Blk 3 MFD CDRL A003_Qualification_Test_Reports Avnx final.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 the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

C. CATEGORY:

TDP _ _ TM _ _ OTHER __ __

D. SYSTEM/ITEM

Multi-Function Display

E. CONTRACT/PR NO.

F. CONTRACTOR

1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM

Qualification Test Reports

3. SUBTITLE

A/MH-6M Block 3.0

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW 3.2.1, 3.2.2 & 3.2.3

6. REQUIRING OFFICE

AMSAM-SPT

7. DD 250 REQ

LT

9. DIST

STATEMENT

B

SEE BLK 16

10. FREQUENCY

SEE BLK 16

12. DATE OF 1ST SUBMISSION

SEE BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

A

11. AS OF DATE

13. DATE OF SUBSEQUENT

SUBMISSION Draft

Final

Reg Repro

16. REMARKS

The government shall have unlimited rights to this document. Contractor format is acceptable.

BLK 8 – Upon submittal the Govt. shall have 45 days from receipt to comment on and/or approve the document. The Govt. shall have 15 days from the receipt of subsequent submittals to comment on and/or approve the document. Final copy should be submitted 20 days after receipt of comments, to include dispositions to each comment and change bars against document modifications.

BLK 9 – The following information shall be included on the deliverable: Distribution Statement B: Distribution authorized to U.S. Government agencies only to protect technical or operational data or information from automatic dissemination under the International Exchange Program or by other means. This protection covers publications required solely for official use or strictly for administrative or operational purposes. This statement may be applied to manuals, pamphlets, technical orders, technical reports, and other publications containing valuable technical or operational data. Determination made on date of final delivery. Other requests for this document shall be referred to the Technology Applications Program Office, 401 Lee Blvd, Fort Eustis, VA 23604

BLK 10 – As required to obtain approval.

BLK 12 – 30 days after test

BLK 14a – Letter only to AMSAM-SPK

BLK 14b – Electronic copies only. Documents requiring signatures shall have signature page scanned, or digital signature shall be applied.

AMSAM-SPK LT

R

AMSAM-SPT 1 1

15. TOTAL --------- 1 1

G. PREPARED BY

Michael L. Chen

H. DATE

11 February 2015

I. APPROVED BY J. DATE

DD Form 1423-1, JUN 90 (EG) Previous editions are obsolete Page _3_ of _6_ Pages

18. ESTIMATED

TOTAL PRICE

17. PRICE

GROUP