ATT 0009 DD 1694 RequestforVariance (RFV).pdf

For the best experience, open this PDF portfolio in

Acrobat X or Adobe Reader X, or later.

Get Adobe Reader Now!

http://www.adobe.com/go/reader

Please wait...

If this message is not eventually replaced by the proper contents of the document, your PDF viewer may not be able to display this type of document.

You can upgrade to the latest version of Adobe Reader for Windows®, Mac, or Linux® by visiting http://www.adobe.com/go/reader_download.

For more assistance with Adobe Reader visit http://www.adobe.com/go/acrreader.

Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc., registered in the United States and other countries. Linux is the registered trademark of Linus Torvalds in the U.S. and other countries.

OMB NO. 0704-0188

OMB Approval Expires

20221130

Page of

DD FORM 1694, (Continuation Page) (REV 4/2015)

FORM WILL NOT WORK CORRECTLY WITHOUT JAVASCRIPT

** PLEASE ENABLE JAVASCRIPT **

PREVIOUS EDITION IS OBSOLETE

Page of

DD FORM 1694 CONTINUATION PAGE INSTRUCTIONS

FORM WILL NOT WORK CORRECTLY WITHOUT JAVASCRIPT

** PLEASE ENABLE JAVASCRIPT **

PREVIOUS EDITION IS OBSOLETE

REQUEST FOR VARIANCE (RFV)

(Continuation Page)

INSTRUCTIONS FOR PREPARATION OF REQUEST FOR VARIANCE UTILIZING DD FORM 1694

Instructions associated with Request for Variance Continuation Page. Use of the Continuation Page should be limited to instances when there is inadequate space provided on the parent Request for Variance, DD Form 1694. If the format or space provided in the Continuation Page is insufficient, the submitter may instead attach the necessary information to the RFV form.

Distribution Statement. Use this block to insert the appropriate Distribution Statement and/or Export Control Warning for this form in accordance with Block 9 of the applicable DD Form 1423, “Contract Data Requirements List” which this document is being delivered against and/or DODI 5230.24, Distribution Statements on Technical Documents.

9.0.0.2.20120627.2.874785

CurrentPage:

PageCount:

distStatmt:

rfvNumber:

procuringActNo:

TextField1:

viewer may not be able to display this type of document.

You can upgrade to the latest version of Adobe Reader for Windows®, Mac, or Linux® by visiting http://www.adobe.com/go/reader_download.

For more assistance with Adobe Reader visit http://www.adobe.com/go/acrreader.

Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc., registered in the United States and other countries. Linux is the registered trademark of Linus Torvalds in the U.S. and other

FORM WILL NOT WORK CORRECTLY WITHOUT JAVASCRIPT

** PLEASE ENABLE JAVASCRIPT **

PREVIOUS EDITION IS OBSOLETE

DD FORM 1694, APR 2017

Page of

AEM LiveCycle Designer

REQUEST FOR VARIANCE

(RFV)

OMB No. 0704-0188

OMB approval expires

November 30, 2022

The public reporting burden for this collection of information, 0704-0188, is estimated to average 2 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. 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 THIS ADDRESS. RETURN COMPLETED FORM TO THE ACQUIRER ISSUING CONTRACTING OFFICER FOR THE CONTRACT/PROCURING ACTIVITY NUMBER LISTED IN BLOCK 22 OF THIS FORM.

5. VARIANCE PRE OR POST-PRODUCTION:

6. BASELINE AFFECTED:

7. SYSTEM INFORMATION

10.a. OTHER EXTERNAL SYSTEM AFFECTED?:

11. IDENTIFICATION OF VARIANCE

11.a. VARIANCE CLASSIFICATION:

16. RECURRENCE

16.a. RECURRING VARIANCE?:

21. CONTRACT INFORMATION

22. CONTRACTING OFFICER

23. ORIGINATING ACTIVITY

BELOW TO BE COMPLETED BY THE APPROVING ACTIVITY

25.a. RECOMMENDATION:

26.a. DISPOSITION: (Configuration Approval Authority)

27. LIST OF ATTACHMENTS

9.0.0.2.20120627.2.874785

DD1694, "Request for Variance"

List Of Attachments

CurrentPage:

PageCount:

Enter the date using the format DD-Mon-YYYY:

rfvNumber:

procuringActNo:

distStatmt:

titleOfVar:

preProd:

postProd:

functional:

allocated:

product:

modelTypeDesign:

sysConfigItemNom:

endItemCageCode:

affectItemNom:

partNoAffectItems:

yes:

no:

block10b:

critical:

major:

minor:

defectNo:

docDefDefect:

descriptOfVar:

needForVar:

correctActTaken:

effectOnPerform:

yes2: 0 no2: 0 provRationale:

block17effectivity:

perUnitCostImpact:

totalCostImpact:

effectOnSched:

supplier:

contractNoLineNo:

nameContractOff:

telephone:

email:

nameOrigAct:

telephoneOrigAct:

cageCode:

emailOrigAct:

address:

submitAuth:

nameTitle:

submitAuthSign:

approval:

approvalWithMod:

Disapproval:

recommendModDescript:

recommendSign:

Enter the date using the format DD-Mon-YYYY:

approved:

approvedWithMod:

Disapproved:

dispositionModDescript:

nameTitle2:

dispositionSign:

attachmentsList:

AddAttachment:

ViewAttachment:

RemoveAttachment:

viewer may not be able to display this type of document.

You can upgrade to the latest version of Adobe Reader for Windows®, Mac, or Linux® by visiting http://www.adobe.com/go/reader_download.

For more assistance with Adobe Reader visit http://www.adobe.com/go/acrreader.

Windows is either a registered trademark or a trademark of Microsoft Corporation in the United States and/or other countries. Mac is a trademark of Apple Inc., registered in the United States and other countries. Linux is the registered trademark of Linus Torvalds in the U.S. and other

INSTRUCTIONS FOR PREPARATION OF

REQUEST FOR VARIANCE UTILIZING DD FORM 1694

DD FORM 1694 INST, APR 2017

Page of

AEM LiveCycle Designer

PREVIOUS EDITION IS OBSOLETE

GENERAL

SCOPE. This instruction establishes uniform requirements for the preparation of DD Form 1694, “Request for Variance (RFV)".

APPLICATION. The provisions of this instruction apply whenever DD

Form 1694 is utilized to request a variance.

APPLICABLE DOCUMENTS. DI-SESS-80640

GENERAL REQUIREMENTS. Use of DD Form 1694. Prepare and submit DD Form 1694 or an Acquirer authorized alternative to request variances from configuration documentation requirements.

Request for Variance (RFV). This form replaces the previous DD Form

1694 “Request for Deviation/Waiver (RFD/RFW)”.

DETAILED REQUIREMENTS. Detailed Instructions for completion of

DD Form 1694 are as follows. Confirm each applicable block of DD Form 1694 is filled or marked appropriately in accordance with the instructions provided herein. Failure to complete all applicable fields may result in rejection from the approving authority.

1. Date Prepared. Enter the submittal, preparation, or revision date of the RFV prepared in the format DD-Mon-YYYY (e.g., 01-Jan-2014).

2. RFV Number. Enter the RFV unique identifier or tracking indicator and, if required, a revision indicator.

3. Procuring Activity No. (PAN). To be entered by the procuring activity to provide an internal processing number, if required.

Distribution Statement. Use this block to insert the appropriate Distribution Statement and/or Export Control Warning for this form in accordance with Block 9 of the applicable DD Form 1423, “Contract Data Requirements List” which, this document is being delivered against and/or DODI 5230.24, Distribution Statements on Technical Documents.

4. Title of Variance. Enter a title to describe the variance.

5. Variance Pre or Post-Production. If the RFV is requested prior to the item being manufactured, check “Pre-Production” (e.g., variance approval is requested prior to need; product to be manufactured as nonconforming). If the need for the variance is identified after the item(s) manufacture, check “Post-Production” (e.g., variance approval is requested after being produced; product was manufactured and found to be nonconforming).

6. Baseline Affected. Enter the affected baseline.

7.a-c. System Information. Enter the model or type designation identifier of the Configuration Item (CI) or Computer Software

Configuration Item (CSCI) for which variance is being submitted (e.g., M16, Mk48, F22, etc.), System/Configuration item nomenclature (e.g., Rifle, Torpedo, Fighter, etc.), and Supplier end item CAGE Code.

8. Affected Item Nomenclature. Enter the specific item nomenclature of the part/assembly affected by the variance (e.g., bracket assembly).

9. Part Number(s) of Affected Item. Enter the specific part number or type designation/nomenclature, if applicable, of the item containing the defect or nonconformance.

10.a. Other External System Affected. Check `Yes' in this field if the variance impacts another system (e.g., interfacing system, training device, and test sets). Check `No' if otherwise.

10.b. List Other Systems or Configuration Items Affected.

Affected. If block 10.a. is checked `Yes', list the other system(s) checked `Yes', list the other system(s) or Configuration Item(s) (CIs) affected.

11.a-c. Identification of Variance. Enter the variance classification, Defect Number (if applicable), and the Document Defining Defect No/Class (if applicable).

11a. Variance Classification: Enter the classification of the variance based on the impact of the variance:

i. Critical. Use this classification when it is a departure from requirements affecting one or more of the following:

(1) safety

(2) human health

(3) environment,

(4) security (local program or national)

ii. Major. Use this classification when it is a departure from requirements affecting one or more of the following:

(1) performance or operational limits

(2) interchangeability, reliability, survivability, maintainability or durability of the item or its repair parts

(3) structural strength

(4) effective use or operation

(5) weight, moment, center of gravity

(6) appearance

(7) limits on product use or operation

(8) temporary use of alternate items

(9) when the configuration documentation defining the requirements for the item classifies the departure from the requirement as major

iii. Minor. Use this classification when it consists of a departure that does not involve any of the factors listed for critical or major, or when the configuration documentation defining the requirements for the item classifies the departure from the requirement as, minor. Note: Departures from the requirements that do not meet the definition of critical or major and are not classified in any configuration documentation (i.e. unlisted characteristic) are treated as minor.

11b. Defect No. (if applicable): Enter the defect number from the document that classifies the defect (e.g., "1A3").

11c. Document Defining Defect No./Class (if applicable): Enter the document number that classifies the defect (e.g., MIL-STD-252).

12. Description of Variance. Enter a description of the variance. Describe the nature of the proposed departure from the technical requirements of the configuration documentation. Marked drawings or other documents are included to describe and justify approval of the variance. Provide the impact of other systems or configuration items, as required. An RFV addressing Nonconforming Material (NCM) produced by pre-production or post-production includes a request for the material (part) be repaired, use-as-is, scrapped, or, in some cases, retrofitted.

13. Need for Variance. Describe the need for the variance. Explain why it is not possible to comply with the configuration documentation within the specified delivery schedule. Also, if applicable, explain why a variance is proposed in lieu of a permanent design change.

Block 14. Corrective Action Taken. Describe any action(s) taken to prevent a future recurrence of this variance.

Block 15. Effect on Performance, Function, Reliability, Durability, Integrated Logistics Support, Interface or, Software. Describe the changes in performance allocations and in the functional/physical interfaces defined in the system specification. Describe the effects of the proposed change on employment, deployment, logistics, and/or personnel and training requirements that have been specified in the approved system and/or CI specification, including any changes or effects on the operability of the system. In particular, there is to be an entry detailing any effect on interoperability. For Computer Software Configuration Items (CSCI): Enter the following information, as applicable, to the degree of design development of the CSCI at the time of ECP submission.

a. Identify any required changes to the database parameters or values, or to database management procedures.

b. Identify and explain any anticipated effects of the proposed change on acceptable computer operating time and cycle-time utilization.

c. Provide an estimate of the net effect on computer software storage.

d. Identify and explain any other relevant impact of the proposed change on the utilization of the system.

16a-b. Recurrence. If the same variance has been requested previously, check "Yes" or check "No" otherwise. If Block 16.a. is "Yes", provide justification for the recurrence of this variance and explain why previous corrective actions did not prevent it from recurring.

17. Effectivity. Describe the product effectivity of this variance. Items affected may be listed by quantity, lot number(s), serial number(s), date(s) produced, or a combination thereof.

18. Per Unit Cost Impact. Enter the per unit cost impact of the variance. Variances accepted Post-Production should result in a reduction in cost; indicate cost reductions by enclosing the value in parentheses.

19. Total Cost Impact. Enter the total cost impact of the affected variance. Variances accepted Post-Production should result in a reduction in cost; indicate cost reductions by enclosing the value in parentheses.

20. Effect on Schedule if Approved/Disapproved. Describe any positive or negative effects on the delivery schedule pending the approval or disapproval of this variance.

21a-b. Contract Information. Enter the Supplier name, contract number, and the line item of the affected item, as applicable.

22a-c. Contracting Officer. Enter the name, telephone no., and email of contracting officer for the Acquirer.

23a-e. Originating Activity. Enter the name, address, CAGE Code, email and telephone number of the originating supplier or organization for the RFV.

24a-c. Submitting Authority. Enter the submitting activity, name, title, and signature of the individual authorized to submit the RFV on behalf of the originating activity (may be the same as identified in Block 23.a-e).

25a. Recommendation. Block 25a Check the appropriate box to indicate the disposition being recommended to the Configuration Approval Authority:

l Approval - RFV is recommended to the approval as submitted;

l Disapproval - RFV is recommended to be disapproved;

l Approval with Modification - RFV is recommended to be approved with modification from its original submittal. Modifications will be clearly delineated and described in the Material Review Board/

Configuration Control Board Directive/Minutes, and the contract instruction letter going back to the contractor as an official contract correcting action (if applicable).

25b. Modification Description. If 'Approval with Modification' is checked in Block 25a, describe the modification in this comment box..

25c-e. Recommendation. Enter the name, title, signature, and date signed. This block is to be completed by the activity making a recommendation in block 25a to the Configuration Approval Authority.

26a. Disposition. Check the appropriate box to indicate the final disposition of the RFV, i.e.

l Approval - RFV is approved as submitted;

l Disapproval - RFV is disapproved;

l RFV is approved with modification from its original submittal.

Modifications will be clearly delineated and described in the

Material Review Board/ Configuration Control Board Directive/

Minutes, and the contract instruction letter going back to the contractor as an official contract correcting action (if applicable).

26b. Modification Description. If 'Approval with Modification' is checked in Block 26a, describe the modification in this comment box..

26c-e. Disposition. Enter the name, title, signature, and date signed. This block is to be completed by the Configuration Approval Authority authorized to make the decision on the RFV.

27. List of Attachment(s). Block 27. Attachment(s). Use this section to provide additional file(s) relevant to the Request for Variance.

a. Add Attachment button. Use this button to attach additional file(s).

b. View Selected Attachment. Use this button to view attached file(s).

c. Remove Selected Attachment. Use this button to remove attached file(s).

d. List of Attachment(s). List the names of all attachments in this field.

9.0.0.2.20120627.2.874785

CurrentPage:

PageCount: