FATR.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

Form Approved 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 this burden estimate or any other aspect of this collection of 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 Contract/PR No. listed in Block E.

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

A TDP TM OTHER ___X_____

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

ICBM PR# FD202022000-00

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

A002 TEST/INSPECTION REPORT First Article Test Report

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

TOTAL PRICE

DI-NDTI-80809/T 414 SCMS/GUEA

7. DD 250 REQ 9.DIST STATEMENT

REQUIRED

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

LT ONE/R SEE BLK 16 b. COPIES

8. APP CODE C 11. AS OF DATE 13. DATE OF SUBSEQUENT SUBMISSION a.

ADDRESSEE Draft

Final

A SEE BLK 16 SEE BLK 16 Reg Repro

16. REMARKS: Changes to office symbols, when necessary, shall be made by the CO/ACO without revisions to the CDRL.

BLOCK 4: Contractor format acceptable.

Paragraph 10.2 of DI-NDTI-80809B clarified as follows:

a. All dimensions and tolerances specified on the manufacturing data shall be listed in one column, with the actual corresponding reading obtained from the inspection of the part listed in another column.

b. Material used in the manufacturing of the “First Article” shall be identified and certified along with a copy of material purchase requirements as conforming to applicable data requirements.

c. Material processing, including finish requirements (plating, heat treatment, welding, anodizing, painting, etc.) utilized in the manufacture of the “First Article” item shall be identified and certified as conforming to applicable requirements. A copy of the purchase order certifying the process accomplished at other than the contractor facility shall be included.

BLOCK 9: Data submittal shall be marked with the following on the cover page:

DISTRIBUTION STATEMENT D: "Distribution authorized to DOD and U.S. DOD contractors only for Intercontinental Ballistic Missiles (ICBM) administrative or operational use determined as of 11/23/2021. Other requests for this document shall be referred to 414 SCMS/GUEA, 6031 Gum Lane, Building 1227, Hill AFB, UT 84056.

WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751 et seq.) or the Export Administration Act of 1979, as amended, Title 50, USE, App. 2401 et seq. Violations of these export control laws is subject to severe criminal penalties. Dissemination of this document is controlled under DOD Directive 5230.25.

DESTRUCTION NOTICE: Destroy by any method that will prevent disclosure of content or reconstruction of the document.

BLOCK 11, 12, and 13: As defined in Contract. Within 15 days after FA testing.

ORG1

ORG 2

ORG 1: Mr. Flygare 414 SCMS/GUEA, 6031 Gum Lane, Bld. 1227, Hill AFB, UT 84056

ORG 2: Wayne Lofthouse wayne.lofthouse@us.af.mil

15. TOTAL 2

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

X Wayne C. Lofthouse, NH-03 Electronics Engineer

See digital signature X

Christian Flygare, GS-12 Logistic Management Specialist

See digital signature

DD Form 1423-1, FEB 2001 Page___1__of__1_ Page

LM 18-09

*SEE ATTACHED

NSP

0.00

LOFTHOUSE

.WAYNE.C.15

39868299

Digitally signed by

LOFTHOUSE.WAYNE.

C.1539868299 Date: 2021.11.23 14:36:08 -07'00'

FLYGARE.CH

RISTIAN.S.14

01705267

Digitally signed by

FLYGARE.CHRISTIAN.

S.1401705267 Date: 2021.11.23 14:46:46 -07'00'

First Article Test Report CLINs Box A: Contract Line Item Numbers:

CLIN for NSN

0001AA 6150‐01‐497‐4605

0002AA 6150‐01‐502‐9480

0003AA 6150‐01‐502‐9483

0004AA 6150‐01‐502‐9485

0005AA 6150‐01‐502‐9487

0006AA 6150‐01‐503‐0033

0007AA 6150‐01‐497‐5945

0008AA 6150‐01‐502‐9481

0009AA 6150‐01‐502‐9484

0010AA 6150‐01‐502‐9486

0011AA 6150‐01‐503‐0032

0012AA 6150‐01‐503‐0035

0013AA 6150‐01‐503‐0037

CUI

CUI