Form 36W – Fill Out and Use This PDF

Form 36W [Apr 2011]

Retention of Qualification

for MIL-PRF-55110, MIL-P-50884

Superseding DSCC Form 36W [May 2010]

GENERAL INFORMATION

WHEN TO USE THIS FORM: Form 36W is used to submit annual retention reports for an assigned reporting period by companies currently listed on the Qualified Products Database (QPD) for QPL-50884 & QPL-55110. For companies with multiple qualifications, a separate Form 36W will need to be submitted to DLA LAND AND MARITIME-VQE (Qualifying Activity) for each qualification.

RETENTION REPORTS: Retention reporting periods for each manufacturer are assigned on the 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 shall be summarized on Form 36W. Copies of group B (and group C for MIL-P-50884) data must be submitted with the Form 36W. 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 its capability to manufacture and test QPL compliant printed boards still exists (see section 9 of Form 36 on page 2). The qualifying activity may require testing samples to be built to evidence this.

QUALIFICATION LISTING(S) VERIFICATION: Manufacturers are encouraged to verify all information regarding the manufacturer's QPL-50884 and/or QPL-55110 listing (s) by clicking on the following applicable links for the QPD Supplemental Information Sheet (QPDSIS). If any discrepancies are found, contact the Qualifying Activity immediately

MIL-P-50884:QPDSIS-50884

MIL-PRF-55110:QPDSIS-55110

INSTRUCTIONS FOR COMPLETION OF FORM 36W (Pages 3 and 4)

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1.Reporting Period: Select from the drop down menus the reporting period for which the data is applicable. The reporting period is assigned by the Qualifying Activity at qualification and can be found on the applicable Notification of Qualification letter.

2.Manufacturer and Point of Contact Information: Input the manufacturer's name, address, and CAGE Code as it appears on the CAGE Code and Central Contractor Registration (CCR). Annotate the manufacturer's current point of contact for all issues related to manufacturer's QPL qualifications.

3.CAGE Code and CCR Registration Verification: Click the check box to confirm that the manufacturer has verified registration information for the CAGE Code and CCR. Verification of CAGE Code and CCR is an annual requirement and can be performed via the links below. If the

CAGE Code listing and CCR are not up-to-date, the manufacturer will not be listed in the

Qualified Products Database. Note: Manufacturers are required to notify the Qualifying Activity prior to any change in company name, location or ownership.

CAGE Code Verification URL: https://www.dlis.dla.mil/BINCS/begin_search.aspx

CCR Verification URL: https://www.bpn.gov/CCRSearch/Search.aspx

(Continued on Instructions page 2 of 2)

DLA LAND AND MARITIME FORM 36W (APR 2011)

INSTRUCTIONS PAGE 1 OF 2

Form 36W [Apr 2011]

Retention of Qualification for MIL-PRF-55110, MIL-P-50884

Superseding DSCC Form 36W [May 2010]

INSTRUCTIONS (CONTINUED)

4.Qualification Information: Select from the drop down menus: the base material, board type, either ‘50884-’ or ‘55110-’. Input the remainder of the manufacturer's qualification reference number for the qualification covered by the data on the form (e.g. ‘1234-mmddyy*#’ or ‘-IL1234-mmddyy*#’). The qualification reference number can be located on the applicable Notification of Qualification letter.

5.Product Assurance Procedures: Click in the applicable check boxes for the manufacturer's product assurance procedures status during the reporting period. If changes have occurred submit a copy of the new procedure (s) with this Form 36W unless these changes have been previously submitted to the Qualifying Activity for review.

6.Electrical Testing: Check the appropriate box for in-house or contract service. Indicate the contract service name and location if warranted.

7.Optional Information: Information provided here will help the Qualifying Activity support the manufacturer's customers.

8.Summary of Production: Indicate the information requested in each column for each month

during the reporting period. (Note: There are two extra rows to allow retest information, if applicable.)

The information for any group B or group C lots that failed testing at a qualified laboratory must also be recorded. For clarification, the manufacturer may add "Retest" or a similar annotation to any test lab report number used for resolving said failures in the additional rows that are provided. If no production occurred during the month, enter -0 - under “# Lots Produced”. Any additional comments can be submitted on a separate sheet.

9.Certification statement: Read the certification statement. The manufacturer's authorized representative signs and date in the space provided.

WHAT TO SUBMIT TO THE QUALIFYING ACTIVITY

Completed pages 3 and 4 of the Form 36W along with complete copies of all Group B (and Group C for MIL-P-50884) test UHSRUWVVhall be submitted. Acceptable formats are data stored on DVD or CD-ROM (the preferred method), attachments in an email (5MB maximum email message size limit), hardcopies through USPS mail, FedEx or UPS, or facsimile. Note: Any changes made to product assurance procedures within the reporting period that have not been reviewed by the Qualifying Activity must be submitted with the retention package.

E-mail: 5998.Qualifications@dla.mil	Facsmilie:	614-693-1659
Standard Mail: DLA LAND AND MARITIME-VQE	UPS or FedEx: DLA LAND AND MARITIME-VQE
PO Box 3990		3990 E. Broad St.
Columbus, Ohio 43218-3990		Columbus, Ohio 43213-1152
DLA LAND AND MARITIME FORM 36W (APR 2011)		INSTRUCTIONS PAGE 2 OF 2