DSCC Form July Retention of Qualification and Certification Statement

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					DSCC Form 36W [July 2008]
Retention of Qualification and Certification Statement for MIL-PRF-55110, MIL-P-50884
Superseding DSCC Form 36W [June 2008]

GENERAL INFORMATION
WHEN TO USE THIS FORM: DSCC Form 36W is used to submit annual retention reports for an assigned reporting period by companies currently on the MIL-PRF-55110 and/or MIL-P-50884 Qualified Products List (QPL). RETENTION REPORTS: Retention reporting periods for each manufacturer are assigned on the DSCC Notification of Qualification letter. Retention reports are due within 60 days of the end of the reporting period to allow the manufacturer to complete group B testing. Retention reporting information may be summarized on DSCC Form 36W. Photocopies of groups B (and group C for MIL-P-50884) data must be submitted with the report. In the event that no production of compliant printed boards occurred during the entire reporting period, the manufacturer shall verify to the qualifying activity that the capability to manufacture and test QPL printed boards still exits and that the manufacturer wants to remain on the QPL. INSTRUCTIONS FOR COMPLETION OF DSCC FORM 36W COMPLETE ALL SECTIONS OF THIS FORM (Unless otherwise noted) 1. Reporting Period: Indicate the reporting period (month/year to month/year) for which the data is applicable. The reporting period is assigned by DSCC at qualification and can be found on the applicable Notification of Qualification letter from DSCC. 2. Company Name, Address and CAGE code: Indicate the company name, address and CAGE code as it appears on the QPL. Note that manufacturers are required to notify DSCC prior to any change in company name, location or ownership. 3. Point of Contact Name, Phone, Fax, Email: Include information for the current point of contact for all issues related to your company’s QPL qualifications. 4. Qualification Information: List the material, type, and company’s qualification reference number for the qualification covered by the data on the form. The qualification reference number is also found on the applicable Notification of Qualification letter from DSCC. 5. Product Assurance Procedures: Indicate if any changes to your product assurance procedures have occurred during the reporting period. If changes have occurred, attach a copy of the new procedure to the retention of qualification form unless these changes have been previously submitted to DSCC for review. 6. Summary of Production: Indicate the information requested in each column for each month during the reporting period. If no production occurred during the month, enter “0” under “# Lots Produced”. 7. Electrical Testing: Check the appropriate box for in-house or contract service. Fill in the location of the contract service. 8. Optional Information: Information provided here may reduce your audit frequency, and will help us support your customers. 9. Summary of Failed and Reworked Lots: Summarize the results of all failed and reworked lots from the reporting period. Any inspection lots that are rejected may be reworked or screened for the defect and resubmitted for tightened inspection. These lots must be identified as a reworked lot. 10. Certification statement: If there was no production for the last two years, put a check in the box, then read the certification statement. The company representative signs and date in the space provided. Complete copies of all Group B (and Group C if MIL-P-50884) test data and changes to product assurance procedures that have not been previously submitted to DSCC for review must be attached to your submission.
DSCC FORM 36W JULY 08 INSTRUCTIONS

DSCC Form 36W [July 2008]
Retention of Qualification and Certification Statement for MIL-PRF-55110, MIL-P-50884
Superseding DSCC Form 36W [June 2008] 1. RETENTION REPORTING PERIOD: 2. COMPANY: NAME, ADDRESS AND CAGE CODE 4. QUALIFICATION INFORMATION: Material: Qualification Reference No.: 5. PRODUCT ASSURANCE PROCEDURES: 3. POINT OF CONTACT: NAME, PHONE, FAX AND EMAIL NO CHANGED CHANGES Type:

In-process and Group A Testing: Test Coupon Configuration and Usage: Group B Complexity and Selection: 6. PRODUCTION SUMMARY: SUMMARY OF GROUP A TESTING # LOTS PRODUCED # FOIL LAMINATED LOTS # FAILED LOTS GROUP B AND C TEST RESULTS TEST LAB REPORT # PART # TEST RESULTS

PRODUCTION MONTH

MIL-P-50884 GROUP C, CLASS A MIL-P-50884 GROUP C, CLASS B 7. ELECTRICAL TESTING PERFORMED:

LIST RESULTS OF ALL FAILED AND REWORKED LOTS ON PAGE 2
DSCC FORM 36W JULY 08

IN HOUSE CONTRACT SERVICE, LOCATION:

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DSCC Form 36W [July 2008]
Retention of Qualification and Certification Statement for MIL-PRF-55110, MIL-P-50884
Superseding DSCC Form 36W [June 2008]

8. OPTIONAL INFORMATION:
QUALITY SYSTEM CERTIFICATION (ISO, QS, ETC.) TOP 3 MILITARY CUSTOMERS (LIST BY NAME) PRODUCTION THAT IS MILITARY %

9. SUMMARY OF FAILED AND REWORKED LOTS:
PRODUCTION MONTH PART NUMBER FAILURE MODE CORRECTIVE ACTION

10. CERTIFICATION STATEMENT:
Check here if no product that was compliant to this qualification was built in the past two years .

I certify that my company has maintained its capability to manufacture compliant products as listed on the Qualified Products List QPL-55110 and/or QPL-50884. All manufacturing during the reporting period listed above was performed at plant locations listed on QPL-55110 or QPL-50884. I have notified the Qualifying Activity of all changes in company name or ownership as required by SD-6 “Provisions Governing Qualification”.

SIGNATURE

DATE

DSCC FORM 36W JULY 08

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