Dd Form 2628 - Request For Approval Of Contractor Flight Crewmember

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OMB No. 0704-0347

REQUEST FOR APPROVAL OF CONTRACTOR FLIGHT CREWMEMBER

OMB Approval Expires

Jul 31, 2007

The public reporting burden for this collection of information is estimated to average 5 minutes 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 the Department of Defense, Executive Services Directorate (0704-0347). 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 FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO THE GOVERNMENT FLIGHT REPRESENTATIVE.

1. FROM

2. TO

(Name and Address of Contractor's Requesting Official)

(Name and Address of Government Flight Representative)

3. CONTRACTOR'S REQUESTING OFFICIAL (CRO).

I have verified the records of (Crewmember's name)

and request that he/she be approved

as a (crew position)

for

(Strike out all inapplicable)

experimental/engineering/acceptance/