Exhibit_J-1_CDRLs.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved ( 1 Data Item) OMB No. 0704-0188

The publ ic report ing burden for th is collection of informat ion is estimated to average 110 hours per response , inc luding the t ime for reviewing instructions, searching existing data sources, gathering and maintain ing the data needed , and completing and rev ie wing the collection of inform ation. Send comments regarding th is burden estimate or any other aspect of th is collection of information, including suggestions for reduc ing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704·0188). Respondents should be aw are that notwithstanding any other provis ion of law, no person shall be subject to any penalty for fa iling to comply with a collect ion 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:

SESS

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

AOOl Certificate of Quality Audit Compliance The Society for Protective Coatings (SSPC) QP-1 Audit Findings Report

4 . AUTHORITY (Data Acquisition Document No .) 15. CONTRACT REFEREN CE 6. REQUIRING OFFICE

DI-SESS-81922* SOW Para. C-2 .01 NSI (009-04) PSNS & IMF Cl41 l

7. DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASREQ* SEE BLOCK16* b. COPIES

8 . APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK16) SUBMISSION Draft NIA NIA SEE BLOCK16* Reg Re pro

16. REMARKS PSNS&IMF,Cl41 l * 1

BLOCK 4: Delete paragraph 2.1, 2.2, 2.4, and 2.6. Delete "(Optional)" from paragraph 3.9.

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, Cl4 l l , Bremerton, WA 98314.

BLOCK 10, 11 , 12 and 13: The report shall be submitted no later than 10 days after receipt of contractor's final audit report .

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE. 11 60801243

ACRES.MARK.R.1 250711170 °'91t;allyM9nfllbyACRESMARILR. 12S071 11 70 ,., ~·- - ··--.... ·-- -----·- ,_,., 011e· 201902.0709: 12.i>O .o8"00"

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED . Page of 1 Pages

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

The public reporting burden for th is collection of informat ion is est imated to average 110 hours per response , including the t ime for review ing instructions, searching exist ing data sources , gather ing and mainta ining the data needed , and complet ing and reviewing the collect ion of information . Send comments regard ing th is burden estimate or any other aspect of this collection of information, including suggestions for reduc ing the burden, to the Department of Defense, Execut ive Services and Communications Directorate (0704-0188), Respondents should be aw are that notw ithstanding any other provision of law, no person shall be subject to any penalty for fail ing to comply w ith a co llection of information if it does not display a currently va lid 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:

ENVR

0004 A TOP - -- TM -- OTHER

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

USS LOUISIANA N4523A 19R0800 TBD

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

A002 Coating Usage and Thinning Report

4 . AUTHORITY (Da ta Acquisition Document No .) , 5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-ENVR-82154 SOW Para. C-2 .0 I NSI (009-97) PSNS & IMF C/41 1

7. DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED MTHLY* SEE BLOCK16* b. COPIES

8. APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final

NIA D(SEE BLK1 6) SUBMISSION Draft SEE BLOCK16* NLT* Reg Re pro

16. REMARKS PSNS&IMF,C/411 * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411 , Bremerton, WA 98314.

BLOCK 10, 11 , 12 and 13: Initial report shall be submitted at the end of the month after first usage. Subsequent reports shall be delivered NL T then 10th of each month throughout the availability.

BLOCK 14: Media requirement. The report shall be deli vered electronically in Adobe Acrobat Version DC, as an e-mail attachment to the Contracting Officer's Representative (COR) specified in the contract.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE. 11 60801243 - - ··-'--"" _ ,., 1/18/19

ACRES.MARK.R.1250711170 DM;i1laily s.9Md by ACRES MAAKJt 125071 1170 ""' ..... ~---------·-·-.. , 0.ll'. 2019 02.0109:12.4441'00'

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

( 1 Data Item) OMB No . 0 704-0188

The public reporting burden for this collection of information is est imated to average 110 hours per response , including the time for re vie wing instructions, searching existing data sources, gathering and maintain ing the data needed , and completing and rev ie wing the collect ion of information. Send comments regard ing th is burden estimate or any other aspect of th is collection of information, including suggestions for reducing the burden, to the Department of Defense , Executive Services and Communicat ions Directorate (0704-01 88). Respondents should be aw are that notw ithstanding any other provision of law, no person shall be subject to any penalty for fa iling 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 C. CATEGORY:

MGMT

0004 A TOP --- TM -- OTHER

D- SYSTEM/ITEM IE. CONTRACT/PR NO. F.CONTRACTOR

USS LOUISIANA N4523A l 9R0800 TBD

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

A003 Compartment Inspection Report

4 . AUTHORITY (Data Acquisition Document No .) 15. CONTRACT REFERENCE 6 . REQUIRING OFFICE

DI-MGMT-82063 SOW Para. C-2.0/NSI 009-06 PSNS & IMF Cl41 l

7. DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASGEN* SEE BLOCK1 6* b. COPIES

8 . APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK16) SUBMISSION Draft NIA NIA SEE BLOCK1 6* Reg Repro

16. REMARKS PSNS&IMF,C/4 11 * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, Cl4 l l , Bremerton, WA 98314.

BLOCK 10, 12 and 13: The report shall be submitted within 1 day of completed inspection for the duration of the availability.

BLOCK 14: Media requirement. Report shall be a legi ble copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.1160801243

__ ., ..... _ ,.. _ ,., 1118119

ACRES.MARK.R.125071 1170 ::~1~~,~~~~1250111 1 10 "" ··-··---......... -- .... - - _._...,. .. _,., DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

(1 Data Item) OMB No. 0704-0188

The publ ic reporting burden for this collection of inform ation is est imated to average 110 hours per response, including the t ime for reviewing instructions, searching existing data sources, gathering and maintaining the data needed , and completing and reviewing the collection of information. Send comments regard ing this burden estimate or any other aspect of th is collection of informat ion, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communicat ions Directorate (0704-0188 ). Respondents should be aw are that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of informat ion if it does not disp lay 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:

MGMT

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

A004 Contractor Furnished Material (CFM) Report NIA

4 . AUTHORITY (Data Acquisition Document No .) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-82049 SOW Para C 2.0 I NSI 009-01 PSNS & IMF Cl41 l

7. DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED MTHLY* 30DAC* b. COPIES

8 . APP CODE 11 . ASOFDATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Fin al D(SEE BLK16) SUBMISSION Draft NIA NIA SEE BLOCK16* Reg Re pro

16. REMARKS PSNS&IMF,Cl41 l * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S . DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411 , Bremerton, WA 98314.

BLOCK 10: Report will be updated and submitted monthly through the contract period of performance.

BLOCK 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. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.1160801243 ~;~;'-.:.;-_.=...-=.::• __ _____ --- 1/18119

ACRES.MARK.R.1250711170 ~~~17;~7~~o!~1250111 1 10

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED . Page at 1 Pages

17. PRICE GROUP

The publ ic reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching exist ing data sources, gathering and mainta ining the data needed, and completing and reviewing the collection of information. Send comments regard ing this burden est imate or any other aspect of th is collection of information, including suggestions for reducing the burden, to the Department of Defense , Executive Services and Communicat ions Directorate (0704·0188 ). Respondents should be aware that notwithstanding any other provision of law , no person shall be subject to any penalty for fa iling 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 C. CATEGORY:

ENVR

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

AOOS Contractor Hazardous Material Inventory Report

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

DI-ENVR-82091 SOW Para. C-2.0 I NSI 009-02 PSNS & IMF C/411 7 . DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED AS GEN* SEE BLOCK16* b. COPIES

8 . APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK16) SUBMISSION Draft A* NIA NLT* Reg Re pro

16. REMARKS PSNS&IMF,C/411 * 1 1

BLOCK 8: Government requires 10 days to review and comment. The Contractor shall have 4 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 (February 2016). Other requests shall be referred to PSNS&IMF, C/411 , Bremerton, WA 98314.

BLOCK 10, 12 and 13: Reports shall be submitted NLT 10 days prior to scheduled use of hazardous materials.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 1 1 0

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

LEWIS.ANNA.DEE.1160801243 ~:;;;:;'..~"!:..~- ----·- _ _. 1/18/19

ACRES.MARK.R.1250711170 ::~1~9;;:1~~.~~::-"" 125011 11 10

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

J 11. PRICE GROUP

CONTRACT DAT A REQUIREMENTS LIST Form Approved ( 1 Data Item} OMB No. 0704-0188

The public report ing burden for th is 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 revie wing the collection of informat ion. Send comments regarding th is burden estimate or any other aspect of this collection of information , including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aw are that notwithstanding any other provision of law, no person shall be subject to any penalty for fail ing 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 C. CATEGORY:

SAFT I 0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523A l 9R0800 TBD

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

A006 Contractor Hazardous Material Usage Report

4. AUTHORITY (Data Acquisition Document No .) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-SAFT-82092 SOW Para. C-2.0 I NSI 009-02 PSNS & IMF C/4[ 1

7. DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED MTHLY* SEE BLOCK16* b. COPIES

8 . APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a . ADDRESSEE Final D(SEE BLK 16) SUBMISSION Draft NIA SEE BLOCK16* NLT* Reg Re pro

16. REMARKS PSNS&IMF,C/411 * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411 , Bremerton, WA 98314.

BLOCK 10, 11 , 12 and 13: Initial report shall be submitted at the end of the first month at the beginning of availability. Subsequent reports shall be submitted NLT then the 10th day of each month throughout availability.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.11 60801243 ~;:;;";,'(a'.;~~·------ -··· 1/18/19

ACRES.MARK.R.1250711170 :~17~7~~~~

125071 1170

DD FORM 1423-1 , FEB 2001 PREVIOUS EDITION MAY BE USED . Page of 1 Pages

17. PRICE GROUP

The public reporting burden for th is collect ion of information is estimated to average 110 hours per response , including the time for re view ing instructions , searching existing data sources , gathering and mainta ining the data needed, and complet ing and reviewing the collec t ion of informat ion. Send comments regard ing th is burden estimate or any other aspect of this collect ion of informat ion , includ ing suggest ions for reduc ing the burden, to the Department of Defense, Execut ive Services and Communications Directorate (0704-0188). Respondents should be aw are that notw ithstand ing any other provis ion of law, no person shall be subject to any penalty for fa iling to comply w ith a collection of information if it does not display a currently val id OMS 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:

MGMT I 0004 A TOP TM OTHER --- --

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

USS LOUISIANA N4523Al 9R0800 TBD

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

A007 Contractor's Competent Person Training Qualification Report I

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

DI-MGMT-82058 SOW Para. C-2 .0/ NSI 009-07 PSNS & IMF C/411 7 . DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

I

LT

REQUIRED AS GEN* SEE BLOCK16* b. COPIES

8 . APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK16) SUBMISSION Draft NIA NIA SEE BLOCK16* Reg Re pro

16. REMARKS PSNS&IMF,C/411 * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411 , Bremerton, WA 98314.

BLOCK 10, 12 and 13 : Initial report shall be submitted 14 days prior to start of availability. Subsequent submissions shall be submitted when changes/updates occur.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPER VISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.1160801243 ~::":':'.::~~~·-------_..

1/1811 9

ACRES.MARK.R. l 250711170 :~1;~,~~~~1250111110

DD FORM 1423-1. FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

( 1 Data Item) OMB No . 0704-0 188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the t ime for reviewing instructions , searching exist ing data sources , gathering and maintaining the data needed , and completing and re viewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reduc ing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aw are that notw ithstanding any other provision of law, no person shall be subject to any penalty for fa iling 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 C. CATEGORY:

MGMT

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523A 19R0800 TBD

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

A008 Contractor's Fire Watch Training Program

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

DI-MGMT-82059 SOW Para. C-2.0/ NSI 009-07 PSNS & IMF Cl411 7 . DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED DFDEL* SEE BLOCK16* b. COPIES

8 . APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK16) SUBMISSION Draft NIA NIA SEE BLOCK16* Reg Re pro

16. REMARKS PSNS&IMF,C/411 * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411 , Bremerton, WA 98314.

BLOCK 10, 12 and 13: The training program delivery is deferred and deli very instructions will be provided by the Supervisor when date has been determined.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.1160801243 ~:;-';~;~":'..:'·-----·- - ..

1/18/19

ACRES.MARK.R.1250711170 ~=~1~~7~~~-~125071 1170

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

The publ ic reporting burden for th is collection of informat ion is estimated to average 110 hours per response , including the t ime for reviewing instructions, searching existing data sources, gather ing and mainta ining the data needed, and completing and rev ie wi ng the collection of information. Send comments regard ing th is burden estimate or any other aspect of th is collection of information , including suggestions for reduc ing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aw are that notwithstand ing any other provision of law , no person shall be subject to any penalty for fa iling to comply with a collection of informat ion if it does not display a currently val id OMS 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:

SAFT

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

A009 Contractor's Safety Plan

4 . AUTHORITY (Data Acquisition Document No .) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-SAFT-82080 SOW Para. C-2.0/ NSI 009-74 PSNS & IMF C/411 7 . DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ONEIR* SEE BLOCK16* b. COPIES

8. APP CODE 11.ASOFDATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final

A* D(SEE BLK16) SUBMISSION Draft NIA SEE BLOCK16* Reg Repro

16. REMARKS PSNS&IMF,C/411 * 1 1

BLOCK: 8 The report shall be delivered 10 day after contract award . Government requires 10 days to review and comment. Contractor has 5 days to incorporate changes and return to the government.

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 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. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 1 1 0

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

LEWIS.ANNA.DEE.1160801243

__ '" ...... - ,.. .... .. , 1/18/19

ACRES.MARK.R.1250711170 ~~~1~~7~~~1 2so711 i 70 .... ··-·" ~ _ _._ ______ ._ ~-·

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

The public report ing burden for this collect ion of information is est imated to average 110 hours per response , including the time for re viewing instructions , searching exist ing data sources, gathering and maintaining the data needed , and completing and review ing the collection of information. Send comments regarding this burden estimate or any other aspect of th is collection of informat ion , including suggestions for reducing the burden, to the Department of Defense , Execut ive Services and Communications Directorate (0704-0188). Respondents should be aw are that notwithstand ing any other provision of law , no person shall be subject to any penalty for failing to comply w ith a collection of information if it does not display a currently valid OMS 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:

MGMT

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

AOlO Critically Coated Surfaces Report

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

DI-MGMT-82066 SOW Para. C-2.0 I NSI 009-04 PSNS & IMF C/411

7. DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED WEKLY* SEE BLOCK16* b. COPIES

8. APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK16) SUBMISSION Draft A* NIA SEE BLOCK16* Reg Re pro

16. REMARKS PSNS&IMF,C/411 * l 1

BLOCK 8: The report shall be delivered NLT 14 days prior to production start date. Government requires 5 days to review and comment. Contractor has 3 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 (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12 and 13: The report shall be submitted NLT 72 hours after completion of preservation of each separate location in the Work Item.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL l 1 0

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

LEWIS.ANNA.DEE. 1160801243 ;:::;;:;:;",~~·~·------·- - ..

1118/19

ACRES.MARK.R.1250711170 ::~~1~~7~~!~125011 1170

DD FORM 1423-1 , FEB 2001 PREVIOUS EDITION MAY BE USED. Page of l Pages

17. PRICE GROUP

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for re viewing instructions, searching existing data sources , gathering and maintain ing the data needed , and complet ing and reviewing the collection of informat ion. Send comments regarding th is burden estimate or any other aspect of this collect ion of informat ion, including suggestions for reduc ing the burden, to the Department of Defense, Execut ive Services and Communicat ions Directorate (0704·0188 ). Respondents should be aw are that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply w ith 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 C. CATEGORY:

MGMT

0004 A TOP --- TM -- OTHER

D_ SYSTEM/ITEM IE_ CONTRACT/PR NO. F. CONTRACTOR

USS LOUISIANA N4523Al9R0800 TBD

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

AOll Environmental Compliance Report NIA

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

DI-MGMT-82052 SOW Para. C-2.01 NSI 009-02 PSNS & IMF C/411 7 . DD 250 REC 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED MTHLY* SEE BLOCK I 6* b. COPIES

8 . APP COOE 11 . ASOFDATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK1 6) SUBMISSION Draft NIA SEE BLOCK16* SEE BLOCK16* Reg Re pro

16. REMARKS PSNS&IMF,Cl41 l * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S . DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, Cl41 l , Bremerton, WA 98314.

BLOCK 10, 11 , 12 and 13: Submit report no later than 10 days after the end of the month throughout the availability.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.1160801243 ~;:;:;;:',~..;;;;"'--::.:· _ _____ -··· 1118119

ACRES.MARK.R.1250711170 ~;~1~9~1~;::~~

1250111 110

DD FORM 1423-1 , FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

1B. ESTIMATED

The public reporting burden for th is collection of information is estimated to average 11 0 hours per response , including the time for reviewing instructions, searc hing exist ing data sources, ga ther ing and mainta ining the dat a needed , and co mplet ing and revie wing the collection of information. Send co mments regarding th is burden estimate or any other aspect of this collect ion of in fo rmation, including suggestions for reduc ing the burden, to t he Department of Defense , Executive Services and Communicat ions Directorate (0704·0188). Respondents should be aw are that notw ithstanding any other provis ion of law, no person shall be sub ject to an y penalty for fail ing to comply w ith a collection of informat ion if it does not display a currently valid OMB control number. Please do not re turn your fo rm to the above organization. Send completed fo rm to the Government Issu ing Cont racting Officer for the Contract fPR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

ENVR

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

A0 12 Extremely Hazardous Substances (EHS) Report

4. AUTHORITY (Data Acquisition Document No.) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

Dl-ENVR-82 152 SOW Para. C-2.0/NSI 009-93 PSNS & IMF Cl411 7 . DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED AS GEN* SEE BLOCK16* b. COPIES

8 . APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final

NIA D(SEE BLK16) SUBMISSION Draft NIA SEE BLOCK16* Reg Re pro

16. REMARKS PSNS&IMF,Cl411 * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, Cl41 1, Bremerton, WA 983 14.

BLOCK 10, 12 and 13: Submission(s) shall be made within 5 working days of bringing each Extremely Hazardous Substances aboard the Government facility .

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWISANNA.DEE.1160801243 ;::::::::;:..;.:'!-.-::.::'-- ---·- --- 1118119

ACRES.MARK.R.125071 11 70 ~:~,i~,~~!·~1250711 170

DD FORM 1423-1 , FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

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 complet ing and rev ie wing the collect ion of inform ation. Send comments regard ing th is burden estimate or any other aspect of this collect ion of information , including suggest ions for reducing the burden, to the Department of Defense, Executive Services and Communicat ions Directorate (0704-0188). Respondents should be aw are that notwithstanding any other provision of law, no person shall be subject to any penalty for fa iling to comply with a collection of informat ion if it does not disp lay 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:

MGMT

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

1. DATA ITEM ND. 2. TITLE OF DATA ITEM 3 . SUBTITLE

A013 Fact Finding Report Fact Finding/Critique Report

4. AUTHORITY (Data Acquisition Document No .) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-82086 SOW Para. C-2.0 / NSI 009-120 PSNS & IMF C/411

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASREQ* SEE BLOCK! 6* b. COPIES

8 . APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK1 6) SUBMISSION Draft A* NIA SEE BLOCK16* Reg Re pro

16. REMARKS PSNS&IMF,C/411 * 1 1

BLOCK 8: Government requires 4 hours prior to Fact Finding Critique Meeting to review and comment. Contractor has 3 days to incorporate 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 (February 2016) . Other requests shall be referred to PSNS&IMF, C/411 , Bremerton, WA 98314.

BLOCK 10, 12 and 13: Submit report NLT 3 days after conclusion of the Critique Meeting.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15.TOTAL 1 1 0

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

LEWISANNA.DEE.1160801243 ~:;":::;;:;"'---,,.:· _______ ,., 1/18119

ACRES.MARK.R.1250711170 ::·~17~,~~~~12so71 111o

DD FORM 1423-1 , FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

I 17. PRICE GROUP

The publ ic reporting burden for th is collec t ion of informat ion is est imated to average 11 0 hours per respons e , inc lud ing the t ime for reviewing ins tructions, searc hing exist ing data sources , gathering and mainta in ing the data needed , and complet ing and reviewing the collec t ion of information. Send comments regard ing th is burden estimate or any other aspect of this collect ion of informat ion , including suggest ions fo r reducing the burden, to the Department of Defense , Executive Services and Communications Directorate (0704-0188 ). Responden ts should be aw are that notw iths tanding any other provis ion of law, no person shall be subject to any penalty for fa iling to comply with a collection of information if it does not display a currently val id OMS 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:

MGMT

0004 A TOP - - - TM -- OTHER

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

USS LOUISIANA N4523A19R0800 TBD

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

A014 Government Furnished Material NIA

4 . AUTHORITY (Da ta Acquisition Document No.) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-82048 SOW Para C-2.0 I NSI 009-20 PSNS & IMF Cl411 7 . DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASREQ* SEE BLOCK1 6* b. COPIES

8 . APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final

NIA D(SEE BLK16) SUBMISSION Draft NIA SEE BLOCK1 6* Reg Re pro

16. REMARKS PSNS&IMF,Cl41 l * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S . DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, Cl411 , Bremerton, WA 98314.

BLOCK 10, 12 and 13 : Report delivery is deferred and delivery instructions shall be provided by the SUPERVISOR when date has been determined.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.1160801243 -.............. -..,.. - .. , 1118119

ACRES.MARK.R.1250711170 ::~17~,~~-~12501111 10 .... ~ ·-· ·- ------ .. ---·-

DD FORM 1423-1 , FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

( 1 Data Item) OMB No. 0704-0 188

The public report ing burden for th is collect ion of information is est imated to average 110 hours per response , including the t ime fo r revie w ing instructions , searching e xisting data sources , gather ing and mainta in ing the data needed , and complet ing and re viewing the collec t ion of information. Send c omments regard ing th is burden est imate or any other aspec t of this collect ion of informatio n, including suggestions for reducing the burden, to the Department of Defense, Execut ive Services and Communicat ions Directorate (0704·0188 ). Respondents should be aw are that notwithstanding any other provision of law, no person shall be subject to any penalty for fa iling to comply wi th a collection of informat ion if it does not display a currently va lid OMS control number. Please do not return your form to the above organization. S end complet ed form to the Government Issuing Contrac t ing Officer for the Contract/PR No . listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

MGMT

0004 A TOP - -- TM - - OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

A0 15 Hazardous Waste Report

4. AUTHORITY (Data Acquisition Document No.) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-82 129 SOW Para. C-2 .0 I NSI 009-03 PSNS & IMF Cl4 11

7. DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED DFDEL* SEE BLOCK16* b. COPIES

8 . APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Fina l D(SEE BLK1 6) SUBMISSION Draft NIA NIA SEE BLOCK I 6* Reg Re pro

16. REMARKS PSNS&IMF,Cl411 * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distri bution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 201 6). Other requests shall be referred to PSNS&IMF, Cl4 l l , Bremerton, WA 98314.

BLOCK 10, 12 and 13: The report delivery is deferred and deli very instructions shall be provided by the SUPERVISOR when date has been determ inded.

BLOCK 14: Media requ irement. Report shall be a legible copy submitted in approved transferable medi a to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.11 60801243 ;;:;,:;-,::,--';;::;~-:.::·- - - --·- _ ...

111811 9

ACRES.MARK.R.1250711 170 :~1~9~7~~~~uso711 1 70

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

[ 11 . PRICE GROUP

( 1 Data Item) OMB No. 0 704 -0188

The public reporting burden for this collect ion of information is est imated to average 110 hours per response , includ ing the t ime for reviewing instructions , searching exist ing data sources , gather ing and maintain ing the data needed , and complet ing and revie wing the collection of information. Send comments regard ing this burden est imate or any other aspect of this collection of informat ion , including suggestions for reducing the burden, to the Department of Defense, Execut ive Services and Communications Direc torate (0704-0188 ). Respondents should be aw are that notw ithstanding any other provis ion of law, no person sha ll be subject to any penalty for fa iling to comply with a collection of information if it does not display a currently val id OMB control number. Please do not return you r form to the above organizat ion. S end completed form t o the Government Issuing Contracting Officer for the Contract fPR No . listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

MGMT

0004 A TOP - -- TM - - OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

A01 6 Heavy Weather Plan

4 . AUTHORITY (Data Acquisition Document No.) 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-82069 SOW Para. C-2.0/NSI 009-69 PSNS & IMF C/41 1

7. DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASREQ* SEE BLOCK1 6* b. COPIES

B. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK16) SUBMISSION Draft A* NIA SEE BLOCK1 6* Reg Repro

16. REMARKS PSNS&IMF,C/411 * 1 1

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 Operati onal use (February 201 6). 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 product ion start date. Subsequent plan submissions shall be updated as they occur.

BLOCK 14: Media requi rement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 1 1 0

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

LEWIS.ANNA.DEE-1 160801243 ~~:;:;"~~-:::.:·-----·- ---

1/18/1 9

ACRES.MARK.R.1250711170 ::~17~,~~~~125011 1110

DD FORM 1423-1. FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

17. PRICE GROUP

1B. ESTIMATED

The publ ic report ing burden for th is co llection of info rmation is estimated to average 1 10 hours per res ponse, including the t ime fo r reviewing instruct ions , searching exist ing data sources, gathering and mainta in ing the data needed, and completing and revie wing the collec t ion of informat ion . Send comments regard ing th is burden estimate or any other aspect of th is collection of informat ion, including sugges t ions for reducing the burden, to the Department of Defense , Execut ive Services and Communicat ions Directorate (0704-0188 ), Respondents should be aw are that notwithstanding any other provision of law , no person shall be subject to any penalty for fa iling to co mply w ith a collect ion of information if it does not display a currently val id OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contrac ting Officer for the Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

MGMT

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523A l 9R0800 TBD

1. DATA ITEM ND. 2. TITLE OF DATA ITEM 3 . SUBTITLE

A0 17 Incident Report

4. AUTHORITY (Dara Acquisition Document No.) I s . coNTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-82071 SOW Para. C-2.0/ NSI 009-74 PSNS & IMF C/411 7 . DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASREQ* SEE BLOCK16* b. COPIES

8 . APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a . ADDRESSEE Final

NIA D(SEE BLKl 6) SUBMISSION Draft NIA SEE BLOCKl 6* Reg Re pro

16. REMARKS PSNS&IMF,C/411 * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, C/411, Bremerton, WA 98314.

BLOCK 10, 12 and 13: Report shall be submitted within 1 day ofoccurrence of an accident/ incident to the ship/equipment or personnel. Subsequent update report shall be provided daily.

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.1160801243 ::::0·70:-:~~.:-:.:· -- ---·- •. 1/18/ 19

ACRES.MARK.R.1250711170 :~~1;~,~~i!~

12so711 17o

DD FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED . Page of 1 Pages

17. PRICE GROUP

The public reporting burden for this collection of information is estimated to average 110 hours per response , including the time for reviewing instruct ions , searching ex isting data sources , gathering and maintaining the data needed, and complet ing and rev iew ing the collection of information. Send comments regard ing th is burden est imate or any other aspect of th is collection of information , including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188) . Respondents should be aw are that notwithstanding any other provision of law, no person shall be subject to any penalty for fa iling to comply w ith 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 Gove rnment Issuing Contracting Officer for the Contract/PR No. listed in Block E.

A . CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

MGMT

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

A018 List of Subcontractors Report

4. AUTHORITY (Data Acquisition Document No .} 15. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-MGMT-82070 SOW Para. C-2.01 NSI 009-74 PSNS & IMF C/411

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED ASREQ* SEE BLOCK16* b. COPIES

8. APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK1 6) SUBMISSION Draft NIA NIA SEE BLOCK16* Reg Repro

16. REMARKS PSNS&IMF,C/411 * 1

BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S . DoD contractors only for Administrative or Operational use (February 2016). Other requests shall be referred to PSNS&IMF, Cl411, Bremerton, WA 98314.

BLOCK 10, 12 and 13 : Initial report shall be delivered to the supervisor 4 days prior to subcontracts commencing work on Naval Facilities or Vessels. Revisions shall be provided as required to the End of Avai lability (EOA).

BLOCK 14: Media requirement. Report shall be a legible copy submitted in approved transferable media to the SUPER VISOR.

15. TOTAL 0 1 0

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

LEWIS.ANNA.DEE.1160801243 ~:;";;;;:~-"-".:.::'- - - --·- ·- ..

1118119

ACRES.MARK.R.1250711170 ::~1~11~1~~!~mo711110

DD FORM 1423-1 , FEB 2001 PREVIOUS EDITION MAY BE USED . Page of 1 Pages

I 17. PRICE GROUP

The public reporting burden for th is collection of informat ion is estimated to average 110 hours per response, includ ing the t ime for review ing instructions, searching exist ing data sources , gather ing and mainta ining the data needed, and completing and reviewing the co llection of information. Send comments regard ing th is burden estimate or any other aspect of this collect ion of information, including suggestions for reducing the burden, to the Department of Defense, Execut ive Services and Communications Directorate 10704·0188) . Respondents should be aw are that notwithstanding any other provision of law, no person shall be subject to any penalty for fa iling to comply w ith a collec tion 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:

NDTI

0004 A TOP --- TM -- OTHER

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

USS LOUISIANA N4523A l 9R0800 TBD

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

A019 Non-Destructive Testing Training Program

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

DI-NDTI-81936 SOW Para. C-2.0 PSNS & IMF C/411

7. DD 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED CP/RQ* SEE BLOCK16* b. COPIES

8. APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK16) SUBMISSION Draft A* SEEBLOCK16 SEE BLOCK16* Reg Re pro

16. REMARKS PSNS&IMF,C/411 * 1 1

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 (February 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. Report shall be a legible copy submitted in approved transferable media to the SUPERVISOR.

15. TOTAL 1 1 0

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

LEWISJ\NNA.DEE.1160801243 ;:.::::;°i:C....:::.~~·-- - --·- -·· 1/18/19 ACRES.MARK.R.1250711170 ::~1';1;;:,~~~12s011 11 10

DD FORM 1423-1. FEB 2001 PREVIOUS EDITION MAY BE USED. Page of 1 Pages

I 17. PRICE GROUP

The publ ic reporting burden for th is collection of informat ion is estimated to average 110 hours per response , including the time for reviewing instructions , searching exist ing data sources , gather ing and mainta ining the data needed , and completing and review ing the collection of information. Send comments regard ing th is burden estimate or any other aspect of this collect ion of information, including sugges tions for reduc ing the burden, to the Department of Defense , Executive Services and Communications Directorate (0704·0188 ). Respondents should be aw are that notw ithstanding any other provision of law , no person shall be subject to any penalty for failing to comply w ith a collection of info rmat ion 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:

SAFT

0004 A TOP --- TM - - OTHER

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

USS LOUISIANA N4523Al 9R0800 TBD

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

A020 Operating, Support, Health and Safety (OSH&S) Hazard Analysis Report

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

DI-SAFT-81 841 SOW Para. C-2.01 NSI 009-07 PSNS & IMF Cl41 l

7. DD 250 REQ 9 . DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

LT

REQUIRED DAILY* SEE BLOCK16* b. COPIES

8. APP CODE 11 . AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final D(SEE BLK16) SUBMISSION Draft NIA NIA DAILY* Reg Repro

16. REMARKS PSNS&IMF,Cl411 * 1 BLOCK 9: "DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S.