DA Form 5170-r Proponent Management Information Requirement Review

DA Form 5170-r or the "Proponent Management Information Requirement Review" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 5170-r - was last revised on May 1, 1986. Download an up-to-date DA Form 5170-r down below in PDF-format or look it up on the Army Publishing Directorate website.

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PROPONENT MANAGEMENT INFORMATION REQUIREMENT
REQUIREMENT CONTROL
REVIEW
SYMBOL CSIM-16
For use of this form, see AR 335-15; the proponent agency is OACSIM.
1. THRU (MICLO) (Include ZIP Code)
2. TO (MICO with jurisdiction)
3. FROM (Proponent office)
(Include ZIP Code)
(Include ZIP Code)
SECTION A - REQUIREMENT IDENTIFICATION
4. MANAGEMENT INFORMATION REQUIREMENT TITLE AND RCS
5. PRESCRIBING DIRECTIVES AND FORMS (If different than DA Pam 335-11 and supplements)
a. DIRECTIVES
b. FORMS
6a. REQUIREMENT SCHEDULED FOR RESCISSION
YES (Indicate date
b. REQUIREMENTS SCHEDULED FOR REVISION
do not complete the remainder of this form)
NO
YES (Explain in item 11)
NO
SECTION B - COST AND WORKLOAD ESTIMATES
PREPARING AGENCY ESTIMATES OF ANNUAL WORKLOAD AND COSTS FOR THIS REQUIREMENT ARE SUMMARIZED BELOW ON
LINE 7. IF YOUR CURRENT ESTIMATES VARY OVER 10 PERCENT FROM LINE 7, INDICATE THAT ESTIMATE ON LINE 8.
a. ANNUAL
b. ANNUAL
ANNUAL COSTS
SUBMISSIONS
MAN-HOURS
c. PERSONNEL
d. ADP
e. MATERIAL
f. OTHER
g. OVERHEAD
h. TOTAL
7.
8.
9. DO THE BENEFITS OF THIS REQUIREMENT EXCEED THE COST BURDEN ON LINE 7 OR 8.
YES
NO
BENEFITS CANNOT BE COST QUANTIFIED, BUT DATA REMAIN ESSENTIAL AFTER
CONSIDERATION OF COSTS
SECTION C - COMMENTS/REMARKS
10. COMMENTS
COMMENTS 1 THROUGH
ARE ATTACHED FOR YOUR REVIEW. FOR EACH ATTACHED COMMENT INDICATE
EITHER:
a. COMMENT NO.
IS VALID AND CHANGES WILL BE MADE TO REQUIREMENT BEGINNING
, OR
b. COMMENT NO.
IS NOT VALID BECAUSE: (Use reverse or additional sheets as required).
11. REMARKS (Use reverse or additional sheets as required)
12. PROPONENT ACTION OFFICER (Name and signature)
a. OFFICE SYMBOL
b. TELEPHONE
c. DATE
NUMBER
(YYMMDD)
DA FORM 5170-R, MAY 86
EDITION OF DEC 82 IS OBSOLETE.
APD V1.01
PROPONENT MANAGEMENT INFORMATION REQUIREMENT
REQUIREMENT CONTROL
REVIEW
SYMBOL CSIM-16
For use of this form, see AR 335-15; the proponent agency is OACSIM.
1. THRU (MICLO) (Include ZIP Code)
2. TO (MICO with jurisdiction)
3. FROM (Proponent office)
(Include ZIP Code)
(Include ZIP Code)
SECTION A - REQUIREMENT IDENTIFICATION
4. MANAGEMENT INFORMATION REQUIREMENT TITLE AND RCS
5. PRESCRIBING DIRECTIVES AND FORMS (If different than DA Pam 335-11 and supplements)
a. DIRECTIVES
b. FORMS
6a. REQUIREMENT SCHEDULED FOR RESCISSION
YES (Indicate date
b. REQUIREMENTS SCHEDULED FOR REVISION
do not complete the remainder of this form)
NO
YES (Explain in item 11)
NO
SECTION B - COST AND WORKLOAD ESTIMATES
PREPARING AGENCY ESTIMATES OF ANNUAL WORKLOAD AND COSTS FOR THIS REQUIREMENT ARE SUMMARIZED BELOW ON
LINE 7. IF YOUR CURRENT ESTIMATES VARY OVER 10 PERCENT FROM LINE 7, INDICATE THAT ESTIMATE ON LINE 8.
a. ANNUAL
b. ANNUAL
ANNUAL COSTS
SUBMISSIONS
MAN-HOURS
c. PERSONNEL
d. ADP
e. MATERIAL
f. OTHER
g. OVERHEAD
h. TOTAL
7.
8.
9. DO THE BENEFITS OF THIS REQUIREMENT EXCEED THE COST BURDEN ON LINE 7 OR 8.
YES
NO
BENEFITS CANNOT BE COST QUANTIFIED, BUT DATA REMAIN ESSENTIAL AFTER
CONSIDERATION OF COSTS
SECTION C - COMMENTS/REMARKS
10. COMMENTS
COMMENTS 1 THROUGH
ARE ATTACHED FOR YOUR REVIEW. FOR EACH ATTACHED COMMENT INDICATE
EITHER:
a. COMMENT NO.
IS VALID AND CHANGES WILL BE MADE TO REQUIREMENT BEGINNING
, OR
b. COMMENT NO.
IS NOT VALID BECAUSE: (Use reverse or additional sheets as required).
11. REMARKS (Use reverse or additional sheets as required)
12. PROPONENT ACTION OFFICER (Name and signature)
a. OFFICE SYMBOL
b. TELEPHONE
c. DATE
NUMBER
(YYMMDD)
DA FORM 5170-R, MAY 86
EDITION OF DEC 82 IS OBSOLETE.
APD V1.01

Download DA Form 5170-r Proponent Management Information Requirement Review

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