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Deviated Text
This text comes from the Word attachment to class deviation 2026-O0030, not from acquisition.gov. The deviation memo directs contracting officers to use it in place of the codified PGI. The source attachment linked below is authoritative.

Text

(a) Departments and agencies must—

(1) Prepare a preliminary record when a request for a contract adjustment under FAR 50.103 is filed (see DFARS 250.103-5(1)).

(2) Prepare a final record stating the disposition of the request (see PGI 250.103-6).

(3) Designate the offices or officials responsible for preparing, submitting, and receiving all records required by DFARS Subpart 250.1. Records must be maintained by the contract adjustment boards of the Army, Navy, and Air Force, respectively, and by the headquarters of the defense agencies.

(b) A suggested format for the record is the Record of Request for Adjustment shown at the end of this section. This format permits the information required for the preliminary and final records to be combined on one form.

The following instructions are provided for those items in the format that are not self-explanatory:

(1) Extent of performance as of date of request. State the degree of completion of the contract; e.g., 50 percent completed or performance not yet begun. If work is completed, state the date of completion and whether final payment has been made.

(2) Award procedure. State whether the contract was awarded under sealed bidding or negotiated procedures. Cite the specific authority for using other than full and open competition, if applicable, e.g., 10 U.S.C. 3204(a).

(3) Type of contract. State the type of contract (see FAR Part 16); e.g., FFP (firm-fixed-price).

(4) Category of case. State whether the request involves a modification without consideration, a mistake, or an informal commitment. If the case involves more than one category, identify both; list the most significant category first.

(5) Amount or description of request. If the request is expressed in dollars, state the amount and whether it is an increase or decrease. If the request cannot be expressed in monetary terms, provide a brief description; e.g., "Cancellation" or "Modification." Even if the adjustment is not easily expressed in terms of dollars, if the contractor has made an estimate in the request, that estimate should be stated.

(6) Action below Secretarial level. State the disposition of the case, the office that took the action and the date the action was taken. The disposition should be stated as "Withdrawn," "Denied," "Approved," or "Forwarded." If the request was approved, in whole or in part, state the dollar amount or nature of the action (as explained in paragraph (2)(v) of this section). The date should correspond with the date of the memorandum of decision or of the letter forwarding the request to the contract adjustment board or other deciding body.

(7) Action by contract adjustment board and date. State the disposition and date of disposition of the case by the contract adjustment board. Provide the same information as for paragraph (2)(vi) of this section.

(8) Implementation and date. State the appropriate action; e.g., "Modification," "New Contract," or "Letter of Denial."

€ PRELIMINARY€ PRELIMINARYRECORD OFRECORD OFRECORD OFRECORD OFRECORD OFRECORD OFRECORD OFFINAL €
REQUEST FOR ADJUSTMENTREQUEST FOR ADJUSTMENTREQUEST FOR ADJUSTMENTREQUEST FOR ADJUSTMENTREQUEST FOR ADJUSTMENTREQUEST FOR ADJUSTMENTREQUEST FOR ADJUSTMENT
DATE OF REQUESTDATE OF REQUESTPUBLIC LAW 85-804PUBLIC LAW 85-804PUBLIC LAW 85-804PUBLIC LAW 85-804PUBLIC LAW 85-804PUBLIC LAW 85-804PUBLIC LAW 85-804DATE RECEIVED BY GOVERNMENT
CONTRACTOR’S NAME AND ADDRESSCONTRACTOR’S NAME AND ADDRESSCONTRACTOR’S NAME AND ADDRESSCONTRACTOR’S NAME AND ADDRESSCONTRACTOR’S NAME AND ADDRESSCONTRACTOR’S NAME AND ADDRESSCONTRACTOR’S NAME AND ADDRESSCONTRACTOR’S NAME AND ADDRESSCONTRACTOR’S NAME AND ADDRESSCONTRACTOR’S NAME AND ADDRESS
€ SMALL BUSINESS€ SMALL BUSINESS€ SMALL BUSINESS€ SMALL BUSINESS
NAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANYNAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANYNAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANYNAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANYNAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANYNAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANYNAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANYNAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANYNAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANYNAME AND ADDRESS OF CONTRACTOR’S REPRESENTATIVE, IF ANY
COGNIZANT CONTRACTING OFFICER OR OFFICECOGNIZANT CONTRACTING OFFICER OR OFFICECOGNIZANT CONTRACTING OFFICER OR OFFICECOGNIZANT CONTRACTING OFFICER OR OFFICEPROCURING ACTIVITYPROCURING ACTIVITYPROCURING ACTIVITYPROCURING ACTIVITYPROCURING ACTIVITYPROCURING ACTIVITY
PROPERTY OR SERVICE INVOLVEDPROPERTY OR SERVICE INVOLVEDPROPERTY OR SERVICE INVOLVEDPROPERTY OR SERVICE INVOLVEDEXTENT OF PERFORMANCE AS OF DATE OF REQUESTEXTENT OF PERFORMANCE AS OF DATE OF REQUESTEXTENT OF PERFORMANCE AS OF DATE OF REQUESTEXTENT OF PERFORMANCE AS OF DATE OF REQUESTEXTENT OF PERFORMANCE AS OF DATE OF REQUESTEXTENT OF PERFORMANCE AS OF DATE OF REQUEST
CONTRACT NUMBERCONTRACT NUMBERCONTRACT NUMBERDATEADVERTISED OR NEGOTIATEDADVERTISED OR NEGOTIATEDADVERTISED OR NEGOTIATEDTYPE OF CONTRACTTYPE OF CONTRACTTYPE OF CONTRACT
CATEGORY OF CASECATEGORY OF CASECATEGORY OF CASECATEGORY OF CASEAMOUNT OF DESCRIPTION OF REQUESTAMOUNT OF DESCRIPTION OF REQUESTAMOUNT OF DESCRIPTION OF REQUESTAMOUNT OF DESCRIPTION OF REQUESTAMOUNT OF DESCRIPTION OF REQUESTAMOUNT OF DESCRIPTION OF REQUEST
ACTION BELOW SECRETARIAL LEVELACTION BELOW SECRETARIAL LEVELACTION BELOW SECRETARIAL LEVELACTION BELOW SECRETARIAL LEVELACTION BELOW SECRETARIAL LEVELACTION BELOW SECRETARIAL LEVELACTION BELOW SECRETARIAL LEVELACTION BELOW SECRETARIAL LEVELDATEDATE
ACTION BY CABACTION BY CABACTION BY CABACTION BY CABACTION BY CABACTION BY CABACTION BY CABACTION BY CABDATEDATE
IMPLEMENTATIONIMPLEMENTATIONIMPLEMENTATIONIMPLEMENTATIONIMPLEMENTATIONIMPLEMENTATIONIMPLEMENTATIONIMPLEMENTATIONDATEDATE
ADDITIONAL DATA OR REMARKSADDITIONAL DATA OR REMARKSADDITIONAL DATA OR REMARKSADDITIONAL DATA OR REMARKSADDITIONAL DATA OR REMARKSADDITIONAL DATA OR REMARKSADDITIONAL DATA OR REMARKSADDITIONAL DATA OR REMARKSADDITIONAL DATA OR REMARKSADDITIONAL DATA OR REMARKS
DATE THIS RECORD SIGNEDDATE THIS RECORD SIGNEDDATE THIS RECORD SIGNEDDATE THIS RECORD SIGNEDDATE THIS RECORD SIGNEDSIGNATURESIGNATURESIGNATURESIGNATURESIGNATURE
Sources: Deviation attachment (.docx) · Codified PGI 250.101-370