Sec_J_Attch_J-2-Contract_Data_Requirements_List(CDRL)-N4523A-16-R-0021_0006.pdf
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- USS Maine (SSBN 741) FY17 ERO
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- N4523A-16-R-0021
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Sec J Attch J-2 Contract Data Requirements List
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CONTRACTDATAREQUIREMENTSLIST
(1 Data Item)
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 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
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A001
2. TITLE OF DATA ITEM
Request for Deviation for Shipyard Standard Work Item
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT 82051
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August
2016). Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: The Request for Deviation Report shall be delivered within one day of identifying the need for a deviation.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/200 Engineering, TBD, C/411 Contracting Officer’s Representative
(COR), Dennis Cayabyab (dennis.cayabyab@navy.mil)
PSNS&IMF, C/411* 0 1 0
PSNS&IMF, C/200* 0 1 0
15. TOTAL 0 2 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/1/16
I. APPROVED BY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 1 of 52 Pages Adobe Professional 8.0
LJH
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 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
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS MAINE (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A002
2. TITLE OF DATA ITEM
Government Furnished Material Condition Found Report
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-82048
5. CONTRACT REFERENCE
SOW para 3.4
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August
2016). Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK-10, 12 and 13: Report delivery is deferred and delivery instructions shall be provided by SUPERVISOR when date has been determined.
BLOCK 14: Media requirement: The report shall be delivered electronically in Adobe
Acrobat, Version DC, and email attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR) Dennis Cayabyab
(dennis.cayabyab@navy.mil)
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/1/16
I. APPROVED BY
Lorraine J. Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 2 of 52 Pages
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 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
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS MAINE (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A003
2. TITLE OF DATA ITEM
Contractor Furnished Material (CFM) Report
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-82049
5. CONTRACT REFERENCE
SOW C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
MTHLY
12. DATE OF FIRST SUBMISSION
30DAC
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use( August
2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.
BLOCK-10, 12 and 13: The Report shall be delivered 30 days after contract award Revisions to be submitted monthly until end of availability.
BLOCK 14: Media requirement: The report shall be delivered electronically in Adobe
Acrobat, Version DC, and email attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR) Dennis Cayabyab
(dennis.cayabyab@navy.mil)
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/1/16
I. APPROVED BY
Lorraine J. Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 3 of 52 Pages
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 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
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS MAINE (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A004
2. TITLE OF DATA ITEM
Report, Production or Delivery Problem(s)
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-81178
5. CONTRACT REFERENCE
SOW C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use( August
2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.
BLOCK-10, 12 and 13: Report delivery is deferred and delivery instructions shall be provided by SUPERVISOR when date has been determined.
BLOCK 14: Media requirement: The report shall be delivered electronically in Adobe
Acrobat, Version DC, and email attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR) Dennis Cayabyab
(dennis.cayabyab@navy.mil)
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/1/16
I. APPROVED BY
Lorraine J. Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 4 of 52 Pages
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 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
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS MAINE (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A005
2. TITLE OF DATA ITEM
Purchase Order(PO)
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-MISC-81616
5. CONTRACT REFERENCE
SOW C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use( August
2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.
BLOCK-10, 12 and 13: The report shall be delivered within 3 days of request.
BLOCK 14: Media requirement: The report shall be delivered electronically in Adobe
Acrobat, Version DC, and email attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR) Dennis Cayabyab
(dennis.cayabyab@navy.mil)
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/1/16
I. APPROVED BY
Lorraine J. Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 5 of 52 Pages
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 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
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A006
2. TITLE OF DATA ITEM
Environmental Compliance Report
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT 82052
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
MTHLY*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
SEE BLOCK 16
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August
2016). Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK-10, 11,12 and 13: Submit report no later than 5 days after the end of the month throughout the availability.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis
Cayabyab (dennis.cayabyab@navy.mil)
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/2/16
I. APPROVED BY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 6 of 52 Pages
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 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
A
C. CATEGORY:
TDP TM OTHER SAFT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A007
2. TITLE OF DATA ITEM
Toxic and Hazardous Substances Process Procedure
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-SAFT 82053
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
DFDEL*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
SEE BLOCK 16
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August
2016). Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK-10, 11, 12 and 13: Process/Procedure delivery is deferred and delivery instructions will be provide by the SUPERVISOR when date has been determined.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis
Cayabyab (dennis.cayabyab@navy.mil)
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/2/16
I. APPROVED BY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 7 of 52 Pages
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 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
A
C. CATEGORY:
TDP TM OTHER SESS
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A008
2. TITLE OF DATA ITEM
Certificate of Quality Audit Compliance
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-SESS-81922*
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (August
2016). Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK-10, 11, 12 and 13: The report shall be submitted no later than 10 days after receipt.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/132 Quality Assurance Specialist (QAS) Del D. Ray (del.lee@navy.mil), and C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab (dennis.cayabyab@navy.mil).
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 2 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/2/16
I. APPROVED BY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 8 of 52 Pages Adobe Professional 8.0
LJH
The Society for Protective Coatings (SSPC) QP-1 Audit Findings Report
BLOCK 4: Delete paragraph 2.1, 2.2, 2.4, and 2.6. Delete "(Optional)" from paragraph 3.9. 0 1 0PSNS&IMF, C/132*
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 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
A
C. CATEGORY:
TDP TM OTHER SESS
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A009
2. TITLE OF DATA ITEM
Quality Audit Finding and Response Record (QAFRR)
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (August
2016). Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK-10, 12 and 13: The report shall be submitted within one day of all preliminary audit for critical items.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/132 Quality Assurance Specialist (QAS) Del D. Ray (del.lee@navy.mil), and C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab (dennis.cayabyab@navy.mil).
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 2 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/2/16
I. APPROVED BY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 9 of 52 Pages Adobe Professional 8.0
LJH
DI-SESS-81923*
0 1 0
The Society for Protective Coatings (SSPC) QP-1 Preliminary Audit Findings Report
BLOCK 4: Delete paragraph 3.7 and Delete "Electronic versions of QAFRRs may be required or substituted for hard copies by contract" from paragraph 3.10.
PSNS&IMF, C/132*
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 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
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A010
2. TITLE OF DATA ITEM
Work Completion Certification Certificate
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASGEN*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (August
2016). Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK-10, 12 and 13: The report shall be submitted within 3 days of Work Item completion. Revisions shall be submitted with 4 days of correction of discrepancies
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/132 Quality Assurance Specialist (QAS) Del D. Ray (del.lee@navy.mil), and C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab (dennis.cayabyab@navy.mil).
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 2 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/2/16
I. APPROVED BY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 10 of 52 Pages Adobe Professional 8.0
LJH
DI-MGMT-82050
0 1 0
Certificate of Completion for Work Item
PSNS&IMF, C/132*
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 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
A
C. CATEGORY:
TDP TM OTHER ADMN
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A011
2. TITLE OF DATA ITEM
Conference Minutes
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATE OF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (August
2016). Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK-10, 12 and 13: The report shall be delivered within 4 days of conference.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab (dennis.cayabyab@navy.mil).
PSNS&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/2/16
I. APPROVED BY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/2/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 11 of 52 Pages Adobe Professional 8.0
DI-ADMN-82050B
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 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 Officerforthe Contract/PRNo. listed in Block E.
A. CONTRACT LINE ITEM NO.
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A012
2. TITLE OF DATA ITEM
Compartment Inspection Report
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
OT-16-20211
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
SEE BLOCK 16
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATEOF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August
2016). Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: The report shall be submitted within 1 day of each completed inspection for the duration of the availability
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab
(dennis.cayabyab@navy.mil).
PSNS&IMF, C/411 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/2/16
I. APPROVEDBY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/3/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 12 of 52 Pages
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 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 Officerforthe Contract/PRNo. listed in Block E.
A. CONTRACT LINE ITEM NO.
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A013
2. TITLE OF DATA ITEM
Contractor Affected Space/Tank Report
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
OT-16-20213
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATEOF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August 2016).
Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: Report shall be submitted one day prior to opening a tank or void.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab
(dennis.cayabyab@navy.mil).
PNSN&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/2/16
I. APPROVEDBY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
DD FORM 1423-1, FEB 2001
PREVIOUS EDITION MAY BE USED.
Page 13 of 52 Pages
8/3/16 LJH
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 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 Officerforthe Contract/PRNo. listed in Block E.
A. CONTRACT LINE ITEM NO.
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER SAFT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A014
2. TITLE OF DATA ITEM
Operating, Support, Health, and Safety (OSH&S)Hazard
Analysis Report
3. SUBTITLE
Daily Safety/Fire Prevention /Housekeeping
Inspection Report
4. AUTHORITY (Data Acquisition Document No.)
DI-SAFT-81841
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
DAILY*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATEOF SUBSEQUENT
SUBMISSION
DAILY*
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August 2016).
Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: The report shall be submitted within 4 hours after completion of inspection throughout availability.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/106, Safety TBD, C/132 Quality Assurance Specialist (QAS) Del D. Ray (del.lee@navy.mil), and C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab (dennis.cayabyab@navy.mil).
PSNS&IMF, C/411* 0 1 0
PSNS&IMF, C/106* 0 1 0
PNSN&IMF, C/132* 0 1 0
15. TOTAL 0 3 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/2/16
I. APPROVEDBY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/3/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 14 of 52 Pages
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 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 Officerforthe Contract/PRNo. listed in Block E.
A. CONTRACT LINE ITEM NO.
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER SAFT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A015
2. TITLE OF DATA ITEM
Environmental Safety and Health (ESH) Discrepancy and
Corrective Action Log
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
OT-16-20281
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATEOF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August 2016).
Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: All discrepancies and corrective actions identified shall be submitted within 4 hours of discrepancy upon completion of daily inspection throughout availability.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab
(dennis.cayabyab@navy.mil), C/106 Safety Ron Hampton (Ronald.hampton@navy.mil ) and
Ship Safety Officer (SSO), TBD.
PSNS&IMF, C/411* 0 1 0
PNSN&IMF, C/106* 0 1 0
Ship Safety Officer 0 1 0
15. TOTAL 0 3 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/3/16
I. APPROVEDBY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
8/3/16
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 15 of 52 Pages
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 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 Officerforthe Contract/PRNo. listed in Block E.
A. CONTRACT LINE ITEM NO.
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A016
2. TITLE OF DATA ITEM
List of Chief of Naval Operations(CNO) Availability Reports
3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-82047*
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
SEE BLOCK 16
13. DATEOF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 4: Delete paragraph 2(f).
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August 2016).
Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: Initial report shall be delivered NLT 15 days prior to availability start date and then weekly thereafter to End of Availability (EOA).
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab
(dennis.cayabyab@navy.mil)
PNSN&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY H. DATE
8/3/16
I. APPROVEDBY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 16 of 52 Pages
8/4/16Kelli Bobb, PSNS&IMF C/411 LJH
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 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 Officerforthe Contract/PRNo. listed in Block E.
A. CONTRACT LINE ITEM NO.
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A017
2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-MGMT-80368A
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
WEKLY*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
N/A
13. DATEOF SUBSEQUENT
SUBMISSIONWEEKLY
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August 2016).
Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: Initial report shall be delivered NLT 5 days after production start date and then weekly NLT 2 hours prior to Daily Priority List (DPL) meeting on the first workday of the week.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis
Cayabyab (dennis.cayabyab@navy.mil).
PNSN&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/3/16
I. APPROVEDBY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 17 of 52 Pages Adobe Professional 8.0
Status Report
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 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 Officerforthe Contract/PRNo. listed in Block E.
A. CONTRACT LINE ITEM NO.
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A018
2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
OT-16-20295
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASREQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
N/A
11. AS OF DATE
SEE BLOCK 16
13. DATEOF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August 2016).
Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: The report shall be delivered within 5 work days of interference removal.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab
(dennis.cayabyab@navy.mil).
PNSN&IMF, C/411* 0 1 0
15. TOTAL 0 1 0
G. PREPARED BY H. DATE
8/3/16
I. APPROVEDBY
J. DATE
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 18 of 52 Pages Adobe Professional 8.0
Interferences Report
Kelli Bobb, PSNS&IMF C/411 Lorraine J Henry, PSNS&IMF C/412 8/4/16LJH
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 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 Officerforthe Contract/PRNo. listed in Block E.
A. CONTRACT LINE ITEM NO.
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER MGMT
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A019
2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
OT-16-20290
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
ASGEN*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
A*
11. AS OF DATE
N/A
13. DATEOF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 8: The Government requires five days to review and comment. Contractor has four days to incorporate comments and resubmit.
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August 2016).
Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: Submit plan no later than 15 days prior to production start date.
Subsequent plan submissions shall be updated as they occur.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis Cayabyab
(dennis.cayabyab@navy.mil)
PNSN&IMF, C/411* 1 1 0
15. TOTAL 1 1 0
G. PREPARED BY
Kelli Bobb, PSNS&IMF C/411
H. DATE
8/3/16
I. APPROVEDBY
Lorraine J Henry, PSNS&IMF C/412
J. DATE
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 19 of 52 Pages Adobe Professional 8.0
Heavy Weather Plan
8/4/16 LJH
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 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 Officerforthe Contract/PRNo. listed in Block E.
A. CONTRACT LINE ITEM NO.
B. EXHIBIT
A
C. CATEGORY:
TDP TM OTHER
D. SYSTEM/ITEM
USS Maine (SSBN-741)
E. CONTRACT/PR NO.
N4523A-16-R-0021
F. CONTRACTOR
TBD
1. DATA ITEM NO.
A020
2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.)
DI-MISC-81940
5. CONTRACT REFERENCE
SOW para C-2.0
6. REQUIRING OFFICE
PSNS&IMF, C/411
7. DD 250 REQ
LT
9. DIST STATEMENT
REQUIRED
D(SEE BLK 16)
10. FREQUENCY
CP/RQ*
12. DATE OF FIRST SUBMISSION
SEE BLOCK 16
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE
A*
11. AS OF DATE
N/A
13. DATEOF SUBSEQUENT
SUBMISSION
SEE BLOCK 16
Draft
Final
Reg Repro
16. REMARKS
BLOCK 8: The report shall be delivered NLT 10 work days after contract award.
Government requires 10 days to review and comment prior to initiation of production work.
Contractor has 5 days to incorporate any changes and return to Government.
BLOCK 9: “DISTRIBUTION STATEMENT D. Distribution authorized to the Department of
Defense and U.S. DoD contractors only for Administrative or Operational use (August 2016).
Other requests shall be referred to PSNS&IMF, C/411 Bremerton, WA 98314.
BLOCK 10, 12 and 13: Subsequent submissions shall be submitted for review and acceptance prior to use as changes/updates occur.
BLOCK 14: Media requirement. The report shall be delivered electronically in Adobe
Acrobat, Version DC, as an e-mail attachment to all addressees.
BLOCK 14 (a): C/411 Contracting Officer’s Representative (COR), Dennis
Cayabyab (dennis.cayabyab@navy.mil), C/132 Quality Assurance Specialist (QAS), Del Lee, (del.lee@navy.mil).
PSNS&IMF,C/411* 0 1 0
PSNS&IMF, C/132* 1 1 0
15. TOTAL 1 2 0
G. PREPARED BY H. DATE
8/3/16
I. APPROVEDBY J. DATE
DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page 20 of 52 Pages Adobe Professional 8.0
Welding Performance Qualification and Training Program
MISC
8/8/16Marina…
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