Exhibit B - Request for Variance - DD FORM 1694.pdf

REQUEST FOR DEVIATION/WAIVER (RFD/RFW)

1. DATE (YYYYMMDD) Form Approved

OMB No. 0704-0188

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ADDRESS. RETURN COMPLETED FORM TO THE GOVERNMENT ISSUING CONTRACTING OFFICER FOR THE CONTRACT/ PROCURING ACTIVITY NUMBER LISTED IN ITEM 2 OF THIS FORM.

2. PROCURING ACTIVITY

NUMBER

3. DODAAC

4. ORIGINATOR

a. TYPED NAME (First, Middle Initial, Last)

b. ADDRESS (Street, City, State, Zip Code) 5. (X one)

DEVIATION WAIVER

6. (X one)

MAJOR CRITICAL

MINOR

7. DESIGNATION FOR DEVIATION/WAIVER 8. BASELINE AFFECTED

a. MODEL/TYPE b. CAGE CODE c. SYS. DESIG. d. DEV./WAIVER NO.

PRODUCT

ALLO-

CATED

FUNC-

TIONAL

9. OTHER SYSTEM/CONFIGU-

RATION ITEMS AFFECTED

YES NO

10. TITLE OF DEVIATION/WAIVER

11. CONTRACT NO. AND LINE ITEM 12. PROCURING CONTRACTING OFFICER

a. NAME (First, Middle Initial, Last)

b. CODE c. TELEPHONE NO.

13. CONFIGURATION ITEM NOMENCLATURE 14. CLASSIFICATION OF DEFECT

a. CD NO. b. DEFECT NO. c. DEFECT CLASSIFICATION

MAJOR CRITICALMINOR

15. NAME OF LOWEST PART/ASSEMBLY AFFECTED 16. PART NO. OR TYPE DESIGNATION

17. EFFECTIVITY

19. EFFECT ON COST/PRICE

18. RECURRING DEVIATION/WAIVER

NOYES

20. EFFECT ON DELIVERY SCHEDULE

21. EFFECT ON INTEGRATED LOGISTICS SUPPORT, INTERFACE OR SOFTWARE

22. DESCRIPTION OF DEVIATION/WAIVER

23. NEED FOR DEVIATION/WAIVER

24. CORRECTIVE ACTION TAKEN

25. SUBMITTING ACTIVITY

a. TYPED NAME (First, Middle Initial, Last)

b. TITLE c. SIGNATURE

26. APPROVAL/DISAPPROVAL a. RECOMMEND APPROVAL DISAPPROVAL

b. APPROVAL

APPROVED DISAPPROVED

c. GOVERNMENT ACTIVITY

d. TYPED NAME (First, Middle Initial, Last)

e. SIGNATURE f. DATE SIGNED

(YYYYMMDD)

g. APPROVAL

APPROVED DISAPPROVED

h. GOVERNMENT ACTIVITY

i. TYPED NAME (First, Middle Initial, Last)

j. SIGNATURE k. DATE SIGNED

(YYYYMMDD)

DD FORM 1694, AUG 96 (EG) PREVIOUS EDITION MAY BE USED. Designed using Perform Pro, WHS/DIOR, Aug 96

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