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Use to reply to a request for maintenance support. Reference: FM 9-43-1.

LINE 1 -- DATE AND TIME______________________________(DTG)

LINE 2 -- UNIT________________________________________(Unit Making Report)

LINE 3 -- REFERENCE _________________________________(DTG and Other Identifying Information of Communications Which Requested Maintenance Support)

LINE 4 -- DISPOSITION_________________________________(Status of Request: APPROVED, DISAPPROVED, MODIFIED)

LINE 5 -- SUPPORTING UNIT____________________________(Identifier or Designator of Supporting Unit)

LINE 6 -- LOCATION___________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 7 -- PRIORITY____________________________________(Priority of Maintenance Support Mission)

LINE 8 -- START_______________________________________(DTG the Requested Support Will Start)

LINE 9 -- COMPLETE___________________________________(Estimated DTG Support Mission Will be Completed)

LINE 10 -- INSTRUCTIONS______________________________(Special Instructions Relevant to Support Required by the SupportingUnit)

LINE 11 -- COORDINATION_____________________________(Coordination Instructions Required Between Supporting Units)

**Lines 5 through 11 are applicable only if line 4 is approved or modified.

LINE 12 -- NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 13 -- AUTHENTICATION___________________________(Report Authentication)