A019_Test-Inspection_Report.doc

DD Form 1423-1, 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 source, gathering and maintaining the data needed, and completing and reviewing the collection of information. Sent 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.

0006, 0107 (Opt 1), and 0205 (Opt 2)

B. EXHIBIT

A

C. CATEGORY:

NDTI

D. SYSTEM/ITEM

Laser Eye Protection Threat Spectacles

E. CONTRACT/PR NO.

N00019-16-C-0017

F. CONTRACTOR

1. DATA ITEM NO.

A019

2. TITLE OF DATA ITEM

Test / Inspection Report

3. SUBTITLE

Test Reports

4. AUTHORITY (Data Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

See Block 16

6. REQUIRING OFFICE

PMA202

7. DD 250 REQ

LT

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

See Block 16

12. DATE OF FIRST SUBMISSION

See Block 16

14. DISTRIBUTION

8. APP CODE

A (See Block 16)

N/A

13. DATE OF SUBSEQUENT SUBMISSION

N/A

b. COPIES

16. REMARKS

Block 5: SOW 3.14.6.2, 3.14.11.2, 3.14.13.4, 3.14.14.4, 3.19.4.1, 3.19.7.1, 3.19.12.1, and 3.19.15.1.

Block 8: The Government will provide approval or disapproval for each submission. The Government will provide comments if disapproved. The Contractor shall provide resubmittal to the Government 5 (five) days after receipt of Government comments.

Block 9: Use Distribution Statement D: Distribution authorized to the Department of Defense and U.S. DoD contractors only, Critical Technology, 4 September 2012. Other requests shall be referred to Naval Air Systems Command, PMA202, 21491 Great Mills Road, Lexington Park, MD 20653.

Block 10 and 12: The Contractor shall submit individual test reports for each test in the contract no later than 20 working days after each test is complete. Lot acceptance test reports shall be submitted at least 5 days prior to asset delivery.

Block 14: CDRL deliverables must be uploaded via AMRDEC SAFE (https://safe.amrdec.army.mil/safe/). The Contractor shall provide email notification to PMA202CDRL@navy.mil when the deliverable product has been submitted. Data submitted under this contract will be deemed delivered once data product is uploaded and email notification to PMA202CDRL@navy.mil is sent.

PMA 202 (See Block 16)

G. PREPARED BY

Robert Estocsin

H. DATE

I. APPROVED BY

J. DATE