2705017_CDRL1_REPORT.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved OMB No. 0704-0188(1 Data Item)

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, Executive Services 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

TDP TM OTHER X

D. SYSTEM / ITEM

F-15 / Head, Linear Actuator

E. CONTRACT / PR NO.

FD20301901281

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Test/Inspection Report

3. SUBTITLE

First Article Inspection Test Report

4. AUTHORITY

DI-NDTI-80809B/T

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

N/A

6. REQUIRING OFFICE

AFLCMC/LZPED

7. DD 250 REQ

NO

8. APP CODE

N/A

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

1 XTIME

11. AS OF DATE

Test Day

12. DATE OF FIRST

SUBMISSION

SEE BLOCK 16

13. DATE OF SUBSEQUENT

SUBMISSION

N/A

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Zilar, Dale NNAME: 31 JAN 2019DATE:

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 9: Distribution Statement A: Approved for public release; distribution is unlimited. Controlling DoD office is

848 SCMG/423 GUEA.

Disposal and destruction notices: Dispose of by putting it in a recycle container or regular trash receptacle.

BLOCK 12: 90 DAYS AFTER CONTRACT AWARD.

SEE ATTACHED DD FORM 1664, DATA ITEM DESCRIPTION.

A. THE PURPOSE OF THE FIRST ARTICLE INSPECTION IS TO GIVE OBJECTIVE EVIDENCE THAT ALL

ENGINEERING, DESIGN AND SPECIFICATION REQUIREMENTS ARE CORRECTLY UNDERSTOOD,

ACCOUNTED FOR, VERIFIED AND RECORDED.

B. SHOW COMPLETION OF INSPECTION AND RESULTS OF INSPECTION PERFORMED TO

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

TECHNICAL REQUIREMENTS.

C. REPORT SHALL DELINEATE THE SPECIFIC RESULTS OBTAINED, THE WITNESSES, AND ANY

OTHER PERTINENT OBSERVATIONS.

D. INSPECTION RESULTS SHALL BE THE APPLICABLE VARIABLE & ATTRIBUTE DATA IN THE FORM

OF RECORDINGS, INSTRUMENT READINGS AND RELATED DATA.

E. AS APPLICABLE, THE FIRST ARTICLE INSPECTION TEST REPORT SHOULD IDENTIFY ANY

DEVIATIONS OR LIMITATIONS IN THE FIRST ARTICLE UNIT(S) INVOLVED.

DELETE PARAS: 10.2.4(a), 10.2.5, 10.2.6.2, 10.2.6.3, 10.2.6.4.2(b-d), 10.2.6.5, 10.2.6.6, 10.2.7.2 & 10.2.8

AS 9102 FORMAT OR EQUIVALENT 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.

COORDINATORS:

423 SCMG/GUEA

3001 Staff Dr., Tinker AFB, OK 73145-3033

0 1 0

AFLCMC/LZPED

3001 Staff DR., Ste. 1AB 85A Tinker AFB, OK 73145-3041 ATTN: FA Monitor, DODAAC FA8111

0 1 0

0 2 015. TOTAL

Page 1 of 2DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 13 Feb 2019

PREVIOUS EDITION MAY BE USED.

CONTRACT DATA REQUIREMENTS LIST Form Approved OMB No. 0704-0188(1 Data Item)

G. PREPARED BY

Zilar, Dale N

424 SCMS / GUBAB

405-736-7976

H. DATE

04 FEB 2019

I. APPROVED BY

//DIGITALLY SIGNED//

EWY.JENNY.NICOLE.1249715707

423 SCMS / GUEA 405-582-9974 / 852-9974

J. DATE

04 FEB 2019

Page 2 of 2DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 13 Feb 2019

PREVIOUS EDITION MAY BE USED.