Dd Form 1696 - Specification Change Notice (Scn)
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1
2
3
4OMB
NO.
0704-0188
1.
DATE
PREPARED:
2.
SCN
NUMBER:
SPECIFICATION CHANGE NOTICE
(DD-Mon-YYYY)
(SCN)
3.
PROCURING ACTIVITY
NO
(PAN).:
The pubt1c repof'ttng burden
f()(
thts conecbon of tnformatJon ts estimated
to
average 2 hours per
response,
tndudtng the
ttme fOf
reVIewmg
tnstrucbOns,
searctung
extsbng
data
sources,
gatheMg and
ma1n1a1n1ng lhe
dala
needed.
and
oomplebng and reVIewmg 1he collecbOn ol1nlonna110n Send commenls regard1ng
lh1s burden
eSl1ma1e
or
any
olher
aspect
ol
lhe
collection
ol
1nlonna110n,
1ndud1ng
sugges110ns
lor
reducong 1he
burden,
lo Departmenl
of
Defense,
Wash1ng1on Headquarters
Serw:es.
Exeeobve SerVIces
Olrecloral
e,
Olrec:bves
DIVISIOn,
4800
Marl<
Cenler
Onve,
Alexandna
,
VA
22350-3100 (0704.0188)
Respondenls
should
be aware lhal
no1W11hsland1
ng
any other proVIsion
of
law,
no
person
shall
be
SUbJecllo
any penally
lor
la1hng to
comply Wllh
a
colleciiOn
ol
1 nlonnabon
rt
1
1
does
nol
d1spla
y
a currenUy
vahd OMB
conlrol
number
PLEASE
DO NOT RETURN
YOUR COMPLETED
FORM TO
THIS
ADDRESS.
RETURN
COMPLETED
FORM
TO
THE ISSUING
CONTRACTING OFFICER
FOR THE
PROCURING
ACTIVITY NUMBER USTED
IN
ITEM 3 OF THIS
FORM.
4
.
ORIGINATOR:
5.
SCN
TYPE:
0
PROPOSED
0
APPROVED
a
.
TYPED
NAME:
(First,
Middle
Initial,
Last)
6.
DESIGN
ACTIVITY
CAGE CODE
:
7.
SPEC. NO.:
b.
ADDRESS:
(Street, City, State,
Zip Code)
8.
PREPARING ACTIVITY CAGE
CODE:
9. DODACC:
10.
SYSTEM
DESIGNATION:
11
.
RELATED
ECP
NO.:
12.
CONTRACT
NO.:
13.
CONTRACTUAL
AUTHORIZATION:
14
.
CONFIGURATION
ITEM
NOMENCLATURE:
15.
EFFECTIVITY:
This
nollce
lnfonns
reclplenlslhat the
speclficallon
ldenllfied
by
tho
number (and
revision leiter)
s
hoWin In Item
7
has been
changed.
Tho
pages
changed
by
lhls
SCN
are those
fumlshod herewith
and cany
tho
approval date
oflhe
rel
ated
ECP listed
In
Block
11.
Tho
pages
of the page
numbers
and
dates listed
In Blocks
16
and
17,
combined with non·llsted
page
s
of
the
original
Issue
of the r evision
s
hoWin In Block
7,
conslltuto
th
o
current
approved
version
of
this
spcclflcallon,
16.
PAGES AFFECTED
BY
THIS
SCN
a.
PAGE(S):
b.
TYPE
OF
CHANGE*:
c.
APPROVAL
DATE:
(DD-Mon-
YYYY)
17.
SUMMARY OF
PREVIOUSLY
CHANGED PAGES
a.
SCN
NO.:
b.
RELATED ECP
NO.:
c.
PAGE(S):
d.
DATE
SUBMITTED:
e
.
TYPE OF
CHANGE•:
f.
APPROVAL
DATE:
(DD-Mon-
YYYY)
(DD-Mon-
YYYY)
I
Remove A
Row
.. 'S"
indicates the page
is superseded
.
"A"
indicates page is added
.
"D"
indicates page is
deleted
.
18.
BELOW
TO
BE
COMPLETED
BY
APPROVING ACTIVITY
a.
PROCURING
ACTIVITY
d.
DATE
PREPARED:
c.
SIGNATURE
(DD-Mon-YYYY}
b.
TYPED
NAME
(First,
Middle
Initial,
Last)
DD
FORM
1696,
MAY
2015
PREVIOUS EDITION IS
OBSOLETE
Page
1
of
2
DISTRIBUTION STATEMENT
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