CDRL_N0025319Q0067.pdf

G. PREPARED BY

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

16. REMARKS

C. CATEGORY:

TDP ________ TM _______ OTHER

Form Approved OMB No. 0704-0188

15. TOTAL

PREVIOUS EDITION MAY BE USED.DD FORM 1423-1, AUG 96 (EG) Page ____ of ____ Pages

A. CONTRACT LINE ITEM NO. B. EXHIBIT

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

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

H. DATE J. DATEI. APPROVED BY

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.

Designed using Perform Pro, WHS/DIOR, Aug 96

0001 A

MK54 PRESSURE CYLINDER TBD TBD

A001 CERTIFICATION/DATA REPORT

DI-MISC-80678 SOW PARAGRAPH 4 NUWC KEYPORT-N00253

DD

A D*

AS REQ. (SEE BLK 16)

N/A

SEE BLK 16

SEE BLK 16

TECHNICAL POC 1

CONTRACT OFFICER 1BLOCK 9:

DISTRIBUTION STATEMENT "D" - DISTRIBUTION AUTHORIZED TO DOD AND

DOD CONTRACTORS ONLY; CRITICAL TECHNOLOGY (DATE 6/12/2015). OTHER

REQUESTS WILL BE REFERRED TO PEO-SUBS (PMS404).

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C. App. 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 per the provisions of OPNAVINST 5510.161.

DESTRUCTION NOTICE – For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

BLOCKS 10, 12, and 13:

Certification data report to show current certification under DOT Special Permit 10915 shall be delivered with the first lot under SOW Paragraph 4. A certification data report shall be provided to the government with all subsequent lot deliveries.

BLOCK 14:

Mailing Address:

NUWC Keyport Attn: Traci Seeley BLDG 1003T Code 423 610 Dowell Street Keyport, WA 98345

12/19/18

MISC

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