CRPA_CDRLS_05AUG22CC_Redacted.pdf

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item) Form Approved

OMB No. 0704-0188 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 this burden, to Department of Defense, Washington Headquarters Service, 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.

TBD

B. EXHIBIT

A

C. CATEGORY

TDP TM OTHER: NDTI

D. SYSTEM/ITEM

Controlled Reception Pattern Antennas

E. CONTRACT / PR NO.

1300985648

F. CONTRACTOR

TBD

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM:

TEST/INSPECTION REPORT

3. SUBTITLE

Quality Assurance (QA) Test Report

17. PRICE GROUP

4. AUTHORITY (Date Acquisition Document No.)

DI-NDTI-80809B

5. CONTRACT REFERENCE

N/A

6. REQUIRING OFFICE

NUWCDIVNPT Code 3413

18. ESTIMATED

TOTAL PRICE

7. DD 250 REQ

9. DIST STATEMNT

REQUIRED 10. FREQUENCY

12. DATE OF FIRST

SUBMISSION 14. DISTRIBUTION

LT D ASREQ See Block 16 b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQNT

SUBMISSION a. ADDRESSEE

Draft Final N/A See Block 16 N/A See Block 16 Reg Repro

16. REMARKS TA 0 1 0

Block 9: See attached Block 16 addendum. 3432 DM 0 1 0

Block 10: One (1) per hardware item delivered. Approximately twenty-one (21) over entire contract.

Block 12 & 13: Test report shall be delivered concurrent with hardware delivery.

Block 14: Media Requirements: The report shall be delivered electronically in Microsoft 2016 or Adobe PDF format with email notification to all addressees.

Technical Advisor (TA) identified at time of Delivery Order

3432 DM:

15 TOTAL ______> 0 2 0

G. PREPARED BY

H. DATE

15 MAR 2022

J. DATE

APPROVED FOR

RFQ

05 AUG 2022

DD Form 1423-1, Feb 2001 Previous Edition May be Used Page 1 of 2 Pages

DD FORM 1423

CONTRACT DATA REQUIREMENTS LIST

BLOCK 16 ADDENDUM

PR 1300985648

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

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

CDRL A001

Distribution Statement D: Distribution authorized to Department of Defense and U.S. DoD contractors only Critical Technology (15 March 2022). Other requests shall be referred to NUWCDIVNPT, Code 349.

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

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 1423-1, Feb 2001 Previous Edition May be Used Page 2 of 2 Pages