SPRBL116R0021_EXHIBIT_A_CDRL_DI-ILSS-80620.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 review ing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and review ing 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 Contract/PR No. listed in Block E.

A. CONTRACT LINE ITEM NO.

B. EXHIBIT

A

C. CATEGORY:

TDP TM OTHER ILSS

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

Doppler Navigation Set

AN/ASN-157

1. DATA ITEM

NO.

2. TITLE OF DATA ITEM 3. SUBTITLE

A001 Government Furnished Equipment Repair Status Report Repair Item Status Report

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-ILSS-80620 PWS para. 3.15.1 RDER-PRA-AB

7. DD 250

REQ

9.DIST

STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST

SUBMISSION

14. DISTRIBUTION

LT QTRLY 120 DAC b. COPIES

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

SUBSEQUENT

SUBMISSION

a. ADDRESSEE Draft

Final

A 0 Reg

Repro

16. REMARKS:

In addition to the reporting requirements of DI-ILSS-80620, the Contractor shall also include in the report those items determined to have no evidence of failure.

BLK 9: Distribution authorized to US Government Agencies only to protect records of contract performance. Other requests for this document shall be referred to AMSEL-LC-CCS-N-AN.

BLK 10: Quarterly

BLK 14 – Reports shall be submitted via electronic mail as follows:

Lawrence.j.donohue.civ@mail.mil. Documents shall be in Microsoft 97 or higher. Contractor format is acceptable.

RDER-PRA-AB

ACO

CCAP-CCE

15. TOTAL

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

Lawrence Donohue Mechanical Engineer

10/08/15 Michael Heussner Chief, Avionics Branch

10/08/15

DD Form 1423-1, 1 Jun 90