Attch_3_-_Contract_Data_Requirements_List_Redacted.pdf

CONTRACT DATA REQUIREMENTS LIST

(2 Data Items)

Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 220 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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:

TBD A TDP TM OTHER See Blk 16

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

EMI Chamber 1300757346 TBD

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

A001 CERTIFICATE OF COMPLIANCE Acoustic EMI Chamber with Shielded Antechamber

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

DI-MISC-81356A SOW PARA# 4.1 NUWCDIVNPT, Code 3431 18 ESTIMATED

TOTAL PRICE

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

LT REQUIRED OTIME See Blk 16 b. COPIES

8. APP CODE D* 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE Draft Final

N/A See Blk 16 See Blk 16 N/A Reg Repr

16. REMARKS Code 3431 0 1 0

Block C: MISC 3432 DM 0 1 0

Block 9: See BLOCK 16 ADDENDUM

Block 10: Approximately one (1) submission is anticipated.

Block 11 & 12: Contractor shall deliver Certificate of Compliance for the doors and acoustic material 45 calendar days prior to installation of chamber.

Block 14: Media Requirements: The certificate shall be delivered electronically in Microsoft 2016 format with email notification to all addressees. See Block 14 Addressee List

15. TOTAL 0 2 0

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

A002 Acceptance Test Report Acoustic EMI Chamber with Shielded Antechamber

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

DI-QCIC-81891 SOW PARA# 4.1 NUWCDIVNPT, Code 3431 18 ESTIMATED

TOTAL PRICE

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

LT REQUIRED OTIME See Blk 16 b. COPIES

8. APP CODE D* 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE Draft Final

N/A See Blk 16 See Blk 16

N/A Reg Repr

16. REMARKS Code 3431 0 1 0

Block C: QCIC 3432 DM 0 1 0

Block 9: See BLOCK 16 ADDENDUM

Block 10: Approximately one (1) submission is anticipated.

Block 11 and 12: Contractor shall deliver acceptance test report 30 calendar days after installation and testing of chamber.

Block 14: Media Requirements: The report shall be delivered electronically in Microsoft 2016 format with email notification to all addressees. See Block 14 Addressee List

15. TOTAL 0 2 0

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

Fredric Stawarz 1 May 2019

DD Form 1423-2, AUG 96 (EG) PREVIOUS EDITION MAY BE USED Page 1 of 3 Pages

(2 Data Items)

Form Approved OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 220 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 this burden to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. 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:

TBD A TDP TM OTHER See Blk 16

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

RF Shielded Door 1300757346 TBD

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

A003 CERTIFICATE OF COMPLIANCE RF Shielded Door

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

DI-MISC-81356A SOW PARA# 4.2 NUWCDIVNPT, Code 3431 18 ESTIMATED

TOTAL PRICE

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

LT REQUIRED OTIME See Blk 16 b. COPIES

8. APP CODE D* 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE Draft Final

N/A See Blk 16 See Blk 16 N/A Reg Repr

16. REMARKS Code 3431 0 1 0

Block C: MISC 3432 DM 0 1 0

Block 9: See BLOCK 16 ADDENDUM

Block 10: Approximately one (1) submission is anticipated.

Block 11 & 12: Contractor shall deliver Certificate of Compliance 45 calendar days prior to installation of the RF shielded-door.

Block 14: Media Requirements: The certificate shall be delivered

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE GROUP

A004 Acceptance Test Report RF Shielded Door

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

DI-QCIC-81891 SOW PARA# 4.2 NUWCDIVNPT, Code 3431 18 ESTIMATED

TOTAL PRICE

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

LT REQUIRED OTIME See Blk 16 b. COPIES

8. APP CODE D* 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE Draft Final

N/A See Blk 16 See Blk 16 N/A Reg Repr

16. REMARKS Code 3431 0 1 0

Block C: QCIC 3432 DM 0 1 0

Block 9: See BLOCK 16 ADDENDUM

Block 10: Approximately one (1) submission is anticipated.

Block 11 & 12: Contractor shall deliver acceptance test report 30 calendar days after installation of the door and testing of chamber.

Block 14: Media Requirements: The report shall be delivered

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

Fredric Stawarz 1 May 2019

DD Form 1423-2, AUG 96 (EG) PREVIOUS EDITION MAY BE USED Page 2 of 3 Pages

DD FORM 1423

BLOCK 14 ADDRESSEE LIST

Complete Address DD Form 1423 (CDRL) Block 14 Entry NUWCDIVNPT 3431

BLOCK 16 ADDENDUM

Block 9: The following information is provided in amplification of the Block 9 Distribution Statement shown on each DD FORM 1423-2.

Distribution Statement paragraphs is in addition to CLASSIFICATION markings of the data.

CDRL A001-A004

Distribution Statement D. Distribution authorized to the Department of Defense and U.S. DoD contractors only (Critical Technology) (22 January 2019). Other requests for this document shall be referred to NUWCDIVNPT Code 349.

The following "EXPORT CONTROL WARNING NOTICE" must be used in conjunction with DISTRIBUTION STATEMENTS identified in all CDRL Items.

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. Violations of these export laws are subject to severe criminal penalties. Disseminate in accordance with provisions of DOD Directive 5230.25.

DD Form 1423-2, AUG 96 (EG) PREVIOUS EDITION MAY BE USED Page 3 of 3 Pages