A07_Attachment_6__W91CRB-16-R-0004_PM_SPE_Form_1_(Engineering_Change_Request).pdf

PM SPE ENGINEERING CHANGE REQUEST (ECR)

(Vendors – Complete Blocks 2 – 19 and Submit to PM SPE)

1. PM SPE CONTROL NUMBER

2. ORIGINATOR 3. ECR TYPE

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

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

□ ECP □ RFD

□ RFW

4. CLASSIFICATION

□ Critical □ Minor

□ Major

5. TITLE OF ECR

6. ITEM DESIGNATION 7. PROCUREMENT ACTIVITY

8. BASELINE AFFECTED

a. MCN / NSN b. MODEL / DESIGN CODE □ Functional □ Product

□ Allocated

9. END ITEM NOMENCLATURE 10. CONTRACT NUMBER AND LINE ITEM

11. LOTS / MATERIAL AFFECTED

12. REOCCURING DEVIATION (if Yes, Provide CAR# in Block 12 & Status in Block 18)

13. EFFECT ON COST / PRICE

14. EFFECT ON DELIVERY SCHEDULE

15. OTHER SYSTEMS / CONFIGURATION ITEMS / INTERFACES AFFECTED

16. DESCRIPTION OF ECR

17. NEED FOR ECR

18. CORRECTIVE ACTION TAKEN

19. SUBMITTING ACTIVITY

a. TYPED NAME (FIRST, MIDDLE INITIAL, LAST)

c. SIGNATURE

b. TITLE / ORGANIZATION

d. DATE (YYYYMMDD)

PM SPE FORM 1 (ECR), JULY 15 Page 1

PM SPE CONTROL NUMBER

TITLE OF ECR

20. PM SPE JUSTIFICATION

21. ATTACHMENTS

22. COR (APPROVAL AUTHORITY FOR MINOR ECRS) / PM SPE TECHNICAL STAFF APPROVAL / DISAPPROVAL FOR MAJOR OR CRITICAL ECRS)

a. APPROVAL

□ Approved

□ Disapproved

b. SIGNATURE

c. DATE SIGNED

(YYYYMMDD)

23. APM APPROVAL / DISAPPROVAL (APPROVAL AUTHORITY FOR MAJOR ECRs)

□ Approved

24. PM SPE APPROVAL / DISAPPROVAL (APPROVAL AUTHORITY FOR CRITICAL ECRs)

□ Approved

PM SPE FORM 1 (ECR), JULY 15 Page 2

PM SPE CONTROL NUMBER

TITLE OF ECR

PM SPE FORM 1 (ECR), JULY 15 Page 3