Narrative:

I requested release for IFR departure from ZKC on mlt. Our standard IFR clearance gives the departure 5000' initial altitude, center gave me a revised altitude of 4000' and the release. I wrote 4000' on the strip and checked the box for released. I failed to give the pilot the revised altitude of 4000'. The local controller cleared the departure for takeoff and did not notice the revised altitude had not been checked. The center controller advised me of the error shortly after the departure. No loss of sep ever existed but I was lucky. This was caused by my lack of undivided attention. The local controller should have checked the strip to make sure it was completed. Traffic was moderate to slow and too much secondary non work related conversation was distracting me from my primary duties.

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Original NASA ASRS Text

Title: FD GND CTLR OBTAINED AN IFR RELEASE AND A REVISED ALT ON A MIL ACFT. HE FORGOT TO ISSUE REVISED ALT TO THE PLT.

Narrative: I REQUESTED RELEASE FOR IFR DEP FROM ZKC ON MLT. OUR STANDARD IFR CLRNC GIVES THE DEP 5000' INITIAL ALT, CTR GAVE ME A REVISED ALT OF 4000' AND THE RELEASE. I WROTE 4000' ON THE STRIP AND CHKED THE BOX FOR RELEASED. I FAILED TO GIVE THE PLT THE REVISED ALT OF 4000'. THE LCL CTLR CLRED THE DEP FOR TKOF AND DID NOT NOTICE THE REVISED ALT HAD NOT BEEN CHKED. THE CTR CTLR ADVISED ME OF THE ERROR SHORTLY AFTER THE DEP. NO LOSS OF SEP EVER EXISTED BUT I WAS LUCKY. THIS WAS CAUSED BY MY LACK OF UNDIVIDED ATTN. THE LCL CTLR SHOULD HAVE CHKED THE STRIP TO MAKE SURE IT WAS COMPLETED. TFC WAS MODERATE TO SLOW AND TOO MUCH SECONDARY NON WORK RELATED CONVERSATION WAS DISTRACTING ME FROM MY PRIMARY DUTIES.

Data retrieved from NASA's ASRS site as of July 2007 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.