MAC PCB CDRL.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, Executive Services and Communications 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:

A

TDP TM

OTHER MISC

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

Printed Circuit Board N6893620R0096

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

A001 Certificate of Compliance

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

DI-MISC-81356A

SOW Para. 3.3.1.1, 3.8.4.1, 3.8.4.2 NAWCWD Code D55J100 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

LT F ASREQ SEE BLK 16

b. COPIES

8. APP CODE SEE BLK 16 11. AS OF DATE 13. DATE OF SUBSEQUENT SUBMISSION a. ADDRESSEE Final

N/A N/A SEE BLK 16 Draft Reg. Repro

16. Remarks: Code D55J100 0 1 0

Block 4: Contractor format is acceptable as long as DID is used for guidance.

Distribution Statement F: Further dissemination only as directed by Naval Air Warfare Center, Weapons Division, Code D55J100, 1 Administration Circle, China Lake, CA 93555-6100, 19 March 2020 or higher DOD authority.

Warning Statement: This document contains technical data whose export is restricted by the Arms 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.

Destruction Notice: Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

Blocks 10, 12 & 13: Submit certificate with each hardware delivery.

Block 14: Submit in an electronic format agreed upon by both Government and Contractor prior to 1st submittal.

See Contract Clause 5252.247-9505, Technical data and Information for distribution address.

Code D220000 0 LTR ONLY

15. TOTAL 0 1 0

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

Naval Air Warfare Center Weapons Division China Lake, CA 93555-6100

03/19/2020

DRRB Chairperson

03/31/2020

DD FORM 1423-1, FEB 2001 PREVIOUS EDITONS MAY BE USED

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, Executive Services and Communications 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.

Printed Circuit Board N6893620R0096

A002 Technical Report – Study/Services

Bill of Materials (BOM)

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

DI-MISC-80508B

SOW Para. 3.6 NAWCWD Code D55J100 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

LT F ASREQ 30 DAC

b. COPIES

Block 4: Contractor format is acceptable as long as DID is used for guidance.

Distribution Statement F: Further dissemination only as directed by Naval Air Warfare Center, Weapons Division, Code D55J100, 1 Administration Circle, China Lake, CA 93555-6100, 19 March 2020 or higher DOD authority.

Warning Statement: This document contains technical data whose export is restricted by the Arms 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.

Destruction Notice: Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

Blocks 10, 12 & 13: Submit BOM with each hardware delivery.

Block 14: Submit in an electronic format agreed upon by both Government and Contractor prior to 1st submittal.

See Contract Clause 5252.247-9505, Technical data and Information for

15. TOTAL 0 1 0

Naval Air Warfare Center

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, Executive Services and Communications 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.

Printed Circuit Board N6893620R0096

A003 Technical Report – Study/Services

Final Test Inspection Report

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

SOW Para. 3.8.4.3 NAWCWD Code D55J100 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

LT F ASREQ SEE BLK 16

b. COPIES

Block 4: Contractor format is acceptable as long as DID is used for guidance.

Distribution Statement F: Further dissemination only as directed by Naval Air Warfare Center, Weapons Division, Code D55J100, 1 Administration Circle, China Lake, CA 93555-6100, 19 March 2020 or higher DOD authority.

Warning Statement: This document contains technical data whose export is restricted by the Arms 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.

Destruction Notice: Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

Blocks 10, 12 & 13: Submit report concurrent with each hardware delivery.

Block 14: Submit in an electronic format agreed upon by both Government and Contractor prior to 1st submittal.

See Contract Clause 5252.247-9505, Technical data and Information for

15. TOTAL 0 2 0

Naval Air Warfare Center

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, Executive Services and Communications 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.

Printed Circuit Board N6893620R0096

A004 Technical Report – Study/Services

Manufacturer’s Material Test Report

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

SOW Para. 3.8.4.4 NAWCWD Code D55J100 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

LT F ASREQ SEE BLK 16

b. COPIES

Block 4: Contractor format is acceptable as long as DID is used for guidance.

Distribution Statement F: Further dissemination only as directed by Naval Air Warfare Center, Weapons Division, Code D55J100, 1 Administration Circle, China Lake, CA 93555-6100, 19 March 2020 or higher DOD authority.

Warning Statement: This document contains technical data whose export is restricted by the Arms 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.

Destruction Notice: Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

Blocks 10, 12 & 13: Submit report concurrent with each hardware delivery.

Block 14: Submit in an electronic format agreed upon by both Government and Contractor prior to 1st submittal.

See Contract Clause 5252.247-9505, Technical data and Information for

Naval Air Warfare Center

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, Executive Services and Communications 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.

Printed Circuit Board N6893620R0096

A005 Technical Repot – Study/Services

Micro Section Test Report

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

SOW Para. 3.8.4.5 NAWCWD Code D55J100 TOTAL PRICE

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

REQUIRED

LT F ASREQ SEE BLK 16

b. COPIES

Block 4: Contractor format is acceptable as long as DID is used for guidance.

Distribution Statement F: Further dissemination only as directed by Naval Air Warfare Center, Weapons Division, Code D55J100, 1 Administration Circle, China Lake, CA 93555-6100, 19 March 2020 or higher DOD authority.

Warning Statement: This document contains technical data whose export is restricted by the Arms 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.

Destruction Notice: Destroy by any method that will prevent disclosure of contents or reconstruction of the document.

Blocks 10, 12 & 13: Submit report concurrent with each hardware delivery.

Block 14: Submit in an electronic format agreed upon by both Government and Contractor prior to 1st submittal.

See Contract Clause 5252.247-9505, Technical data and Information for

Naval Air Warfare Center