Attachment_B_CDRL.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, Executive Services and Communications 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. B. EXHIBIT C. CATEGORY:

A

TDP TM

OTHER MISC

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

Avionics Test Set Cable Assemblies N68936-19-R-0011

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

A001 Certification/Data Report

Quality Assurance Certification

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

DI-MISC-80678

SOW para 3, 3.1, 3.2, 3.3, 3.4, 3.5, 3.6, 5.1

NAWCWD Code 486M00E TOTAL PRICE

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

REQUIRED

LT E ASREQ SEE BLK 16

b. COPIES

8. APP CODE SEE BLK 16 11. AS OF DATE 13. DATE OF SUBSEQUENT SUBMISSION a. ADDRESSEE Final

N/A N/A SEE BLK 16 Draft Reg. Repro

16. Remarks: Code 486M00E 0 1 0

Block 4: Contractor format is acceptable as long as DID is used for guidance.

Block 9: Use Distribution Statement E: Distribution authorized to DoD Components only, Administrative or Operational use, 01 September 2016.

Other U.S. requests shall be referred to Commander: Naval Air Warfare Center Weapons Division (Code 486M00E), Point Mugu, CA 93042-5033.

Blocks 10, 12 & 13: Shall be delivered concurrent with hardware.

Block 14: Submit in an electronic format agreed upon by both Government and Contractor prior to 1st submittal.

See Contract Clause 5252.247-9505, Technical data and Information for distribution address.

Code 2544430D 0 LTR ONLY

15. TOTAL 0 1 0

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

Naval Air Warfare Center Weapons Division China Lake, CA 93555-6100

01/24/2019

DRRB Chairperson

01/24/2019

DD FORM 1423-1, FEB 2001 PREVIOUS EDITONS MAY BE USED