CDRL A004 ACCEPTANCE TEST REPORT.docx

CONTRACT DATA REQUIREMENTS LIST

(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.

A

D. SYSTEM/ITEM

ECO PBX UPGRADE

E. CONTRACT/PR NO. F. CONTRACTOR

TBD

1. DATA ITEM NO.

A004

2. TITLE OF DATA ITEM 3. SUBTITLE

ACCEPTANCE TEST REPORT

H56A0

7. DD 250 REQ

NO

9. DIST STATEMENT

D

10. FREQUENCY

1TIME

12. DATE OF 1ST SUBMISSION

SEE BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

N/A

11. AS OF DATE

TBD YY/MMM/DD

13. DATE OF SUBSEQUENT SUBMISSION N/A

16. REMARKS

BLK 4: The ATR shall be submitted electronically within 3 days of testing completion as stated in PWS Paragraph 3.2.2.

No Government response to the ATR within 30 days of submission constitutes approval.

BLK 9: The following information shall be included on the deliverable:

DISTRIBUTION STATEMENT D: Distribution authorized to the DoD and U.S. DoD contractors only; Proper date to be determined by Program Manager and affixed by contractor. Other requests shall be referred to:

SPACE AND NAVAL WARFARE SYSTEMS CENTER PACIFIC

PACIFIC C4ISR DEPARTMENT, CODE H56A0

Pearl City, HI 96782-3356 WARNING: This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., sec. 2751, et seq.) or the Export Administration Act of 1979, as amended, Title 50, U.S.C., App. 2401 et seq. Violation of these export laws are subject to severe criminal penalties. Disseminate in accordance with the provisions of DoD Directive 5230.2 BLK 14: Deliver by Electronic Media. Regular copy E-Mail Addresses:

CODE H56A0: waylen.wataru@navy.mil

G. PREPARED BY

WAYLEN WATARU

H. DATE

01/31/2018

18. ESTIMATED TOTAL PRICE

17. PRICE GROUP

DD Form 1423-1, FEB 2001

PREVIOUS EDITION MAY BE USED

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