APPLICATION FOR RECORDS RETENTION SCHEDULE - Part 1
Schedule Number:
Agency Name:
Address:
City:
State:
Zip:
For Records Management Use
Contact Person:
Title:
Telephone No:
Action Requested: [Yes / No]
a.
Establish Retention Schedule for all past, present and future accumulations of this period series.
b.
Dispose of present accumulation; no further accumulation anticipated.
c.
Amend / Schedule No.
Choose One | Change:
Supercode:
Void:
Date of Series
Earliest
Latest
Record Series Title
(followed by title used in office; if different)
Office Function
(State the function of the Office in which this record series is created.)
Record Series Description
This file contains the following attached OptiScanned documents
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Document relating to:
Included are:
File is arranged:
Monthly Reference Rate:
(How often are records referred to which are:)
Select Monthly Ref. Rate
One to Six Months old
Seven to Twelve Months old
Thirteen to twenty-four Months old
Twenty Five to older
Monthly Rate:
Annual Rate Accumulation of Records
Letter-size drawers:
; Legal-size drawers:
; Shelves:
; Other(Specify):
;
Current Accumulation:
Yes/No | Questionnaire(Type in all the proper answers)
a. Is this the official copy of the series? If not, where is it?
b. Does the series contain confidential information requiring security handling? If yes, cite law or regulation.
c. Is this a vital record?
d. Does this series have historical or long term research value?
e. When one or two documents in the file make it neccessary to keep the entire file for a long period, could these
documents be scheduled seperately
f. Is the information contained in the series ever published? If yes, see attached copies.
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g. Is the information contained in the series ever analyzed and/or recorded in a summarized report? If yes, see attached copies.
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h. Is there a duplication of this series in your office, or in another office or agency? If yes, where?
i. Is this series (or a major portion of it) regularly microfilmed?
j. Does the record series result in a computer printout?
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