Attachment_0015-2_DD_Form_1695_NOR(pg2).pdf

DoD Form PDF 50 KB Posted

Attached to
Expeditionary Shelter Protection System (ESPS)
Solicitation number
W911QY-16-R-0003
Issued by

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Attachment 0015-2_DD Form 1695_NOR(pg2)

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Text version

16. THIS SECTION COMPLETED BY THE ACTIVITY ACCOMPLISHING REVISION UPON NEW REVISION RELEASE

BELOW TO BE COMPLETED BY THE APPROVING ACTIVITY

5. ORIGINATOR

INFORMATION

NOTICE OF REVISION (NOR)

(TABULATED)

13. DESCRIPTION OF REVISION:

3. ECP NO.:

b. NAME: c. ADDRESS (Street, City, State, Zip Code):a. CAGE CODE:

1. DATE PREPARED

(DD-MMM-YYYY)

6.

TITLE OF AFFECTED

DOCUMENT:

9.

CURRENT

REVISION:

OMB No.

0704-0188

c. DATE SIGNED

(DD-MMM-YYYY)

14.

(X only one)

a. EXISTING DOCUMENT SUPPLEMENTED BY THIS NOR MAY BE USED IN MANUFACTURE.

b. REVISED DOCUMENT MUST BE RECEIVED BEFORE MANUFACTURING MAY INCORPORATE THIS CHANGE.

11.

CONFIGURATION ITEM (OR SYSTEM)

TO WHICH ECP APPLIES:

15.a. ACTIVITY AUTHORIZED TO APPROVE CHANGE:

b. NAME AND TITLE (Configuration Change Authority):

2. PROCURING ACTIVITY NO. (PAN):

8.

DOCUMENT

NO.:

7.

DOCUMENT

CAGE CODE:

c. REVISION COMPLETED (Signature):

4. NOR NO.

OF

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 this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management 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 GOVERNMENT ISSUING CONTRACTING OFFICER FOR THE CONTRACT/PROCURING ACTIVITY NUMBER LISTED IN ITEM 2 OF THIS FORM.

d. TELEPHONE: e. E-MAIL:

10.

NOR

NO.:

13.a. REMARKS/RATIONALE:

d. SIGNATURE:

a. NAME AND TITLE: b. DATE SIGNED

(DD-MMM-YYYY)

Adobe Designer 9.0

DISTRIBUTION STATEMENT:

DD FORM 1695-1 (Tabulated NOR), MAR 2013

DD Form 1695-1, Notice of Revision (Tabulated), March 2013

WHS/ESD/IMD

16. THIS SECTION COMPLETED BY THE ACTIVITY ACCOMPLISHING REVISION UPON NEW REVISION RELEASE

BELOW TO BE COMPLETED BY THE APPROVING ACTIVITY

5. ORIGINATOR

INFORMATION

NOTICE OF REVISION (NOR)

(TABULATED)

13. DESCRIPTION OF REVISION:

3. ECP NO.:

b. NAME:

c. ADDRESS (Street, City, State, Zip Code)

a. CAGE CODE

1. DATE PREPARED

(DD-MMM-YYYY)

6.

TITLE OF AFFECTED

DOCUMENT:

9.

CURRENT

REVISION:

OMB No.

0704-0188

c. DATE SIGNED

(DD-MMM-YYYY)

14.

(X only one)

a. EXISTING DOCUMENT SUPPLEMENTED BY THIS NOR MAY BE USED IN MANUFACTURE.

b. REVISED DOCUMENT MUST BE RECEIVED BEFORE MANUFACTURING MAY INCORPORATE THIS CHANGE.

11.

CONFIGURATION ITEM (OR SYSTEM)

TO WHICH ECP APPLIES:

15.a. ACTIVITY AUTHORIZED TO APPROVE CHANGE:

b. NAME AND TITLE (Configuration Change Authority)

2. PROCURING ACTIVITY NO. (PAN):

8.

DOCUMENT

NO.:

7.

DOCUMENT

CAGE CODE:

c. REVISION COMPLETED (Signature)

4. NOR NO.

OF

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 this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management 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 GOVERNMENT ISSUING CONTRACTING OFFICER FOR THE CONTRACT/PROCURING ACTIVITY NUMBER LISTED IN ITEM 2 OF THIS FORM.

d. TELEPHONE:

e. E-MAIL:

10.

NOR

NO.:

13.a. REMARKS/RATIONALE:

d. SIGNATURE:

a. NAME AND TITLE:

b. DATE SIGNED

(DD-MMM-YYYY)

Adobe Designer 9.0

DISTRIBUTION STATEMENT:

DD FORM 1695-1 (Tabulated NOR), MAR 2013

1. Date prepared (2 digit day-3 letter month-4 digit year).:
2. Procuring Activity Number (PAN).:
3. Engineering Change Proposal (ECP) number.:
4. Notice of Revision (NOR) number.:
Of::
5. Originator. a. CAGE code.:
b. Name (first, middle initial, last).:
c. Address (street, city, state, zip code).:
d. Telephone number.:
e. E-mail address.:
6. Title of affected document, line 1.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 1.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 3.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 4.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 5.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 6.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 7.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 8.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 9.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 10.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 11.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 12.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 13.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 14.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 15.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 16.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
6. Title of affected document, line 17.:
7. Document CAGE code.:
8. Document number.:
9. Current revision.:
10. Notice of Revision number.:
11. Configuration item (or system) to which ECP applies.:
12. Description of revision.:
13. Remarks/rationale.:
14. To be completed by the approving authority. a. X first box if existing document may be used, second if revised document must be received.:
15.a. Activity authorized to approve change.:
b. Name (first, middle initial, last).:
e. Date signed (2 digit day-3 letter month-4 digit year).:
d. Signature.:
b. Name (first, middle initial, last).:
d. Date signed (2 digit day-3 letter month-4 digit year).:
c. Revision completed (signature).:
Distribution statement.:

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