CDRL_FA.pdf

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

PREVIOUS EDITION MAY BE USED.

Form Approved OMB No. 0704-0188

The 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 the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. 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 address. 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:

TDP ________ TM _______ OTHER

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

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE

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

7. DD 250 REQ

8. APP CODE

9. DIST STATEMENT

REQUIRED

10. FREQUENCY

11. AS OF DATE

12. DATE OF FIRST SUBMISSION

13. DATE OF SUBSEQUENT

SUBMISSION

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

Draft Final

Reg Repro

15. TOTAL

16. REMARKS

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

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

Page of Pages

AA NDTI

Circuit Card Assembly FD2020-19-01469

A001 Test/Inspection Report First Article Test Report

DI-NDTI-80809B/T CLIN for Data 416 SCMS/GUEAA

DD

A B

OTIME

SEE BLK 16

SEE BLK 16

SEE BLK 16

416 SCMS/ 1

GUEAA

6070 Gum LN Bldg. 1213 Hill AFB, UT 84056-5825

SEE BLK 16

SEE BLK 16 1

0 2 0

NOTE: Changes to office symbols and/or e-mail addresses, when necessary shall be made by letter through the CO/ACO without further revision to this CDRL.

NSN: 5998-01-303-5871WF

1. BLK 4: Contractor's format is acceptable. Paragraph 10.2 of DI-NDTI-80809B is clarified as follows:

a. All dimensions and tolerances specified on the manufacturing data shall be listed in one column, with the actual corresponding reading obtained from the inspection of the part listed in another column.

b. Materials utilized in the manufacture of "First Article" item shall be identified and certified along with a copy of material purchase requests as conforming to applicable data requirements.

c. Material processing, including finish requirements (plating, heat treatment, welding, inspecting, anodize, painting, etc.) utilized in the manufacture of "First Article" item shall be identified and certified as conforming to applicable requirements. A copy of the purchase order certifying the process accomplished at other than contractor facility shall be included.

d. Other requirements as called out on Engineering Data Requirement (OO-ALC Form 462).

2. The Distribution Statement, Export Control Warning and Destruction Notice shall be placed on the first sheet of each document and located in a conspicuous location.

BLK 9: DISTRIBUTION STATEMENT "B"" Distribution authorized to U.S.

Government agencies only. (Test & Evaluation) (July 2019). Other requests for this document shall be referred to (416 SCMS/GUEAA, Hill AFB, UT 84056-5825).

EXPORT CONTROL WARNING: All technical documents/data (printed, digital/electronic) that are determined to contain export-controlled technical data, shall be marked with the following statement:

NSP

0.00

17 July 2019 17 July 2019

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O'DELL.KRISTIN.M.1

255785679

Digitally signed by

O'DELL.KRISTIN.M.1255785679

Date: 2019.07.18 07:05:35 -06'00'

LEFEVRE.STEVEN

.R.1231476250

Digitally signed by

LEFEVRE.STEVEN.R.1231476250

Date: 2019.07.18 08:07:30 -06'00'

0001AB

DD FORM 1423-1, FEB 2001

CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP ________ TM _______ OTHER

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

16. REMARKS (Continued)

Page of Pages

A NDTI

Circuit Card Assembly FD2020-19-01469

EXPORT CONTROL 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 (Title 50, U.S.C., App. 2401 et seq.), as amended.

Violations of these export laws are subject to severe criminal penalties. Disseminate IAW provisions of DoD Directive 5230.25.

DESTRUCTION NOTICE: For classified documents, follow the procedures in DoD 5220.22-M, National Industrial Security Program Operating Manual (NISPOM), Section 5-705, or DoD 5200.1-R, Information Security Program Chapter VI. For unclassified, limited documents, destroy by any method that will prevent disclosure of contents or reconstruction of the document.

3. BLKs 10, 11, 12, 13, 14:

a. For Contractor Testing - submit IAW the current delivery schedule.

b. For Government Testing - Report to assist in "First Article" testing by the Air Force shall be submitted concurrently with the "First Article" item either in the packaging of the shipping container or separately if the report will not fit within the container packaging unfolded. When shipped in the "First Article" container, the report shall be enclosed in a paper or plastic envelope.

c. SHIP TO: Non-Accountable Bay Transportation Officer Building 849 West Hill AFB, UT 84056-5999

MARK FOR: 809 MXSS/MXDEB

7278 4th Street (Bldg. 100, Bay D) Hill AFB, UT 84056-5205

NOTE: If report is shipped separate from "First Article" item, send report to "MARK FOR" address listed above.

d. Contractor shall deliver the Test/Inspection Report via e-mail to the following e-mail address: steven.lefevre@us.af.mil

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