Attachment 4: RFV Form DD1694 Example Only (dated 6 5 25)

RFV Form DD1694 Example Only dated 06/05/2025

2. RFV NUMBER:

1. DATE

PREPARED:

REQUEST FOR VARIANCE

(RFV)

24CK999-V001

(DD-MMM-YYYY)

OMB No. 0704-0188

OMB approval expires
October 31, 2019

3. PROCURING ACTIVITY NO. (PAN):

14-FEB-2024

N00104

The public reporting burden for this collection of information, 0704-0188, 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at [email protected]. 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 ACQUIRER ISSUING CONTRACTING OFFICER FOR THE CONTRACT/PROCURING ACTIVITY NUMBER LISTED IN BLOCK 22 OF THIS FORM.

Critical

Verity distribution statement with the contract.

DISTRIBUTION STATEMENT:

DISTRIBUTION STATEMENT D: Distribution authorized to Department of Defense and U.S. DoD contractors only; Controlled Technical Information (CTI); January 1, 2024. Other requests for this document shall be referred to Commanding Officer or Technical Verity date with the contract.
Director, NSWC Indian Head Division.

4. TITLE OF VARIANCE:

5. VARIANCE PRE OR POST-PRODUCTION:

Pre-Production

6. BASELINE AFFECTED:

Post-Production

Functional

Allocated

Product

7.a. MODEL/TYPE DESIGNATION: 7.b. SYSTEM/CONFIG. ITEM NOMENCLATURE:

7.c. END ITEM CAGE CODE:

CKU-5C/A (JM60)

14083

F-16, F-22

8. AFFECTED ITEM NOMENCLATURE:

PL
E

7. SYSTEM

INFORMATION

Brief description of intent/purpose to include identifying info such as DODIC/model/type

JM60 Catapult battery voltage check

End item cage code

9. PART NUMBER(S) OF AFFECTED ITEM(S):

Per Section B of the contract ("See attached" if cont.
page if needed). Nomenclature name should match
affected item name.

Inflation Device,Water Activated FLU-11/A 855AS110, 1812-172-01

If needed, enter the appropriate
title or reference number of the
document that details/lists
10.a. OTHER EXTERNAL SYSTEM AFFECTED?: 10.b. IF YES, LIST OTHER SYSTEMS OR CONFIGURATION ITEMS AFFECTED:supplier the defect numbers, or identifies