TB 11-5841-305-23
Completion instructions by block
(7) PD Enter the priority designator
(13) DATE ACCEPTED When the
number and title.
(PD) that applies to the action. This
form is used as a receipt, the
unit or organization listed in block 3
exchange activity will enter the Juilian
(1) SUPPORT AGENCY (DODAAC)
normally assigns the PD. When the
date.
Enter the DODAAC of the support
exchange supports a customer
activity that will exchange the item for
(14) SIGNATURE The person who
maintenance request, use the PD of
you. When this form Is used for other
receives the unit for exchange signs.
the maintenance request.
than exchanges, use the DODAAC or
(8) PD Authorization
(15) NWCS Prints the word "yes" for
UIC.
a. The commander or the
an NMCS condition.
designated representative signs when
(2) DATE Enter the Juilian date was
(16) JON The facility that will repair
a PD of 01 through 10 is in block 7.
prepared for exchange.
the item numbers the job order
b. Enter job order number when a
(3) ORGANIZATION (DODAAC)
number.
PD of 01 through 10 is from a
Enter the DODAAC of the unit or
maintenance request.
(17) INITIALS The person receiving
organization wanting to exchange the
the item for repair initials in this block.
unit. When this form is used for other
(9) END ITEM NOMENCLATURE
exchanges, use the DODAAC or UIC.
Enter the noun abbreviation of the end
(18) DATE REPAIRED The person
item for the part or component in Block
doing the work enters the date the
(4) EIR EXHIBIT/EXCHANGE Mark
5.
work was finished.
the block to show an exchange or EIR
exhibit. When used for warranty
(10) MODEL Enter the model
(19) INITIALS The person doing the
claims, put a "W" in the open space to
number of the end item.
work initials in this block.
the right of EIR EXHIBIT.
(11) SERIAL NO. Enter the serial
(5) NSN Enter the NSN of the part.
number of the end item.
(6) NOUN NOMENCLATURE Put
(12) DEFICIENCY OR SYMPTOM
the noun abbreviation of the item to be
Briefly describe the problem.
exchanged.
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