DD-250 Material Inspection and Receiving Report

Form Approved
OMB No. 0704-0248

MATERIAL INSPECTION AND RECEIVING REPORT

The public reporting burden for this collection of information is estimated to average 30 minutes 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
(0704-0248), 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 COMPLETED FORM TO THE ABOVE ADDRESS.
SEND THIS FORM IN ACCORDANCE WITH THE INSTRUCTIONS CONTAINED IN THE DFARS, APPENDIX F-401.
1. PROCUREMENT INSTRUMENT IDENTIFICATION
(CONTRACT) NO.
2. SHIPMENT NO.

3. DATE SHIPPED

ORDER NO.

6. INVOICE NO./DATE

4. B/L

7. PAGE OF

8. ACCEPTANCE POINT

5. DISCOUNT TERMS

TCN
9. PRIME CONTRACTOR

CODE

11. SHIPPED FROM (If other than 9) CODE

CODE

13. SHIPPED TO

15.
ITEM NO.

FOB:

DESCRIPTION
16. STOCK/PART NO.
(Indicate number of shipping containers - type of
container - container number.)

10. ADMINISTERED BY

CODE

12. PAYMENT WILL BE MADE BY

CODE

14. MARKED FOR

CODE

17. QUANTITY
SHIP/REC'D*

21. CONTRACT QUALITY ASSURANCE
a. ORIGIN
CQA

ACCEPTANCE of listed items

19.
UNIT PRICE

20.
AMOUNT

22. RECEIVER'S USE
b. DESTINATION

has been made by me or under my supervision and
they conform to contract, except as noted herein or
on supporting documents.

18.
UNIT

CQA
ACCEPTANCE of listed items has
been made by me or under my supervision and they
conform to contract, except as noted herein or on
supporting documents.

Quantities shown in column 17 were received in
apparent good condition except as noted.

DATE RECEIVED

SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE

TYPED NAME:
TITLE:

DATE

SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE

DATE

SIGNATURE OF AUTHORIZED
GOVERNMENT REPRESENTATIVE

MAILING ADDRESS:

TYPED NAME:

TYPED NAME:

TITLE:

TITLE:

MAILING ADDRESS:

MAILING ADDRESS:

COMMERCIAL TELEPHONE
NUMBER:

COMMERCIAL TELEPHONE
NUMBER:

* If quantity received by the Government is the same
as quantity shipped, indicate by (X) mark; if different,
enter actual quantity received below quantity shipped
and encircle.

COMMERCIAL TELEPHONE
NUMBER:

23. CONTRACTOR USE ONLY

DD FORM 250, AUG 2000

PREVIOUS EDITION IS OBSOLETE

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