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
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, Directorate for Information Operations and Reports (0704-0188), 1215 Jefferson Davis Highway, Suite
1204, Arlington, VA 22202-4302. 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.
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