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Records Transfer and Receipt Form Instructions


Instructions for filling out the Records Transfer and Receipt Form

Item 1. Agency Code

Enter the four-digit budget code assigned to your agency.

Item 2. Account Number

This is an optional field. Contact your agency records management officer (RMO) to determine whether you should complete this space.

Item 3. Records Retention Schedule Number

Enter the schedule application number from the official records retention schedule in effect for the records.

Item 4. Approval Date

Enter the date the records retention schedule covering the records was approved or amended.

Item 5. Records Series Title

Enter the title of the records series exactly as it appears on the retention schedule.

Item 6. File Years

List the date span of the records to be transferred, the earliest and latest dates of the records in the shipment.

Item 7. Cite Specific Law(s) if any, that state(s) this series is confidential

Under Georgia's "Open Records Act," agency records are classified "open," unless a specific state or federal law or regulations states that information in a particular records series must be kept confidential. Enter "None" if records are open.

Item 8. Transfer Records To

Check the box next to "State Records Center."

Item 9. Cut Off

Check the appropriate box for the cut off specified by the records retention schedule. If the cut off is not one of the four indicated by blocks, write in the cut off in the space following "Other:"

Item 10. Calculated Transfer/Disposition Date

Total Retention Time: Total number of years records are to be retained (according to the appropriate retention schedule).

Eligible Disposition Date: This date is calculated automatically.

Send to Archives, Destroy, Other: Check the appropriate space for final disposition specified in records retention schedule.

Other Disposition Instructions: Enter any special instructions required by the records retention schedule that cannot be indicated above.

Example: Destroy, except that Archives will retain a random sample of each years' files for permanent retention.

Item 12. Transferring Agency RMO

Agency records management officer must sign and enter the current date.

Item 13.Transferring Site

Enter the address where the records are located, including: name of the agency, division, office room number, building, city, state and zip code.

Item 14. Transferring Records Custodian

Enter the name of the office supervisor; the name, telephone number, and FAX number of the office contact person, and the date the transfer form is completed.

Item 15. Unit Format

Enter the appropriate format code from the list provided.


Contact

214 State Capitol
Atlanta, Georgia 30334
404.656.2881
E-Mail
© 2012 Georgia Secretary of State