C002.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:

0004AG, 0012AG C TDP TM OTHER SAFT

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

Ground Power Modernization FD2060-21-31511

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

GROUP

C002 System Safety Hazard Analysis Report N/A

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

TOTAL PRICE

DI-SAFT-80101C SOW para 3.4.1.1, 3.8.2 AFLCMC/WNZ-SEV NSP

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

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

LT See BLK 16 30 calendar days prior to

PDR

b. COPIES

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

SUBMISSION

a. ADDRESSEE DRAFT FINAL

N/A N/A See BLK 16 Reg Repro

16. REMARKS AFLCMC/ WNZ-

SEV 0 1 0

BLK 7: The PCO will issue approval outside iRAPT.

BLK 9: DISTRIBUTION STATEMENT B: Distribution authorized to U.S.

Government agencies only for Administrative or Operational Use; 20 May 2021.

Other requests shall be referred to AFLCMC/WNZ.

BLKs 10, 12 and 13: Updates shall be delivered 30 calendar days prior to CDR and 30 calendar days prior to phase one and phase two TRRs. The Government will have 15 business days to review the updates and approve or disapprove and provide comments to the contractor. The contractor shall have 5 calendar days after receipt of the Government comments to resubmit the report. The final update shall be delivered with each end item’s final first article test report. When an ECP is approved, the contractor shall deliver an updated report.

BLK 14: Documents shall be provided via electronic media utilizing standard Microsoft Office applications and submitted via email to the points of contact (POC) actual name, phone, and email provided by the Procuring activity at the time of contract award:

Support Equipment & Vehicles Division

ATTN: AFLCMC/WNZ-SEV

235 Byron Street, Suite 19A Robins AFB GA 31098-1813

Notification of submission shall be provided to the PCO via e-mail.

Support Equipment & Vehicles Division

ATTN: AFLCMC/WNK

235 Byron Street, Suite 19A Robins AFB GA 31098-1813

AFLCMC/WNK 0 1 0

15. Total 0 2 0

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

Relious Grant 07/26/2021

DD FORM 1423-1, Feb 2001 Previous editions are obsolete Page of Pages

9/01/2021

30 calendar days prior to PDR