See Instructions on Reverse.
1. Agency
2. Division/Section
3. Location of Records
4. Records Series Title 5. Records Series Description. Include contents (e.g. contracts, reports, applications, correspondence), purpose, and form numbers.
Original File Duplicate File 7. If duplicate, STORAGE MEDIA (Check all that apply) Paper Other, including: Microfilm (not COM) Photographs Computer Output Computer Cards Microfilm (COM) X-Rays Electronic (Tapes, Disks) Slides _______________ 6. 8.
list location of original file. 9. DATA PRIVACY CLASSIFICATIONS
Statute Number or Date of Temporary Classification
Public Private Confidential Nonpublic Protected Nonpublic
YEARS CITATION 11. RECOMMENDED RETENTION PERIODS 10. RETENTION REQUIREMENTS A. Federal Law A. Agency Office B. State Law B. Agency Storage C. Statute of Limitations C. State Records Center (State Agencies Only) D. Audit Period D. Total Retention (A + B + C) E. Administrative Needs 12. A vital record is essential to the continuation or resumption of your operations after a disaster. Are any documents in this records series considered vital? Yes No If yes, which documents are vital and why?
13. VOLUME Office Cubic Feet Inclusive Dates
(See Chart) Storage Cubic Feet Inclusive Dates
VOLUME CHART TO DETERMINE CUBIC FEET
Letter Size Drawer = 1.5 Legal Size Drawer = 2.0 Shelving 4' Letter = 2.3 Shelving 4' Legal = 3.0 Records Center Box = 1.0 (12” X 15” X 10") 3X5 Card 12” Row = 0.1 4X6 Card 12” Row = 0.2 5X8 Card 12” Row = 0.3 Printouts 12” Stack = 1.25 Transfer Case = 2.5 (24” X 16” X 11")
14. Inventory Completed By (Print Name)
Title
Date
Phone
* Adapted from Minnesota Department of Administration, Information Policy Analysis Division, Preserving and Disposing of Government Records, July 2000.
INSTRUCTIONS
All items are self-explanatory except:
4.
A records series is a group of records filed