DD1423_FATR_(A002)_-_17-33121.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

A002 Acceptance Test Report

DI-QCIC-81891/T

Blk 4:

Contractor notification to the ACO and PCO of the First Article Test (FAT) and location is due 45 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 FATR per contract schedule.

Blk 14:

The FATR shall be submitted in searchable Adobe PDF format and submitted by Email.

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C17/PSE/17G460580-501 FD2060-17-33121

Anthony Lemar Jones AFLCMC/WLE; DSN 472-1932 02-Sep-17

Cable Assy. Set - Fuel Quantity Computer, O-Level

AFLCMC/WLE (C-17 Engr)

SS

A D

One/R

See Blk 16

See Blk 16

N/A AFLCMC/WLE (C17 Eng)

235 Byron Street, Suite 19A

Robins AFB, GA 31098

E-copy

Searchable Adobe PDF

Email to:

Anthony.Jones.42@us.af.mil

Marcia.Roach@us.af.mil

Digital Data

1 1 1

ROACH.MARCIA.

C.1229969770

Digitally signed by ROACH.MARCIA.C.1229969770 Date: 2017.11.06 13:34:14 -05'00'

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

A

C17/PSE/17G460580-501 FD2060-17-33121

Intentionally Blank

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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