I. 22_CDRLs Signed.pdf

0030, 1030, 2030, 3030, DD FORM 1423-1, AUG 96 (EG) Page 1 of Pages Designed using Perform Pro, WHS/DIOR, Aug 96

PREVIOUS EDITION MAY BE USED.

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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

A

C. CATEGORY:

TDP TM OTHER SEE BLOCK 16

D. SYSTEM/ITEM

CABLE FAB &

TECH SERVICES

E. CONTRACT/PR NO.

1300867735

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Quality Assurance Program Plan (QAPP)

3. SUBTITLE

VENDOR QUALIFICATION REPORT

4. AUTHORITY (Data Acquisition Document No.)

DI-QCIC-81794A

5. CONTRACT REFERENCE

SOW PARA. 4.0

6. REQUIRING OFFICE

NUWCDIVNPT CODE 8541

7. DD 250 REQ

LT

9. DIST STATEMENT

REQUIRED

D

SEE BLK 16

10. FREQUENCY

OTIME

12. DATE OF FIRST SUBMISSION

30DAC

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

N/A

Draft

Final

Reg Repro

16. REMARKS

Block C: Category Other – QCIC

Block 16: See Block 16 Addendum

COR 0 1 0

15. TOTAL 0 1 0

G. PREPARED BY

Brian Wohler

H. DATE

7/30/2020

I. APPROVED BY

J. DATE

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

2030, 3030, DD FORM 1423-1, AUG 96 (EG) Page 2 of 4 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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

A

C. CATEGORY:

TDP TM OTHER SEE BLOCK 16

D. SYSTEM/ITEM

CABLE FAB &

TECH SERVICES

E. CONTRACT/PR NO.

1300867735

F. CONTRACTOR

A002

Quality Conformance Test Reports

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

SOW PARA 4.1, 4.2

6. REQUIRING OFFICE

NUWCDIVNPT CODE 8541

7. DD 250 REQ

LT

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

Block C: Category Other - NDTI

BLK12: Included with each contract delivery

Brian Wohler

H. DATE

2030, 3030, DD FORM 1423-1, AUG 96 (EG) Page 3 of 4 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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

A

C. CATEGORY:

TDP TM OTHER SEE BLOCK 16

D. SYSTEM/ITEM

CABLE FAB &

TECH SERVICES

E. CONTRACT/PR NO.

1300867735

F. CONTRACTOR

A003

Repairable Item Inspection Report

DI-PSSS-80386A

SOW PARA 4.2

LT

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

Block C: Category Other - PSSS

BLK12: Due 14 days after analysis completion

Brian Wohler

H. DATE

2030, 3030, DD FORM 1423-1, AUG 96 (EG) Page 4 of 4 Pages

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 Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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

A

C. CATEGORY:

TDP TM OTHER SEE BLOCK 16

D. SYSTEM/ITEM

CABLE FAB &

TECH SERVICES

E. CONTRACT/PR NO.

1300867735

F. CONTRACTOR

A004

Technical Report

DI-MISC-80508B

SOW PARA 4.3

LT

10. FREQUENCY

ASREQ

12. DATE OF FIRST SUBMISSION

8. APP CODE

N/A

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

Block C: Category Other - MISC

Brian Wohler

H. DATE

v1.0_NOVEMBER2007

DD FORM 1423

N0025321D0002 BLOCK

16 ADDENDUM

BLOCK 9: The following information is specifically included in amplification of the Block 9

Distribution Statement selected:

Distribution Statement paragraphs are in addition to CLASSIFICATION markings of the data.

CDRLs: A001-A004

Distribution Statement D: Distribution authorized to Department of Defense (DoD) and DoD

Contractors only; Critical Technology as of March 2019. Other requests for this document shall be referred to Program Executive Office Submarines, Program Manager, Undersea Defensive

Warfare Systems, PMS415, Washington Navy Yard, DC.

The following "EXPORT CONTROL WARNING NOTICE" must be used in conjunction with

DISTRIBUTION STATEMENTS identified in all CDRL Items.

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, U.S.C., App. 2401 et seq. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of Dod Directive 5230.25.

MEDIA FORMAT: All electronic media to be in Microsoft Office (MS) 2010 format or newer.

ADDRESSEES: iPDM will be used to disseminate information, if not available, encrypted email will suffice.