A004.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

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 the Department of Defense, Executive Services (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 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:

TDP ________ TM _______ OTHER

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

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

TBD A X

Smokey Sam Launcher LMU-24 B/E TBD TBD

A004 Test Procedure Lot Acceptance Test Plan

DI-NDTI-80603A SOW paragraph 4.1.4 NSWC IHEODTD, Code E34SD

C

ASREQ

N/A

ASREQ

ASREQ

E34SD 0 1 0

0 1 0

BLOCK 4: DID is for guidance only. Contractor format is acceptable.

BLOCK 9: Distribution Statement C: Distribution is authorized to U.S. Government Agencies and their contractors (18 April 2016). Other requests for this document shall be referred to E34SD.

BLOCK 14:

NSWC IHEODTD

4154 Fowler Road Bldg. 1900, Suite 104 Indian Head, MD 20640

(301) 744-1650 shirley.delrosario@navy.mil

Data shall be delivered in electronic format (version Microsoft Office Word 2007) to the recipient identified in Block 14.

DELROSARIO.SHIRLEY.A.11658

00229

Digitally signed by DELROSARIO.SHIRLEY.A.1165800229 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN, cn=DELROSARIO.SHIRLEY.A.1165800229 Date: 2016.04.21 14:56:01 -04'00'

4/21/2016 PIEGOLS.BRUCE.W.122942

Digitally signed by PIEGOLS.BRUCE.W.1229421553 DN: c=US, o=U.S. Government, ou=DoD, ou=PKI, ou=USN, cn=PIEGOLS.BRUCE.W.1229421553 Date: 2016.04.21 15:24:04 -04'00'

4/21/16

4 7 Adobe Professional 8.0