CDRL_A001_-__Request_for_Deviation.doc

CONTRACT DATA REQUIREMENTS LIST (1 Data Item) FORM APPRVD 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 Services, Directorate for information Operations and Reports, 1215 Jefferson Davis HWY, Suite 1204, Arlington VA, 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-01880, 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

B. Exhibit

A C. Category: TDP ( ) TM( ) Other ( XX )

D. System/Item

Buddy/Jump Start Hose Assembly

E. Contract/PR No.

Solicitation N68335-16-T-0003

F. Contractor

TBD

1. Data Item No.

A001

2. Title of Data Item

Request for Deviation

3. Subtitle

4. Authority (Data ID No.)

DI-CMAN-80640

5. Contract Reference

SOW Para. 3.11

6. Requiring Office

NAVAIR LKE Code 132800B

7. DD 250 REQ

LT

9. Dist. Statement Req.

N/A

10. Frequency

AS REQ

12. Date of first submission

AS REQ

14. Distribution

See Block 16

8. APPCODE

A

11. As of Date

AS REQ

13. Date of Subsequent Submission

AS REQ

486300B

Request for Deviation shall be submitted IAW this CDRL and paragraph 3.11 of the

Statement of Work. MIL-HDBK-61 referenced in the DATA Item Description (DID) associated with this CDRL is for guidance only.

Block 8: Government approval/disapproval shall be provided 30 days after receipt.

TOTAL

G. Prepared By: John Newcomer

H. Date

29 September 2015

I. Approved By: Scott T Wheeler

J. Date

29 September 2015

DD FORM 1423-1, JUN 09 PREVIOUS EDITIONS ARE OBSOLETE PAGE (1) OF (1) 10 June 2009