REQUEST FOR EXTENSION or DOWNGRADE or DECONTROL

(circle one)

OFFICE OF THE SECRETARY/EXECUTIVE SECRETARIAT

Date:_____________

Requesting DOC Agency:__________________________________________________________

Contact Name and Phone #:_________________________________________________________

Web CIMS Control # and Correspondent:_____________________________________________

Assigned Due Date to OSEC Exec Sec: ______________________________________________

Requested Due Date to ITA Sec: ___________________________________________________

Requested Due Date to OSEC Exec Sec:_____________________________________________

REASON FOR REQUEST:___________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Request approved:__________________

Request denied:____________________

Request Approved as Amended:_______________________________________________________

__________________________________________________________________________________

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