Request for Variance Form 1694 Additional Guidance Rev A.pdf

PREVIOUS EDITION IS OBSOLETEDD FORM 1694, APR 2017 Page 1 of 2 AEM LiveCycle Designer

REQUEST FOR VARIANCE

(RFV)

1. DATE PREPARED:

(DD-MMM-YYYY)

DD-Mon-YYYY

2. RFV NUMBER:

XXXX-XXXX

3. PROCURING ACTIVITY NO. (PAN):

N00104

OMB No.

0704-0188 Exp 10/31/2019

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 BLOCK 22 OF THIS FORM.

DISTRIBUTION STATEMENT:

(Please insert the appropriate distribution statement/export control warning IAW DODI 5230.24)

4. TITLE OF VARIANCE: Housing, Firing Pin Discrepancies

5. VARIANCE PRE OR POST-PRODUCTION: 6. BASELINE AFFECTED:

Pre-Production Post-Production Functional Allocated Product

7. SYSTEM

INFORMATION

7.a. MODEL/TYPE DESIGNATION:

JAU-13 (M596)

7.b. SYSTEM/CONFIG. ITEM NOMENCLATURE:

Initiator, Cartridge Actuated JAU-13/A

7.c. END ITEM CAGE CODE:

30003

8. AFFECTED ITEM NOMENCLATURE:

Housing, Firing Pin

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

851AS115 Rev D

10.a. OTHER EXTERNAL SYSTEM AFFECTED?:

Yes No

11. IDENTIFICATION

OF VARIANCE

11.a. VARIANCE CLASSIFICATION:

Critical Major Minor

11.b. DEFECT NO.

(if applicable):

N/A

11.c. DOCUMENT DEFINING DEFECT NO./CLASS (if applicable):

N/A (e.g. a discrepancy record)

12. DESCRIPTION OF VARIANCE:

Three dimensional discrepancies - see block 22 of attached RFD XXXX-14.

13. NEED FOR VARIANCE:

No other parts are available for immediate use. Previously approved RFD XXXX-14 provided acceptance of the part but limited effectivity to work order M596-N-XXXX, which is not valid for this assembly.

14. CORRECTIVE ACTION TAKEN:

Resolve dimensional discrepancies with an ECP.

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

None

16. RECURRENCE 16.a. RECURRING VARIANCE?:

Yes No

16.b. IF YES, PROVIDE RATIONALE:

Prior RFD XXXX-14 effectivity was limited to M596-N-XXXX

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

Work Order M596-R-XXXX

18. PER UNIT COST IMPACT:

$100.00

19. TOTAL COST IMPACT:

$11,000.00

20. EFFECT ON SCHEDULE IF APPROVED/DISAPPROVED:

8 Months for re-manufacture

21. CONTRACT

INFORMATION

21.a. SUPPLIER:

ABC Manufacturing Inc

21.b. CONTRACT NO. AND LINE ITEM:

Contract NXXXXX-XX-X-XXXX (Line item(s) if applicable)

22. CONTRACTING

OFFICER

22.a. NAME:

John Doe

22.b. TELEPHONE:

+1 (555) 555-5555

22.c. E-MAIL:

john.doe@navy.mil jacob.appelbaum Highlight jacob.appelbaum Highlight jacob.appelbaum Highlight melina.andino-rivera Typewritten Text RFV Form 1694 Additional Guidance Revision A dated 03/16/18

PREVIOUS EDITION IS OBSOLETEDD FORM 1694, APR 2017 Page 2 of 2 AEM LiveCycle Designer

23. ORIGINATING

ACTIVITY

23.a. NAME: Jane Smith

23.c. TELEPHONE: +1 (123) 456-7890

23.d. CAGE CODE:XXXXX 23.e. E-MAIL: jane.smith@navy.mil

23.b. ADDRESS: (Street, City, State, Zip Code) XXX Red Robin Ln.

Somewhere City, STATE 12345

24.a. SUBMITTING AUTHORITY:

ABC Manufacturing Inc

24.b. NAME AND TITLE:

Jane Smith, Manufacturing Branch Manager

24.c. SIGNATURE:

BELOW TO BE COMPLETED BY THE APPROVING ACTIVITY

25.a. RECOMMENDATION: Approval Approval with Modification Disapproval

25.b. MODIFICATION DESCRIPTION:

(If a modification from the original submittal is described, an official contract correcting action must be sent back to the contractor)

25.c. NAME AND TITLE:

Joe Smith Manager, In-Service Engineering

25.d. SIGNATURE: 25.e. DATE: (DD-MMM-YYYY)

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

26.b. MODIFICATION DESCRIPTION:

(If a modification from the original submittal is described, an official contract correcting action must be sent back to the contractor)

26.c. NAME AND TITLE:

Jane Doe Chief Engineer

26.d. SIGNATURE: 26.e. DATE: (DD-MMM-YYYY)

27. LIST OF ATTACHMENTS

List Of Attachments (2) dd1694c.pdf dd1694-Inst.pdf jacob.appelbaum Highlight jacob.appelbaum Highlight