APPLICATION FOR RECORD RETENTION SCHEDULE	DEPARTMENT OF FINANCE

OFFICE OF THE CONTROLLER

RECORD MANAGEMENT DIVISION
instructions: contact your records officer for assistance in completing this form or call the records

management division at (404) 817-6803 or write the records management division, 675 ponce de leon avenue, n.e.,

suite 3109, atlanta, ga 30309
1. Agency Address	For Records Management Use
Application Number	Date Received
Date Completed	Schedule Number
2. Person to Contact

Working Title

Telephone Number

3. Action Requested
a. Establish Retention Schedule for all past, present & future accumulations of this record series.
b. Dispose of present accumulation; no further accumulation anticipated.
c. Amend Schedule No.	Check One:	Change	Supersede	Void
4.	Date of Series	5. Record Series Title (Followed by title used in office; if different)
Earliest

Latest

6. Office Function (State the function of the Office in which this record series is created)
7. Record Series Description	This file contains the following documents (include titles and form numbers, if any):
Attach samples of the files.
Document relating to:
Included are:

Files is arranged:
8. Monthly Reference Rate	How often are records referred to which are:
One to six months old	; Seven to twelve months old	; Thirteen to twenty-four
months old	; Twenty-five months and older
9. Annual Rate of Accumulation of Records
Letter-size drawers	; Legal-size drawers	; Shelves	Other (Specify)
Current Accumulation

YES	NO	10. Questionnaire (Place an “X” in the proper column.)
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 necessary to keep the entire file for a long period could these documents be scheduled separately?
f. Is the information contained in the series ever published? If yes, attach copy.
g. Is the information contained in this series ever analyzed and/or recorded in a summarized report? If yes, attach copy.
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?
11.	Retention Requirements. The following requires the series to be kept?
A.	State Law	Years	E.	Audit Period	Years
B.	City Code	Years	F.	Administrative Needs	Years
C.	Statute of Limitations	Years	G.	Federal Instructions	Years
D.	Federal Law	Years	H.	Historical Value	Years
Attach copy or excerpt of laws regulations. Explain administrative need which exceeds 3 yrs.
12. Approved Disposition Instructions. The agency recommends that the file series be cut off at the end of each
Calendar Year; Fiscal Year; Other	then,
Hold in the current files area	month(s)	year(s); then
Transfer to local holding area; hold	year(s); then
Transfer to Municipal Records Center; hold	year(s); then
Destroy
Transfer to Municipal Archives for permanent retention.
Other (attach additional sheet, if necessary)
Agency Head/Designee (Signature)	Date	Agency Records Officer (Signature)	Date
RECORDS ADMINISTRATION COMMITTEE	SIGNATURES	DATE
THIS RECORD SERIES HAS BEEN EVALUATED FOR LEGAL, FISCAL, ADMINISTRATIVE AND HISTORICAL RETENTION REQUIREMENTS, AND THE RECOMMENDATION IN PARAGRAPH 12 ARE APPROVED	MAYOR/DESIGNEE
CLERK/DESIGNEE
COMMISSIONER OF

FINANCE/

DESIGNEE
CITY ATTORNEY/DESIGNEE
CHIEF INFORMATION OFFICER/DESIGNEE
STATE RECORDS COMMITTEE	SIGNATURES	DATE
Recommendations in paragraph 12 are approved.
(If disapproved, attach letter of explanation)

C I T Y O F A T L A N T A

Form ARM 2 Revised (5/01/07)

APPLICATION FOR RECORD RETENTION SCHEDULE

VLivsey

2007-05-15

cid