HSCG23-11-R-ADB013 Attach 6.pdf

SUPPLY ITEM CHANGE RECORD

13A. SOURCE CODE 14A. SOURCE MAINT.

RECOVER CODE

D.

INVENTORY MANAGER

ACMS □ ATS □ PRIME UNIT □

ORIGINATOR □ PUBS □

29. COPY TO:

I.

H.

C.

ESD ENGINEERING SUPPORT CELL LEADER

ENG CELL ASSET LINE MANAGER

ASSET TYPE___________

ENG CELL ASSET LINE MANAGER

ASSET TYPE___________

ENG CELL ASSET LINE MANAGER

ASSET TYPE___________

Use if Item is on other Assets B.

ENG CELL ASSET LINE MANAGER

ASSET TYPE___________

PRODUCT LINE SICR MANAGER

IM/EQUIP SPECIALIST ( IF APPL.)

G.

DATA MANAGEMENT

F.

EQUIP SPECIALIST

E.

SUPPLY CELL LEADER ENGINEERING CELL LEADER

ASSET TYPE___________

A.

27. REVIEW – SIGN and DATE

25. ENGINEERING INFORMATION

CHANGES: FORM □ FIT □ FUNCTION □ N/A □

DRAWING PROVIDED:

ATTACHED □ FOLLOWS □ N/A □

22. PUB CHANGE REQUIREMENT

REFERENCE INFO ONLY

TCTO # _________________________________________________________________________

CEINUM(s)_______________________________________________________________________

MPC No._________________________________________________________________________

CMS Code _________________________________________________________________________

Tech Doc Number _________________________________________________________________

FIG# / ITEM# ____________________________________________________________________

NEXT HIGHER ASSY# _____________________________________________________________

REMARKS ______________________________________________________________________

REQUIREMENT:

( MONTHLY, QUARTERLY, HOURLY ETC.) __________________ AS NEEDED ______________

28. DATA MANAGEMENT INFORMATION

26. SUPPLY INFORMATION

U/I = ______ MATERIAL TYPE _____

ASSIGN NIIN □ ADD TO ALMIS □ “AAC” _____

24. REMARKS

PHONE 23. SICR INITIATED BY: (PRINT)

21. AMC AMSC

NEW

20. AMC AMSC

OLD

19. OLD Mission Critical NEW Mission Critical

YES □ NO □ YES □ NO □

ONE WAY □

TWO WAY □

NOT □

NEW ITEM OLD ITEM

18. ESTIMATED UNIT COST

USE UNTIL EXHAUSTED □

MODIFY □

SCRAP □ OTHER □ N/A □

17. DISPOSITION OF ARSC STOCK 16. INTERCHANGEABLE

15A. REPARABILITY

R C

13. SOURCE CODE

12A. ACMS/ATS SERIAL NUMBER TRACKED 11A. NOMENCLATURE 12. ACMS/ATS SERIAL NUMBER TRACKED

YES □ NO □

14. SOURCE MAINT.

RECOVER CODE

15. REPARABILITY

R C

11. NOMENCLATURE

10B. SHELF LIFE 10A. CAGE 9A. P/N 10. CAGE 9. P/N

8. NSN

7A. ITEM STATUS

□ INVENTORY □ SUPERSEDING □ ALTERNATE

□ NON-INVENTORY □ ADDED □ OTHER

PRIMARY □ SECONDARY □ 8A. NSN

7. ITEM STATUS

□ SUPERSEDED □ DELETED

□ NON-INVENTORY □ REDUCED □ OTHER

PRIMARY □ SECONDARY □

OLD ITEM (ALREADY IN ALMIS) NEW ITEM

6. SICR NO.

5. PAGE OF

4. DATE:

ARMY □ NAVY□

AF □ CG □ OGA □

3. COMMONALITY

ENG CELL

LEADER

2. AUTHORITY

OTHER:

1. PRIMARY PRODUCT LINE CELL

DEPARTMENT OF HOMELAND SECURITY

U.S. COAST GUARD

YES □ NO □

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HSCG23-11-R-ADB013 GFI ATTACHMENT 6