Attachment 0007 - Request for Use of Prohibited Materials.docx

CUI

Attachment [xx] – Request for Use of Prohibited Material

Attachment 0007 Request for Use of Prohibited Materials

Revision No.: 001 Contract No. W912CH-24-R-00025 Date: XX XXX XX

Distribution Statement A – Approved for Public Release; distribution unlimited

(*Distribution Statement A only applies when form is not filled in. Once filled check the PEO CS&CSS Security Class Guide for proper distribution statement/markings)

Controlled by: Department of Army Controlled by: PEO CS&CSS, PdM HTV CUI Category: CTI Distribution Statement C POC: Eric Murphy, APM MET

Distribution Statement C: Distribution authorized to U.S. Government agencies and their contractors for critical technology date of determination 2 August 2022. Other requests for this document shall be referred to Product Manager Multi-Mission Protected Vehicle Systems, Warren, MI

WARNING - This document contains technical data whose export is restricted by the Arms Export Control Act (Title 22, U.S.C., Sec 2751, et seq). or the Export Administration Act of 1979, (Title 50, U.S.C., App. 2401 et seq). as amended. Violations of these export laws are subject to severe criminal penalties. Disseminate IAW provisions of DoD Directive 5230.25.

1. General Information

Requesting Company

Date of Request

Point of Contact

MET Prohibited material for which waiver is requested

2. Explanation of Use

Instructions: Provide a description of the parts/processes where the prohibited material will be used. Identify all components/parts which will contain the prohibited materials upon vehicle delivery including quantities of these parts. Indicate the specific variant and/or trailer the components/parts are on. Identify whether or not the material will be required for operation or maintenance (including during vehicle rebuild). A separate spreadsheet may be attached listing the specific parts/processes, if needed.

3. Health Hazard

Instructions: Provide an explanation of any health hazards associated with the use or presence of the prohibited material. Include likely routes of exposure to both the operator and the maintainer. Identify if any personal protective equipment (PPE) that would be required as a result of using this material. Include the type of PPE and under what circumstances it would be required (manufacturing, operation, maintenance, etc.).

4. Analysis of Alternatives

Instructions: Identify all alternative which were considered for the prohibited material. If the alternative is only for specific applications, identify what type of parts it is a potential alternative for. Include explanation as to why each cannot be implemented.

5. Technical Justification

Instructions: Provide technical justification for the use of MET prohibited material. Explain why it is necessary and why it cannot be eliminated.

6. Program Risk

Instructions: Describe the program risk(s) (cost, schedule, and performance) associated with denial of this request by the Government.

7. Get Well Plan

Instructions: Identify which parts where an alternative may be integrated at a later date. Provide a get well plan explaining how this will be accomplished. Also, indicate which parts you will not be able to eliminate and provide a brief explanation.

The following Sections will be filled in by the Government

8. Environmental Safety and Occupational Health Working Group (ESOH WG) Evaluation/ Recommendation

Instructions: Government ESOH WG will to provide evaluation of the above information and a recommendation to the Product Director/Project Manager regarding approval/disapproval of the prohibited material request.

ESOH Representative

9. Concurrence

I concur that use of {prohibited material} as described above under the {Contractor Name} Contract –{Contract Number} is acceptable and justified:

MET Lead Engineer

Product Manager

10. Approval

Upon the basis of the findings above, I hereby determine that use of {prohibited material} in the parts identified in Section 1 for {Contractor Name} Contract {Contract Number}is acceptable and justified.

Project Manager