Section_J_-_Atch_63_-_CDR.pdf

FTC-ADM-67 (5/90)

CONTRACT DISCREPANCY REPORT

1. CONTRACT NUMBER 2. REPORT NUMBER FOR THIS DISCREPANCY

3. To: (Contractor and Managers Name) 4. From: (Name of COTR)

5 DATES

PREPARED CONTRACTOR NOTIFIED RETURNED BY CONTRACTOR ACTION COMPLETED

6. DISCREPANCY OR PROBLEM: (Describe in Detail: include reference to SOW/Directive:attach continuation sheet if necessary.)

7. SIGNATURE OF CONTRACTING OFFICER DATE

TO: (Contracting Officer) FROM: (Contractor)

9. CONTRACTOR RESPONSE AS TO CAUSE, CORRECTIVE ACTION AND ACTIONS TO PREVENT RECURRENCE: ATTACH CONTINUATION SHEET IF NECESSARY. (Cite applicable Q.C.program procedures or new Q.C. program procedures.)

10. SIGNATURE DATE

11. GOVERNMENT EVALUATION (Acceptance, partial acceptance, rejection, attach continuation sheet if necessary.)

12. GOVERNMENT ACTIONS (Payment deduction, cure notice, show cause, other)

13 CLOSE OUT

NAME - TITLE SIGNATURE DATE

CONTRACTOR

NOTIFIED

COTR

CONTRACTING

OFFICER

ORIGINAL - CONTRACTOR COPY - COTR COPY - PROCUREMENT

Atch 63 (Page 1 of 1)

Sheet1