DD1423.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 X TM OTHER

D. SYSTEM / ITEM

5955013832748SO/bit oscillator

E. CONTRACT / PR NO.

FD20601900132

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

Counterfeit Prevention Plan for NSN 5955013832748SO, Bit Oscillator

3. SUBTITLE

N/A

4. AUTHORITY

di-misc-81832

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

FD20601900132

6. REQUIRING OFFICE

WIU

7. DD 250 REQ

LT

8. APP CODE

N/A

9. DIST STATEMENT

REQUIRED

D

10. FREQUENCY

ONE/R

11. AS OF DATE

N/A

12. DATE OF FIRST

SUBMISSION

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

N/A

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS

Gonzalez, Barbara ENAME: 13 NOV 2018DATE:

Joseph Bradham 235 Byron Street Suite 19A Robins AFB, GA 31098-1670

1 1 1

1 1 115. TOTAL

G. PREPARED BY

Gonzalez, Barbara E

411 SCMS / GUBAC

478-926-7035

H. DATE

15 NOV 2018

I. APPROVED BY

//DIGITALLY SIGNED//

STEWART.TODD.RICHARD.1071073277

411 SCMS / GULB 478-926-3258 / 468-3258

J. DATE

13 NOV 2018

Page 1 of 3DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 19 Nov 2018

PREVIOUS EDITION MAY BE USED.

Name: Joseph Bradham- Engineer IAW DI-MISC-81832 Submission Date: 90 days ARO Inspection: Destination Acceptance: Destination COORDINATORS:

COORDINATORS:

Early delivery is acceptable at no cost to the government. Email to the following: danielle.crosby@us.af.mil and joseph.bradham.1@us.af.mil. DoDAAC for payment in WAWF is SPRWA1.

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

TDP X TM OTHER

D. SYSTEM / ITEM

5955013832748SO/bit oscillator

E. CONTRACT / PR NO.

FD20601900132

F. CONTRACTOR

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

First Article Qualification Test Plan and Procedures

3. SUBTITLE

5955-01-383-2748SO

4. AUTHORITY

di-ndti-80809b

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

FD20601900132

6. REQUIRING OFFICE

WIU

7. DD 250 REQ

N/A

8. APP CODE

A

9. DIST STATEMENT

REQUIRED

N/A

10. FREQUENCY

ONE/P

11. AS OF DATE

See Block 16

12. DATE OF FIRST

SUBMISSION

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

N/A

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

16. REMARKS Attn: Traci Polk DLA Central Receiving/DDWG-ER Special Handling: FA UNIT-

DO NOT POST

455 Byron St, Bldg 376 Robins AFB, GA 31098-1887

1 1 1

1 1 115. TOTAL

G. PREPARED BY

Gonzalez, Barbara E

411 SCMS / GUBAC

478-926-7035

H. DATE

15 NOV 2018

I. APPROVED BY

//DIGITALLY SIGNED//

STEWART.TODD.RICHARD.1071073277

411 SCMS / GULB 478-926-3258 / 468-3258

J. DATE

13 NOV 2018

Page 2 of 3DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 19 Nov 2018

PREVIOUS EDITION MAY BE USED.

Deliver 1 unit(s) 30 days after contract award. Early delivery is acceptable at no cost to the government. Contractor's notification to ACO and AFLCMC/WIUEA of test time and location due 10 days prior to start of testing.

Government has 20 days to approve/disapprove test plan.

COORDINATORS:

A002

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

TDP X TM OTHER

D. SYSTEM / ITEM

5955013832748SO/bit oscillator

E. CONTRACT / PR NO.

FD20601900132

F. CONTRACTOR

1. DATA ITEM NO.

A003

2. TITLE OF DATA ITEM

First Article Qualification Test Inspection Report

3. SUBTITLE

5955-01-383-2748SO

4. AUTHORITY

di-ntdi-80809b/t

(Data Acquisition Document No.) 5. CONTRACT REFERENCE

FD20601900132

6. REQUIRING OFFICE

WIU

7. DD 250 REQ

N/A

8. APP CODE

A

9. DIST STATEMENT

REQUIRED

N/A

10. FREQUENCY

ONE/P

11. AS OF DATE

See Block 16

12. DATE OF FIRST

SUBMISSION

N/A

13. DATE OF SUBSEQUENT

SUBMISSION

N/A

a. ADDRESSEE

Draft Final

ReproReg

b. COPIES

14. DISTRIBUTION

Attn: Traci Polk DLA Central Receiving/DDWG-ER Special Handling: FA UNIT-

DO NOT POST

455 Byron St, Bldg 376 Robins AFB, GA 31098-1887

1 1 1

1 1 115. TOTAL

G. PREPARED BY

Gonzalez, Barbara E

411 SCMS / GUBAC

478-926-7035

H. DATE

15 NOV 2018

I. APPROVED BY

//DIGITALLY SIGNED//

STEWART.TODD.RICHARD.1071073277

411 SCMS / GULB 478-926-3258 / 468-3258

J. DATE

13 NOV 2018

Page 3 of 3DD FORM 1423-1, FEB 2001 Version 1Generated by PRPS using Jasper Reports on 19 Nov 2018

PREVIOUS EDITION MAY BE USED.

16. REMARKS

Deliver 1 unit(s) 10 days after completion of first article qualification test. Early delivery is acceptable at no cost to the government. Government written notice of approval/disapproval due 30 days after receipt of contractor's report.

COORDINATORS: