SOLICITATION: CANISTER, CHEMICAL BIOLOGICAL: M61 (NSN: 4240-01-529-2289)

This information/supporting documentation is part of your quote/offer. Contact the buyer if you have any questions about the acquisition offer/quote requirements. Submitter completes Sections 1 through 6. FIRST ARTICLE WAIVER REQUEST WORKSHEET Request for Information and Supporting Documentation BUYER'S NAME DEVCOM CBC FORM 081 Revision A 6 April 2022 1. CURRENT ACQUISITION INFORMATION: NOMEN PART # NSN TOP DRAWING # SOLICITATION/CONTRACT # REVISION LEVEL 2. TYPE OF REQUEST: Partial Waiver: Includes waiver of only a specific test(s) of the First Article Test requirement as required by the Technical Data Package (TDP) and/or solicitation. Full Waiver: Includes waiver of all First Article Testing as required by the TDP and/or solicitation. TDP Reference(s) of test(s) to be waived: (Please be specific and reference specification paragraph and/or drawing note as appropriate). 3. JUSTIFICATION TO SUPPORT WAIVER REQUEST: (Check and complete all that apply) Successful completion of a First Article Test on a recent contract for the same item(s). Complete the following & attach supporting documentation*. If NO, please describe the differences in detail below and include any considerations these changes will require for the First Article Test waiver request DATE OF FIRST ARTICLE TEST APPROVAL CONTRACT # ISSUING GOVERNMENT AGENCY Was the above contract manufactured at the same facilities using the same equipment, processes, procedures, and subcontractors in which the current item will be produced? Page 1 of 4 A) DEVCOM CBC FORM 081 -- 1 of 4 -- Successful completion of a First Article Test on a similar item on a recent contract and the item has been tested on the same or substantially similar specification(s) as those herein referenced. Complete the following for the similar item & attach supporting documentation*: Briefly describe the major differences between the similar item and the item being procured such as size, materials, and/or other characteristics. NSN CONTRACT # DATE OF FIRST ARTICLE TEST APPROVAL Was the similar item manufactured at the same facilities using similar equipment, processes, and procedures in which the current item will be produced? B) NOMENCLATURE PART NUMBER If NO, please describe the differences in detail below and include any considerations these changes will require for the First Article Test waiver request Material has been in continuous production. Complete and attach supporting documentation*: Remarks (if needed) LENGTH OF PRODUCTION RUN C) APPROVAL DATE OF LAST SUCCESSFUL FIRST ARTICLE TEST Provide a full explanation justifying why duplicate testing is unnecessary: Recent and successful performance of a first article test on the next higher assembly. A waiver may be requested in order to eliminate duplication of testing on the lower assembly. Complete the following for the next higher assembly and attach supporting documentation*: D) NSN CONTRACT # DATE OF FIRST ARTICLE TEST APPROVAL NOMENCLATURE PART NUMBER Was the next higher assembly manufactured at the same facilities in which the current item is being procured? If NO, please explain: Page 2 of 4 DEVCOM CBC FORM 081 -- 2 of 4 -- Page 3 of 4 Other: A waiver or partial waiver of the FAT is being requested based on the following: Please be specific and attach supporting documentation* as appropriate: E) 4. OTHER PERTINENT INFORMATION Are there quality issues which affect the fit, form, or function of the item being procured, which may not be known by the Government? Please briefly discuss below: A) Have changes been made to the item, processes or subcontractors used to manufacture the item, which may not be known by the Government? Please describe below. B) Have there been any Request for Variance (RFV) submitted or Material Review Board (MRB) actions approved related to manufacture of this item? NOTE: This waiver does not replace DD Form 1694. Please describe below. C) 5. ATTACH SUPPORTING DOCUMENTATION 6. SUBMISSION NAME COMPANY NAME PHONE NUMBER TITLE COMPANY ADDRESS CAGE CODE SIGNATURE * See the solicitation/contract for information on submitting supporting documentation as well as additional requirements regarding First Article Test Waiver Requests DEVCOM CBC FORM 081 -- 3 of 4 -- STOP: The sections below are FOR GOVERNMENT USE ONLY 1. FAT Waiver Disposition 2. Partial FAT Waiver Description (if needed) 3. Justification for FAT Waiver Disposition Quality Assurance/Engineer Contact Information E-MAIL ADDRESS NAME SIGNATURE Configuration Manager Information NAME E-MAIL ADDRESS SIGNATURE RECOMMENDATION DECISION Page 4 of 4 DEVCOM CBC FORM 081 -- 4 of 4 --