1129158_CDRL1_REPORT.pdf

DD Form 1423-1, JUN 90 (EF) Generated By PRPS Using Oracle Reports Version Page of11 2

FD20301301159F-15/HEAD, LINEAR ACTUATING

A001

CONTRACT DATA REQUIREMENTS LIST Form Approved

OMB NO.0704-D188

(1 Data Item)

Public reporting burden for this collection of information will reflect 110 hours per data item (5 data items would be 550 hours), 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 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.: B. Exhibit: C. Category:

TDP TM OTHER X

D. System/Item: E. Contract/Pr No.: F. Contractor:

1. Data Item No.: 2. Title of Data Item: 3. Subtitle:

TEST/INSPECTION REPORT FIRST ARTICLE INSPECTION TEST REPORT

4. Authority(Data Acquisition Document No.): 5. Contract Reference: 6. Requiring Office:

DI-NDTI-80809B/T N/A AFLCMC/EZGED

7. DD250 Req: 9. Dist.Statement Required:

10. Frequency: 12. Date of First Submission:

14. Distribution:

NO

8. APP Code:

A A

11. As of Date: 13. Date of Subsequent Submission:

SEE BLOCK 16

N/A

1 XTIME

a. Addressee:

b. Copies:

Final

Draft Reg Repro

TEST DAY

423 SCMS/GUEA

AFLCMC/EZGED

15. Total: 0 2 0

16. Remarks:

NAME: Zilar, Dale N DATE: 24 APR 2013

BLOCK 7: ALL INSPECTION AND ACCEPTANCE SHALL BE AT DESTINATION

UTILIZING WAWF. A COMBINATION OF AN INVOICE AND RECEIVING REPORT SHALL

BE SUBMITTED THROUGH WAWF IN ORDER TO RECEIVE PAYMENT FOR DATA

REPORTS.

BLOCK 8: GOVERNMENT WRITTEN NOTICE OF APPROVAL/DISAPPROVAL IS DUE 90

DAYS AFTER RECEIPT OF CONTRACTOR'S REPORT

BLOCK 12: 90 DAYS AFTER CONTRACT AWARD.

SEE ATTACHED DD FORM 1664, DATA ITEM DESCRIPTION.

FIRST ARTICLE INSPECTION (FAI) TEST REPORT IS USED TO DOCUMENT RESULTS

OF PREPRODUCTION TEST AND EXAMINATIONS.

A. SHOW COMPLETION OF INSPECTION AND RESULTS OF INSPECTION PERFORMED

TO DEMONSTRATE THAT THE FIRST ARTICLE UNIT(S) CONFORM TO THE

APPLICABLE

CONTRACT TECHNICAL REQUIREMENTS.

B. REPORT SHALL DELINEATE THE SPECIFIC RESULTS OBTAINED, THE

WITNESSES, AND ANY OTHER PERTINENT OBSERVATIONS.

C. INSPECTION RESULTS SHALL BE THE APPLICABLE QUANTITATIVE DATA IN THE

FORM OF RECORDINGS, INSTRUMENT READINGS AND RELATED DATA.

D. AS APPLICABLE, THE FIRST ARTICLE INSPECTION TEST REPORT SHOULD

IDENTIFY ANY DEVIATIONS OR LIMITATIONS IN THE FIRST ARTICLE UNIT(S)

INVOLVED, RECOMMENDED ACTIONS RELATING TO EACH DEVIATION OR

LIMITATION AND SUMMARY CONCLUSION(S).

CONTRACTOR FORMAT IS ACCEPTABLE.

REMARK APPLICABLE TO HAZARDOUS ITEMS ONLY: THE TESTS REQUIRED ARE AS

SPECIFIED IN CHAPTER 9 OF THE UNITED NATIONS TRANSPORT OF DANGEROUS

GOODS (ORANGE BOOK) RECOMMENDATIONS.

DD Form 1423-1, JUN 90 (EF) Generated By PRPS Using Oracle Reports Version Page of21 2

FD20301301159F-15/HEAD, LINEAR ACTUATING

CONTRACT DATA REQUIREMENTS LIST Form Approved

OMB NO.0704-D188

(1 Data Item)

Public reporting burden for this collection of information will reflect 110 hours per data item (5 data items would be 550 hours), 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 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.: B. Exhibit: C. Category:

TDP TM OTHER X

D. System/Item: E. Contract/Pr No.: F. Contractor:

G. Prepared By: H. Date I. Approved By: J. Date:

16. Remarks:

Zilar, Dale N

424 SCMS / GUBA

405-736-7045

26 APR 2013 //DIGITALLY SIGNED//

COORDINATORS:

423 SCMS / GUEA

LOUTHAN.MEL.J.1230955480

405-736-7008 / 336-7008

25 APR 2013