Request_for_Variance_Form_1694_Additional_Guidance_Rev_NA_dated_03_23_17.pdf

Page 1 of 3 DD FORM 1694, MAY 2015 PREVIOUS EDITION IS OBSOLETE

DISTRIBUTION STATEMENT:

REQUEST FOR VARIANCE

(RFV)

1. DATE PREPARED:

(DD-Mon-YYYY)

2. RFV NUMBER:

3. PROCURING ACTIVITY NO. (PAN):

OMB No.

0704-0188

The public reporting burden for this collection of information 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 this burden estimate or any other aspect of the collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive, Alexandria, VA 22350-3100 (0704-0188). 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 ITEM 23 OF THIS FORM.

4. TITLE OF VARIANCE:

5. VARIANCE PRE OR POST-PRODUCTION:

Pre-Production Post-Production

6. BASELINE AFFECTED:

Functional Allocated Product

7. SYSTEM

INFORMATION

a. MODEL/TYPE DESIGNATION: b. SYSTEM/CONFIG. ITEM NOMENCLATURE: c. END ITEM CAGE CODE:

8. AFFECTED ITEM NOMENCLATURE: 9. PART NUMBER(S) OF AFFECTED ITEM(S):

10a. OTHER EXTERNAL SYSTEM AFFECTED?:

Yes No

b. IF BLOCK 10a IS YES, LIST OTHER SYSTEMS OR CONFIGURATION ITEMS AFFECTED:

11. IDENTIFICATION

OF DEFECT

a. VARIANCE CLASSIFICATION:

Critical Major Minor

b. DEFECT NO.: c. DOCUMENT DEFINING DEFECT NO./CLASS:

12. DESCRIPTION OF VARIANCE:

13. NEED FOR VARIANCE:

14. CORRECTIVE ACTION TAKEN:

15. EFFECT ON PERFORMANCE, FUNCTION, RELIABILITY, DURABILITY, INTEGRATED LOGISTICS SUPPORT, INTERFACE OR SOFTWARE:

16. RECURRENCE a. RECURRING VARIANCE?:

Yes No

b. IF BLOCK 16a IS YES, PROVIDE RATIONALE:

17. EFFECTIVITY: (Quantity Affected, Lot Numbers Affected, Serial Numbers, Dates)

18. PER UNIT COST IMPACT: 19. TOTAL COST IMPACT: 20. EFFECT ON SCHEDULE IF APPROVED/DISAPPROVED:

21. CONTRACT

INFORMATION

a. SUPPLIER: b. CONTRACT NO. AND LINE ITEM:

22. CONTRACTING

OFFICER

a. NAME: b. TELEPHONE: c. E-MAIL:

23. ORIGINATING

ACTIVITY

a. NAME:

c. TELEPHONE:

b. ADDRESS: (Street, City, State, Zip Code)

e. E-MAIL: d. CAGE CODE:

24a. SUBMITTING AUTHORITY: b. NAME AND TITLE: c. SIGNATURE:

BELOW TO BE COMPLETED BY THE APPROVING ACTIVITY

25a. RECOMMENDATION: Approval Approval with Modification Disapproval

b. NAME AND TITLE: c. SIGNATURE: d. DATE: (DD-Mon-YYYY)

26a. DISPOSITION: (Configuration Approval Authority) Approved Approved with Modification Disapproved

b. NAME AND TITLE: c. SIGNATURE: d. DATE: (DD-Mon-YYYY) elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line elizabeth.braun Line melina.andino-rivera Typewritten Text RFV Form 1694 Additional Guidance Revision NA dated 03/23/17

Page 2 of 3 DD FORM 1694 INSTRUCTIONS, MAY 2015

INSTRUCTIONS FOR PREPARATION OF

REQUEST FOR VARIANCE UTILIZING DD FORM 1694

GENERAL

SCOPE. This instruction establishes uniform requirements for the preparation of the 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 the 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.

Block 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).

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

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

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

Block 5. Variance Pre or Post-Production. If the RFV is requested prior to manufacture of the item, check “Pre-Production” (e.g. variance approval requested prior to need (pre DD 250); 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 requested after being produced (post DD 250); product manufactured and found to be nonconforming).

Block 6. Baseline Affected. Enter the affected baseline.

Block 7a-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.

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

Block 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.

Block 10a. 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.

Block 10b. List Other Systems or Configuration Items Affected. List Other External Systems or Configuration Items Affected. If block 10.a. is checked `Yes', list the other system(s) or Configuration Item(s) (CIs) affected.

Block 11a-c. Identification of Defects. Enter the variance Defect classification, Supplier Defect Number (optional), and the Supplier Document Defining Defect No/Class (optional).

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

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, and

(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, or

(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 which 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. (optional): Enter the Supplier defect number which corresponds with the Variance listing of defect characteristic(s) from which an authorized variance can be released.

11c. Document Defining Defect No./Class (optional): If needed, enter the appropriate title or reference number of the Supplier document that details/lists the defect numbers or identifies the variance classification based on the defect number definition(s).

Block 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, or scrapped, and in some cases retrofitted.

Block 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.

Page 3 of 3 DD FORM 1694 INSTRUCTIONS, MAY 2015

INSTRUCTIONS FOR PREPARATION OF

REQUEST FOR VARIANCE UTILIZING DD FORM 1694

Block 15. Effect on Performance, Function, Reliability, Durability, Integrated Logistics Support, Interface or Software. Describe the effects of the variance on any of the factors listed on Page 2 of DD Form 1692, Engineering Change Proposal (ECP). Describe any effects this variance may have on these factors, contract requirements or configuration documentation. If the variance has no effect on these factors, then provide a statement acknowledging the DD Form 1692 review and identify which factors have no impact.

Block 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.

Block 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.

Block 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.

Block 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.

Block 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.

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

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

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

Block 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).

Block 25a-d. Recommendation. Enter the name, title, signature and date signed. This block is completed by the activity making a recommendation to the Configuration Approval Authority, as required.

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

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.

(Provide enough specific details to support the understanding of the proposed variance.)

Blk13-NfV: Rubber IAW MIL-R-81090 Type I is unavailable. It is requested that the Shorting Cap be made of 6061-T6 Aluminum for this contract IAW the red-lined drawing (attached) (Explain why needed with technical justification.)

Somewhere City, STATE 55555