Report Puller Assembly - Test Report

DI-QCIC-81891 AFLCMC/WLE (C17 Engr)

DD

A D

One/R

See Blk 16

See Blk 16

N/A

235 Byron Street

AFLCMC/WLE (C17 Eng)

Suite 19A

1Digital Data

Marcia.Roach@us.af.mil

Hau.Nguyen@us.af.mil

Julian.Stevenson@us.af.mil

Email to:

11Searchable Adobe PDF

E-copy

Robins AFB, GA 31098

Hau Nguyen

AFLCMC/WLE; DSN 468-7318 2017-08-02

1 1 1

1 2

ROACH.MARCIA.C.1229969770

Digitally signed by ROACH.MARCIA.C.1229969770 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USAF, cn=ROACH.MARCIA.C.1229969770 Date: 2017.08.11 13:59:10 -04'00'

Blk 4:

Contractor notification to the ACO and PCO of the First Article Test (FAT) and location is due 30 days prior to the start of testing. The First Article Test Report (FATR) shall cover pre-production/First Article testing and shall document conformance to the Technical Data Package (TDP) requirements and traceability of test and/or measurement equipment calibrations to accepted standards. The FATR shall include text, tables, sketches, photos, etc. as applicable or required.

Tabulated data formats in the FATR shall conform to those approved in the FAT plan unless the format changes are coordinated through contracting by the technical authority. Photo documentation is required of all exposed permanent markings (ID plates, stenciling, cable banding, etc.) confirming conformance to the item TDP marking requirements. All text and/or numerical designations must be legible in photos (more than one photo may be required in some instances to document the adjacent texts). Traceability of calibration for all equipment and measurement tools is required. Copies of all calibration certifications and Bill of Materials (BOM) showing conformance of materials to applicable material standards shall be supplied as part of the FATR deliverables. MIL-HDBK-831 and the FATP may be used as a guide in preparing the FATR. See the attached document for information required to be on the cover page of the FATR.

The FATR will be certified by Government QAR and C-17 SPO Support Equipment Engineering (Ref MIL-HDBK-831, paragraph 4.1.4.2).

Blk 7:

The Government will accept the Receiving Report through WAWF upon delivery.

Blk 11/12:

The contractor shall submit the FATR per contract schedule.

Blk 14:

The FATR shall be submitted in searchable Adobe PDF format and submitted by Email and on a CD-ROM.

Reset

CONTRACT DATAREQUIREMENTSLIST

(1 Data Item)

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

TDP TM OTHER

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

16. REMARKS (Continued)

DD FORM 1423-1, FEB 2001 Page of Pages

INTENTIONALLY BLANK

2 2

A

C17/PSE/17G

INSTRUCTIONS FOR COMPLETING DD FORM 1423

(See DoD 5010.12-M for detailed instructions.)

FOR GOVERNMENT PERSONNEL

Item A. Self-explanatory.

Item B. Self-explanatory.

Item C. Mark (X) appropriate category: TDP - Technical Data Package;

TM - Technical Manual; Other - other category of data, such as "Provisioning,""Configuration Management," etc.

Item D. Enter name of system/item being acquired that data will support.

Item E. Self-explanatory (to be filled in after contract award).

Item F. Self-explanatory (to be filled in after contract award).

Item G. Signature of preparer of CDRL.

Item H. Date CDRL was prepared.

Item I. Signature of CDRL approval authority.

Item J. Date CDRL was approved.

Item 1. See DoD FAR Supplement Subpart 4.71 for proper numbering.

Item 2. Enter title as it appears on data acquisition document cited in Item 4.

Item 3. Enter subtitle of data item for further definition of data item (optionalentry).

Item 4. Enter Data Item Description (DID) number, military specification number, or military standard number listed in DoD 5010.12-L (AMSDL), or one-time DID number, that defines data content and format requirements.

Item 5. Enter reference to tasking in contract that generates requirement for the data item (e.g., Statement of Work paragraph number).

Item 6. Enter technical office responsible for ensuring adequacy of the data item.

Item 7. Specify requirement for inspection/acceptance of the data item by the Government.

Item 8. Specify requirement for approval of a draft before preparation of the final data item.

Item 9. For technical data, specify requirement for contractor to mark the appropriate distribution statement on the data (ref. DoDD 5230.24).

Item 10. Specify number of times data items are to be delivered.

Item 11. Specify as-of date of data item, when applicable.

Item 12. Specify when first submittal is required.

Item 13. Specify when subsequent submittals are required, when applicable.

Item 14. Enter addressees and number of draft/final copies to be delivered to each addressee. Explain reproducible copies in Item 16.

Item 15. Enter total number of draft/final copies to be delivered.

Item 16. Use for additional/clarifying information for Items 1 through 15.

Examples are: Tailoring of documents cited in Item 4; Clarification of submittal dates in Items 12 and 13; Explanation of reproducible copies in Item 14.; Desired medium for delivery of the data item.

FOR THE CONTRACTOR

Item 17. Specify appropriate price group from one of the following groups of effort in developing estimated prices for each data item listed on the DD Form 1423.

a. Group I. Definition - Data which is not otherwise essential to the contractor's performance of the primary contracted effort (production, development, testing, and administration) but which is required by DD Form 1423.

Estimated Price - Costs to be included under Group I are those applicable to preparing and assembling the data item in conformance with Government requirements, and the administration and other expenses related to reproducing and delivering such data items to the Government.

b. Group II. Definition - Data which is essential to the performance of the primary contracted effort but the contractor is required to perform additional work to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, or quality of the data item.

Estimated Price - Costs to be included under Group II are those incurred over and above the cost of the essential data item without conforming to Government requirements, and the administrative and other expenses related to reproducing and delivering such data item to the Government.

c. Group III. Definition - Data which the contractor must develop for his internal use in performance of the primary contracted effort and does not require any substantial change to conform to Government requirements with regard to depth of content, format, frequency of submittal, preparation, control, and quality of the data item.

Estimated Price - Costs to be included under Group III are the administrative and other expenses related to reproducing and delivering such data item to the Government.

d. Group IV. Definition - Data which is developed by the contractor as part of his normal operating procedures and his effort in supplying these data to the Government is minimal.

Estimated Price - Group IV items should normally be shown on the DD Form 1423 at no cost.

Item 18. For each data item, enter an amount equal to that portion of the total price which is estimated to be attributable to the production or development for the Government of that item of data.

These estimated data prices shall be developed only from those costs which will be incurred as a direct result of the requirement to supply the data, over and above those costs which would otherwise be incurred in performance of the contract if no data were required. The estimated data prices shall not include any amount for rights in data. The Government's right to use the data shall be governed by the pertinent provisions of the contract.

DD FORM 1423-1 (BACK), FEB 2001

Company Logo Company Name

Address Phone and/or email (all optional)

Cage Code

Item Name (taken from Boeing drawing)

First Article Test Report Submitted For

NSN: XXXX-XX-XXX-XXXX

Contract No.: XXXXXX-XX-X-XXXX Part No.: 17GXXXXXX-XXX, Rev X

Serial No: XXXX-XXXX (supplied by PCO) CDRL Item No.: A002

Submitted On: MM/DD/YYYY Test Quantity: XX

Contractor Document #.: XXXXXXXX Rev.: XXX

Submitted To

AFMC AFLCMC/WLE

Attn: (C-17 ENGR) 235 Byron St, Suite 19A Robins AFB, GA 31098

Prepared by: Full Name Checked by: Full Name (Contractor QA) Title: XXXXXXXXX Title: XXXXXXXXX

Signed: __________________ Signed: __________________

Date: MM/DD/YYYY Date: MM/DD/YYYY