DRAFT_A017_FEMCA.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, 0105 (Opt 1), and 0203 (Opt 2)

B. EXHIBIT

A

C. CATEGORY:

SESS

D. SYSTEM/ITEM

Laser Eye Protection Threat Spectacles

E. CONTRACT/PR NO.

N00421-15-D-XLEP

F. CONTRACTOR

1. DATA ITEM NO.

A017

2. TITLE OF DATA ITEM

Failure, Mode, Effects and Criticality Analysis Report

3. SUBTITLE

FMECA Report

4. AUTHORITY (Data Acquisition Document No.)

DI-SESS-81495A (See Block 16)

5. CONTRACT REFERENCE

SOW 3.14.5.2, 3.14.8.3, and 3.17.1

6. REQUIRING OFFICE

PMA202

7. DD 250 REQ

LT

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

ONE/R

12. DATE OF FIRST SUBMISSION

See Block 16

14. DISTRIBUTION

8. APP CODE

A (See Block 16)

N/A

13. DATE OF SUBSEQUENT SUBMISSION

See Block 16

b. COPIES

15. REMARKS

Block 4: Contractor format is acceptable. Content will be in accordance with cited data acquisition document number with details to the second level of indenture (SRA). For additional guidance refer to DI-RELI-81497, Reliability, Prediction and Documentation of Support Data and MIL-STD-1629A.

Block 8: The Government will provide approval or disapproval for each submission. The Government will provide commentaries 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 12: Draft submission of the FMECA shall be 30 working days prior to the Preliminary Design Review / Technical Interchange Meeting.

Block 13: Subsequent submission shall be 30 working days prior to the Critical Design Review.

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

Lan Phan

H. DATE

I. APPROVED BY

J. DATE