OMB NO 0704-0188
1. DATE PREPARED:
2.
ECP NUMBER:
ENGINEERING CHANGE PROPOSAL
(
00-Mon
-YYYY)
(ECP)
3.
PR
OCURING ACTIVITY NO. (PAN):
The
publte
reporllng
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tor
thts
collection
ot
tn
t
ormauon
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average
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hours
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response
,
tnduding
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tor
reV>ewtng
t
nstruetoos
, s
ea
rehtng
extsuno
da
ta
sources
.
ga
th
enng
and
matntatn.ng
tho
data
needed
and
eompleung
and
reYiew>ng
the
co11ee110n
ot
1111ormauon
Send
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rega
ro
.,o
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e
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ate
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ot
llllorm
a
oon
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ud
tng
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tor
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biJrden
.
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rt
ment
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t
on
Headquarters
SCIV!Ces
,
Exeeuuve
Se
Mees
Olr
eel
orate
,
Ol
te
ellves
DIVISIOn
, 4
800
Ma
ll<
Ce
nte
r
Onve
,
Ale
xand
na
,
VA
22350-3100 (0704.0188)
Respondents
shou
ld
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aware
tha
t
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iWith
standtng
any
ot
her
proVISion
ot
law
,
no
person
sh
all
be
su
bJed
to
an
y
pena
lty
t
or
lat
hng
to
com
pl
y
With
a
collectio
n ot
tn
torma
bon
''
11
does
not
dtsplay
a
eurrenUy
vah
d
OM
B
con
tr
ol
num
ber
PLEASE
DO
NOT
RETURN
YOUR
COMPLETED
FORM
TO
THIS
ADDRESS
.
RETURN
COMPLETED
FORM
TO
THE
ACQU
I
RER
ISSUING
CO
NTRA
CTING
OFFICER
FOR
THE
CONTRACT/PROCURING
ACTIV
I
TY
NUMBER
USTED
IN
I
TEM
23
OF
THIS
FORM
.
4. TITLE OF CHANGE:
5.
GlASS
OF ECP: 16. PRIORITY:
I 0 Maj or (Class I) D Minor
(C
lass
II
) In E - Emergency n U -
Urg
ent
n R - Routine
17. ECP TYPE:
In p - Preliminary n F - Formal
8.
JUSTIFICATION CODE: 0 B - Interface 0 C -
Co
mpatibility 0 D -
Co
rrection
of
Deficiency 0 0 - Operational or Logistic Support
I D p - Production Stoppage n R - Cost Reduction n s - Safety n v -
Va
lue Engineering n A
-A
dministrative (Used with
Minor
Class
Only
)
9. DESCRIPTION OF CHANGE:
10. NEED FOR CHANGE:
11
. TOP-LEVEL ITEM NAME AND DESIGNATION:
112. HIGHER-LEVEL ITEM
NAME AND DESIGNATION:
13. PRIMARY ITEM I a. ITEM NAME AND DESIGNATION:
I
b. PART NO
.:
c. NSN:
14. AFFECTED I a. ITEM NAME AND DESIGNATION:
I
b.
PART
NO.:
I
c. NSN:
1
1
d. ALTER, ADD. OR
ITEM(S)
REMOVE:
15. LIST OTHER EXTERNAL SYSTEMS OR EXTERNAL CONFIGURATION ITEMS AFFECTED:
16.
DOCUMENTS AFFECTED
d.
e. f. REVISED
CURRENT NOR
DO
CUMENT
a.
CAGE b. DOCUMENT NO.
c. TITLE/NOMENCLATURE/NAME
REVISION NO. ATTACHED (YIN)?
17.
BASELINE AFFECTED: 118. IN PRODUCTION:
19. PRODUCTION EFFECTIVITY:
20.
EFFECT ON DELIVERY SCHEDULE
IO
Funct
ional 0 Alloca
ted
0 Produc
ti
O
Yes
0 No
(quanttry, Lot
No
. Senal No . Date)
21a. COST IMPACT FROM ECP?
0
Yes
O No
IF BLOCK 2
1A
IS YES.
IN
CLUDE REFERENC
ES
:
21
b. RETROFIT
EX
ISTING ASSETS?
f l
Ye
s
[
]No
21
c. RETROFIT EFFECTIVITY:
(I
F 21b IS YES,
EN
T
ER
RETROFIT
EFFECTIVITY INFORMATION, IF
218
IS
NO
ENTER NIA)
21d. RETROFIT DELIVERY SCHEDULE:
(
IF
21b
IS
Y
ES
. ENTER RETROFIT DELIV
ERY
SCHEDULE
INFORMAT
I
ON
; IF 2
18
IS
NO
,
ENTER
NIA)
22. CONTRACT
a. SUPPLIER: I b. CONTRACT NO./LINE ITEM:
23. CONTRACTING OFFICER Ia . NAME:
r· TELEPHONE:
lc
. E-MAIL:
24 . ORIGINATOR
a. NAME:
b.
ADDRESS: (Street, Cit
y,
State, Zip Code)
e. CAGE CODE:
c. TELEPHONE:
d.
E-MAIL:
f. SUBMITTING ACTIVITY: , g . AUTHORIZED SIGNATURE:
h. NAME AND TITLE (A
ut
horizing Offi
ci
al)
25. BELOW
TO
BE COMPLETED BY THE APPROVING ACTIVITY
a. RECOMMENDATIONS:
O Approv
al
O
Disapproval
0 Approv
al
With
Mod
ification
b. NAME AND
TITLE
I
c.
UA
I I::
::Sit;Nt:U
: (DD-Mon-YYYY} I d. SIGNATU
RE
:
26a. DISPOSITION:
(C
onfiguratton Approval
Authonty
) 0 Appro
va
l
0 Di
sapprova
l 0 Approv
al
With
Mod
tlication
b. NAME AND
TITLE
~
t'
DATE SIGNED: (DD-Mon-YYYY)
1
d. SIGNATURE:
27. ACTIVITY ACCOMPLISHING REVISION AND DATE OF REVISION
a. NAME AND TIT
LE
DD
FORM 1692, MAY 2015
DISTRIBUTION
STATE
MENT
I b. DATE SIGNED: (
DD
-Mon- YYYY) I c. SIGNATURE:
PREVIOUS EDITION IS OBSOLETE
Page 1 of 5
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