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Home My WebLink About2013-232 RECORDS MANAGEMENT COMPLIANCE STATEMENT ) al03/ 13 for Fiscal Year 2012 =2013 $ g • Agency ID : C0620500 cQO / O .. 4=2,,9 C 1 . This agency is in compliance with Section 257 . 36(5), Florida Statutes' , and Rule 1B-24.003(9), Florida O Administrative Code2, for all public records regardless of media or format (e.g. , paper, electronic including 600010 email , microfilm, audio, video, etc. ). Yes ❑ No ( Please explain and indicate areas in need of assistance on reverse side . ) C 1: 2. This agency has disposed of 79 . 22 cubic feet of records for the fiscal year indicated above. (It is not O Lj necessary to indicate volunaemoe electronic records disposed. ) MOM U) Agency Head Signature : Date : •fl" Name of Agency Head ( please print): Peter D . 0 ' Bryan E O Title of Agency Head (please print) : Chairman , Indian River County Board of County V Co i Toners Please indicate changes to Agency Inforbat"079 on lines ided on right. OCurrent Information : s �: 0 ��J"; Please do not erase or cover informa�o*beloW� 0 * � Indicate changes or additions on lines below: EAgency Name: Indian River County Boarlof CounonemC C O �y: :p • "++ C Agency Head : Mr. Joseph E . Flescher •••�9,t; ` per,•'" " Mr . Peter D . 0 ' Bryan U) V Address : 1801 27th Street, Building A ' n•. C 4) Q Vero Beach , Florida 32960-3365 Section 257 .36( 5)(a ) , Florida Statutes' , requires public agencies to designate a Records Management Liaison Officer ( RMLO). Please indicate changes to RMLO Information on lines provided on right. If Current Information is blank , please Cdesignate an RMLO for your agency on lines provided on right. w+ Current Information : SOUPED E Please do not erase or cover information below. Indicate changes or additions on lines below: LW O O RMLO: Ms. Laura E . Vasquez y.. 400 C Address : 1801 27th Street, Building A N OJ Vero Beach , FL 32960-3365 Phone: (772 ) 226-1919 Ext. : Email : Ivasquez@iregov.com 'Section 257.36(5), Florida Statutes: "For the purposes of this section , the term "agency" shall mean any state, county, district, or municipal officer, department, division , bureau, board , commission , or other separate unit of government created or established by law. It is the duty of each agency to: (a ) Cooperate with the division in complying with the provisions of this chapter and designate a records management liaison officer. (b) Establish and maintain an active and continuing program for the economical and efficient management of records. " 'Rule 1 B-24.003(9), Florida Administrative Code: "Public records may be destroyed or otherwise disposed of only in accordance with retention schedules established by the Division . Photographic reproductions or reproductions through electronic recordkeeping systems may substitute for the original or paper copy, per Section 92 .29, F. S. , Photographic or electronic copies . . . Prior to records disposition , agencies must ensure that all retention requirements have been satisfied . For each record series being disposed of, agencies shall identify and document the following: 1 . Records retention schedule number; 2. Item number; 3 . Record series title; 4. Inclusive dates of the records ; 5 . Volume in cubic feet for paper records; for electronic records , record the number of bytes and/or records and/or files if known , or indicate that the disposed records were in electronic form ; and 6. Disposition action (manner of disposition ) and date. " Please complete and return this compliance statement by December 31 , 2013 (submit one copy only, please) to : Department of State Records Management Program , Mail Station 9E OR Email to : recmgt@dos . myflorida.com Tallahassee, FL 32399=0250 RECORDS DISPOSITION DOCUMENT NO• PAGE l OF 1 PAGES 1 . AGENCY 2. DIVISION 3 . BUREAU INDIAN RIVER COUNTY BCC ROAD AND BRIDGE DIVISION OF PUBLIC WORKS 4. ADDRESS (Street, City, and Zip Code) 5. CONTACT (Name and Telephone Number) 4550 41ST ST1 . VERO BEACHr FL 32967 LAURA VAS UEZ 772-226- 1919 6. SUBMITTED &y , h- hereby certify that the records to be 7. NOTICE OF INTENTION disposed of are correctly r7ep0Wi rated below, that any audit requirements f the records have been y justified, and that The scheduled records listed in Item 8 are to be disposed of in the further rete on is not require or litiga ' pending or manner checked below (specify only one): ;nJ ine X a. Destruction _ b. Microfilming and Destruction n re Date Susan E. Forsythe, Staff Assistant III Road and Bridge Division — c. Other Name and Title (RECORDS CUSTODIAN ) 8. LIST OF RECORD SERIES a. be ca do e. f. g. Schedule Item Title Retention Inclusive Volume Disposition Item No. Dates in Action and Date Cubic Completed After Feet Authorization GSI-SL 1 � s � VEHICLE SAFETY RECORDS 4 YEARS 10-01-06 TO 1.04 I .tdrw' 6` 09-30-07 sot GOOD � /3 GSI-SL 124 OPERATIONAL & STATISTICAL REPORT RECORDS 3 YEARS 10-01-07 TO 6.24 44Ae& 09-30-08 Z � '- /3 GSI-SL 124 OPERATIONAL & STATISTICAL REPORT RECORDS 3 YEARS 10-01-06 TO 3. 12 /d 09-30-07 slow GSI-SL 94 COMPLAINTS: CITIZEN /CONSUMERS/ EMPLOYEES 1 YEAR 10-01-06 TO 1.04 to FROM 09-30-07 COMPLETION GSI-SL 340 DISBURSEMENT RECORDS DETAILS (DUPLICATES) UNTIL 10-01-09 TO 3. 12 ja OBSOLETE 09-3040 rwzr GSI-SL 340 DISBURSEMENT RECORDS DETAILS (DUPLICATES) UNTIL 10-01- 10 TO 4. 16 OBSOLETE 09-30- 1i see 9. DISPOSAL AUTHORIZATION Disposal for the above listed 10. DISPOSAVERTIFICATE The aboveli reco hav en disposed records is authorized . Any deletions or modifications are of in the er and on the da o r in co se indicated. 7 Signature Date . NEW 'u r Fo E1 Shm QPMloss&7A oat so Name an i e pervisor SignAWE /Date Witness NOTE: U on disposition retain this fonn for your records & send copy to % RMLD. AM Form GSR- 2 ( Rev 10/ 2008) I . R . C . Landfill I . R . C . LANDFILL 1325 74th Avenue SW Vero Beach , FL 32968 Weighed : Carol j Deposit : Frances BILL T0 : 178111 I . R . C . ROAD & BRIDGE 4550 41ST STREET VERO BEACH FL 333320000 Vehicle ID : Reference : 293 DATE IN : 02/07/ 2013 TIME IN : 13 : 36 : 35 DATE OUT : 02/07/2013 TIME OUT : 13 : 52 : 58 INBOUND TICKET Number : 03-00225668 SCALE 1 GROSS WT . 5060 LB SCALE 2 TARE WT . 4500 LB NET WEIGHT 560 LB Qty Description Amount 0 . 280 GARBAGE / NO CHARGE 0 . 00 NET CHARGE AMOUNT : 0 . 00 X + j RECORDS DISPOSITION DOCUMENT NO PAGE 1 OF 1 PAGES rIndian AGENCY NAME and ADDRESS 2. AGENCY CONTACT (Name and Telephone Number) WIFFIF River County BCC man Resources Department Shelley Nowlin 1800 27th Street , ( 772 ) 226 - 1456 Ext . Vero Beach , Florida 32960 3. NOTICE OF INTENTION : The scheduled records listed in Item 5 are to be disposed of in the manner checked below (specify only one) . ® a . Destruction ❑ b . Microfilming and Destruction ❑ c . Other 4. SUBMITTED BY : I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for tlFW records have bee y� fully , and that further retention is not required for any litigation pending or imminent. Colleen Peterson , Human Resources Manager 02/20/2013 Signature Name and Title Date 5. LIST OF RECORD SERIES f. g . a . b. C. d e. Volume Disposition Schedule Item Title Retention Inclusive In Action and No. No. Dates Cubic Date Feet Completed I After Authorization Personnel Records : FL Retirement GS1 -SL. 19_ ...... . . .._System....................... 25 FY 10/ 1 /86 — 09/30/87 5 . 0 _...................__...........................__......._........................ . ........__............... ..._................................_.......... ......._.._..._......._.._...._....................._._........................ ..... ._...._..............._.. ..._ . .......... .._........... . .. . ... .._ WWII GS IFFEL 111 Insurance Records 5 FY 10/ 1 /06 — 09/30/07 5 0 _ . . ........ . . . . . .. . . WWII_....._. . ... ......... _ ._. . _ WWII _ . WWII. . . GS1 - SlFW, 17 Correspondence & Memoranda : Administrative 3 FY 10/ 1 /08 — 09/30/09 2 . 0 . . ... ... .. _ _ WWII.. . ... .. .... ..... . Eq . Equal Employment Opportunity GS1 - SL. 103 Compliance Records _ . . . .. . . . . . _ (A/A Survey. Forms.)... ... ........... . . . . . .. . .............. ... ..... . .... .. ............. . 4 Yrs 01 /01 - 12/31 /08 1 0 GS1 SL 24 Employment Application & Selection Records ( Record Copy) I . . III2....Y...d..rs ..01. /0. 1 - 12/31 / 10 5 . 0 ....._ .._ . ..._..... .. .._ . __........... . . . . . GS1 SL 195 Payroll RecoI.IFrds : SuWWWpporting Documents 3 Yrs 01 /01 - 12/31 /09 28 . 0 . .. .. . . ........ . ... . ... ........... ..... . . . __................ .. . . . . ........... . .. . ...... ...... .. .. ..... . . . .. . I � Personnel Records OPIF ww""SNolunteer/ GS1SL 66da4da Intern/Temporary Employment 3 FY 10/ 1 /08 — 09/30/09 1 . 0 ........ . . _. _..._.. __.... .. ....._......_......._...._ _ ..... .... ...... _ . ... . . .. _ ... GS1 SLS _ 88 Budge Records 2 FY 10/ 1 /09 - 09/30/ 10 1 . 0 6 . DISPOSAL AUTHORIZATION : Disposal for the above listed records 7 . DISPOSAL CERTIFICATE : The above listed records have been is authorized . Any deletions or modifications are indicated . disposed of in the anner and on the date shown in column 1 J3 - IF Signature Date L@V Colleen Peterson , Human Resources Manager stodian/Records Manageme 6aiso Offic r Date Name and Title `W`W,PWW,, SV,.,.F k Laura Vasquez Witness LE outheast ecure hredding SECURE SOLUTIONS FOR DOCUMENT DESTRUCTION CERTIFICATE OF DESTRUCTION THIS CERTIFIES THAT ALL RECORDS AND MATERIALS RECEIVED FROM Indian River County Human Resources 1800 27 ' Street, Building B Vero Beach, FL, 32960 HAVE BEEN COMPLETELY DESTROYED BY A CERTIFIED SHREDDING PROCESS . It is further certified that records were not excessively handled, tampered with, or read by anyone with Southeast Secure Shredding, Inc. 3910 US Highway 1 Vero Beach, FL 32960 772- 562-6556 Date Destroyed 03 / 06 /2013 •� Weight or Lot # 670 lbs . C E R T I FIE D Presi xz3 • yzapazus T : ��IbzaM Ag ( Sq ) :s;unooarc : area : ainjeu613 : 9jn;eu6ls � ! 1 JanlJa jawo1sno 'Palo a eq uayl lym lepejew Papp y a4l 1e4l pu a�f a ue palpuey �fjlelluapyuoo aq ' m alep anoge aUl uo oaa /elaalew ayl l l s ao gaaau Buippo ryS a rno S jseay;noS Blom As (8l) 00!40 a 6wpima smeJs Jas y uawooe - o;g 11eW Z ssaippy i uewnH f4unoo ja uelpul 000000000000000-21HNIO : ol Iile 096Z £ l =1 ` 40888 oaan :1isIAMINI 8 6ulpiln8 14S 41LZ 009L : ssaippb soomosal uewnH f} unoo Janlb uelpul MH2110 :jawojsno all S_JIO ❑ a180111PaO 6ulppaJ4S alis- uO ❑ 9999-Z99-ZLL (x130) 096Z£ IJ ` 4oe98 oJan ( oloevvvv) II IIIIIIN II III�I 6u ! PP jUS a oeS jseaujnog I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIII : 96ed £ I. OZ/90/£0 v Of ce of INDIAN RIVER COUNTY y ATTORNEY Dylan Reingold, County Attorney William K. DeBraal, Deputy County Attorney Kate Pingolt Cotner, Assistant County Attorney RECEIVED OCT 0 9 2013 MEMORANDUM BOARD OF COUNTY COMMISSION TO : Laura Vasquez — Records Management Liaison Officer FROM : Dylan Reingold — County Attorney DATE : October 8, 2013 SUBJECT: Records Disposition Documents The following listed record series that were authorized for destruction have now been destroyed , and a completed and fully executed copy of each Records Disposition Document is attached for your records and/or reporting needs : Series Description Administrative Support Records READ files ( 3/2003- 5/2010 ) Transitory Messages telephone message books ( 12/ 2004- 8/2009 ) Calendars calendars ( 2000-2011 ) nhm attachments cc : Dori Roy RECORDS DISPOSITION DOCUMENT NO . PAGE OF PAGES 1 . AGENCY NAME and ADDRESS 2. AGENCY CONTACT ( Name and Telephone Number) Board of County Commissioners of Indian Laura Vasquez , RMLO River County 1801 27`h Street 1801 27th Street Vero Beach, FL 32960 Vero Beach , FL 32960 1 ( 772 ) 226 - 1919 Ext , 3. NOTICE OF INTENTION : The scheduled records listed in Item 5 are to be disposed of in the manner checked below (specify only one) . ® a . Destruction ❑ b . Microfilming and Destruction ❑ c. Other 4. SUBMITTED BY: I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the records have been fu fled , and that further retention is not required for any litigation pending or imminent. P ' nature Nah4e and Title Date Y OEM t-'RE f. g. a. b. c, d e. Volume Disposition Schedule Item Title Retention Inclusive In Action and No. No, Dates Cubic Date Feet Completed After Authorization GSI - 3 Administrative Support Records Duplica 3/2003 - 5/2010 10 . 5 recycled SL tes 10 / 7 / 201 6. DISPOSAL AUTHORIZATION : Disposal for the above listed 7. DISPOSAL CERTIFICATE: The above listed records have been records is authorized. Any deletions or modifications are indicated. disposed of in the manner and on the to shown in column g . Iv '7 0 nature Date tto J i C , �n u odian/Records Management L' n Offi r Dae Nam d Title Witness CuW\ iW h% J61 1i RECORDS INVENTORY WORKSHEET Department/Section Contact Phone No. Indian River County Attorney ' s Dylan Reingold, County Attorney 772-22& 1427 Office Location of Records Schedule No. Item No . GS1 - SL 3 Room A2-612 File Records Series Title Administrative Support Records Record/File Title READ files ( WGC ; WKD ; MEF ; GG ; BO ) Description (Contents, Purpose, and Use : Include form title and numbers , if any) Duplicate copies of work product chronologically filed by originator . Only used by originator for purposes of reference ease . No longer has administrative value . ❑ Record Copy Duplicate Copy File Type Cut-Off Date Arrangement Authorization for Series ❑ Subject ❑ Calendar Year ❑ Alphabetic by ❑ a. Statute ❑ Case/Business Activity ❑ Fiscal Year ❑ Alphanumeric by ❑ b. Regulations ❑ Working Papers ❑ Anniversary ❑ Numeric by ❑ c. Administrative ® Reference ® Continuous ® Chronological by N /A ❑ Index ❑ Other ❑ Other (Citation ) Record Form ® 8-1 /2" x 11 " paper ( letter size) ❑ 11 " x 15" computer printouts ❑ Computer disks ❑ 8A /2" x 14" paper (legal size) ❑ 11 " x 8-112" computer printouts ❑ Compact disks ❑ Bound books, catalogs ❑ Roll microfilm ❑ Computer tapes/cartridges ❑ 3 " x 5" Cards ❑ Microfiche ❑ Videotapes ❑ 4" x 6" Cards ❑ Other ❑ Optical disks Electronic Records Filing a. What is the name of the system ? b. Who owns the system ? c. What operating system is needed to retrieve and view files ? d. What application software is needed to retrieve and view files ? e. What is the file format? (. doc, .xis, .tif, . rtf, etc. ) f. What is current age of media on which records are stored? ( 1 year, 5 years , etc. ) g . How quickly is this information usually needed? (within minutes , days , weeks, etc . ) h . How often is this information accessed ? (daily, weekly, monthly, etc. ) Is What business activity do these records support? j . Are there any records related to these records? k. Do you need more assistance with assessing these records ? Current Holdings Year Paper Electronic (Inclusive Dates ) Cubic Feet Bytes/Item Type Filing Equipment Used Quantity Count 10 . 5 file drawers 7 How active are these records ? Who uses these records ? ❑ Active (accessed frequently ; weekly or immediately) Not used - no administrative ❑ Semi-active (accessed periodically ; monthly or less often ) value ® Inactive (no need to retain in the active office area ) Place an "X" in the proper column (If the answer is "yes " , explain on the below.) YES NO 1 . Is this Department the official record holder? ❑ I Are there copies of this record series or major portion of it in this Department? ® ❑ 3. Are there copies of this record series or major portion of it in another Department? ❑ 4. Does this record series contain information exempt from public access ? ❑ 5. Is there any legal requirement affecting disposal of this record series ? ❑ 6. Does this record series contain information subject to regulatory requirements ? ❑ 7. Does this record series contain information subject to legal requirements ? ❑ 8. Does this record series contain information used in the subject to audits ? ❑ 9 . Is this record series needed because of archival or historic interest? ❑ 10. Are these vital records? ❑ Responses to Questions and Additional Comments Retention Recommended Retention !F �l Inventoried By Dat6 Reviewed By Date RECORDS DISPOSITION DOCUMENT N0 . PAGE OF PAGES 1 . AGENCY NAME and ADDRESS 2. AGENCY CONTACT ( Name and Telephone Number) Board of County Commissioners of Indian Laura Vasquez , RMLO River County 1801 27`h Street 1801 27th Street Vero Beach, FL 32960 Vero Beach , FL 32960 1 ( 772 ) 226 - 1919 Ext . 3. NOTICE OF INTENTION : The scheduled records listed in Item 5 are to be disposed of in the manner checked below (specify only one) . ® a . Destruction ❑ b . Microfilming and Destruction ❑ c. Other 4. SUBMITTED BY: I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the records have been fully justified , and that further retention is not required for any litigation pending or imminent. 4i ( �, 9 gnature me and Titl Date _ .•, , FINEate' LLL f, g1 a, b, C. d. e. Volume Disposition Schedule Item Title Retention Inclusive In Action and No. No, Dates Cubic Date Feet Completed After Authorization GS ] - 146 Transitory Messages Record 12 /2004 - 8/2009 1 r SL Copy ecycle 10 / 7 / 2013 6. DISPOSAL AUTHORIZATION : Disposal for the above listed 7. DISPOSAL CERTIFICATE: The above listed records have been records is authorized. Any deletions or modifications are indicated . disposed of in the manner and on the date shown in column g . "IISignature Date AL4uoddian/Records Manage ent Lim ice Dat4 d Title Nei itrill ( V il a�L Witness Na r} Cy RECORDS INVENTORY WORKSHEET EMEN Department/Section Contact Phone No . Indian River County Attorney ' s Dylan Reingold, County Attorney 772-226- 1427 Office Location of Records Schedule No. Item No. GS1 - SL 146 Room A2-612 File Records Series Title Transitory Messages Record/File Title Phone Message Books Description (Contents , Purpose, and Use : Include form title and numbers, if any) canary copy of phone messages logged by SW and NM for periods from 12 / 2004 through 8 / 2009 ® Record Copy Duplicate Copy File Type Cut-Off Date Arrangement Authorization for Series ❑ Subject ❑ Calendar Year ❑ Alphabetic by ❑ a . Statute ❑ Case/Business Activity ❑ Fiscal Year ❑ Alphanumeric by ❑ b. Regulations ❑ Working Papers ❑ Anniversary ❑ Numeric by ❑ c. Administrative ® Reference ® Continuous ® Chronological by N / A ❑ Index ❑ Other ❑ Other (Citation) Record Form ❑ 8-1 /2" x 11 " paper (letter size) ❑ 11 " x 15 " computer printouts ❑ Computer disks ❑ 84 /2" x 14" paper (legal size) ❑ 11 " x 8-1 /2" computer printouts ❑ Compact disks ® Bound books, catalogs ❑ Roll microfilm ❑ Computer tapes/cartridges ❑ 3 " x 5" Cards ❑ Microfiche ❑ Videotapes ❑ 4" x 6" Cards ❑ Other ❑ Optical disks Electronic Records Filing a . What is the name of the system ? b. Who owns the system ? c . What operating system is needed to retrieve and view files ? d. What application software is needed to retrieve and view files ? e. What is the file format? (.doc, .xIs, .tif, . rtf, etc. ) f. What is current age of media on which records are stored? ( 1 year, 5 years , etc . ) g . How quickly is this information usually needed ? (within minutes, days , weeks , etc . ) h . How often is this information accessed? (daily, weekly, monthly, etc . ) i . What business activity do these records support? Js Are there any records related to these records? k. Do you need more assistance with assessing these records ? Current Holdings Year Paper Electronic ( Inclusive Dates ) Cubic Feet Bytes/Item Type Filing Equipment Used Quantity Count 12 / 7004 awn 1 file drawer 1 / 2 How active are these records ? Who uses these records? ❑ Active (accessed frequently ; weekly or immediately) Not used - no administrative ❑ Semi-active (accessed periodically ; monthly or less often) value ® Inactive (no need to retain in the active office area ) Place an "X" in the proper column (If the answer is "yes " , explain on the below. ) YES NO 1 . Is this Department the official reco�mmrd holder? 1:1I Are there copies of this record series or major portion of it in this Department? ❑ 3 . Are there copies of this record series or major portion of it in another Department? ❑ 4. Does this record series contain information exempt from public access? ❑ 5. Is there any legal requirement affecting disposal of this record series? 6. Does this record series contain information subject to regulatory requirements? ❑ 7 . Does this record series contain information subject to legal requirements ? ❑ 8. Does this record series contain information used in the subject to audits? El9. Is this record series needed because of archival or historic interest? 10. Are these vital records ? ❑ Responses to Questions and Additional Comments Retention Recommended Retention Inventoried By Date Reviewed By Date ' RECORDS DISPOSITION DOCUMENT NO. PAGE OF PAGES 1 . AGENCY NAME and ADDRESS 2. AGENCY CONTACT (Name and Telephone Number) Board of County Commissioners of Indian Laura Vasquez , RMLO River County 1801 27h Street 1801 27th Street Vero Beach, FL 32960 Vero Beach , FL 32960 1 ( 772 ) 226 - 1919 Ext , 3. NOTICE OF INTENTION : The scheduled records listed in Item 5 are to be disposed of in the manner checked below (specify only one) . ® a . Destruction ❑ b . Microfilming and Destruction ❑ c. Other a. SUBMITTED BY: I hereby certify that the records to be disposed of are correctly represented below, that any audit requirements for the records have bee tified , and that further retention is not required for any litigation pending or imminent. Dylan Reingold , County Attorney C1 Signature Name and Title Date ff . . _ f, g1 a. b, c, d e. Volume Disposition Schedule Item Title Retention Inclusive In Action and No. No. Dates Cubic Date Feet Completed After Authorization GSI - 89 Calendars Record 2000-2011 1 SL COPY recycle 10 / 7 / 2013 6. DISPOSAL AUTHORIZATION : Disposal for the above listed 7. DISPOSAL CERTIFICATE : The above listed records have been records is authorized . Any deletions or modifications are indicated . disposed of in the manner and on the date shown in column g . IUA3 ignature Crate ,oIo woo L7�\ li. rl �11C3 T3 \ � odian/Records M nagement Offs ate Name Title , ,. iffY j I IV Witnes �j aul Ly V L15 d � I RECORDS INVENTORY WORKSHEET Department/Section Contact Phone No . Indian River County Attorney ' s Dylan Reingold, County Attorney 772 -226- 1427 Office Location of Records Schedule No. Item No. GS1 - SL 89 Room A2-612 File Records Series Title Calendars Record/File Title Calendars Description (Contents, Purpose, and Use : Include form title and numbers, if any) . Calendars showing appointments and meetings - used only by attorneys and staff WGC - 2000 ; WKD- 05 / 06 ; LK- 2007 ; NM - 2000 - 2011 ® Record Copy ❑ Duplicate Copy File Type Cut-Off Date Arrangement Authorization for Series ❑ Subject ❑ Calendar Year ❑ Alphabetic by ❑ a . Statute ❑ Case/Business Activity ❑ Fiscal Year ❑ Alphanumeric by ❑ b. Regulations ❑ Working Papers ❑ Anniversary ❑ Numeric by ❑ c. Administrative ® Reference ® Continuous ® Chronological by N / A ❑ Index ❑ Other ❑ Other (Citation ) Record Form ❑ 8-1 /2" x 11 " paper (letter size) ❑ 11 " x 15" computer printouts ❑ Computer disks ❑ 8-112" x 14" paper (legal size) ❑ 11 " x 8=112" computer printouts ❑ Compact disks ® Bound books, catalogs ❑ Roll microfilm ❑ Computer tapes/cartridges ❑ 3" x 5" Cards ❑ Microfiche ❑ Videotapes ❑ 4" x 6" Cards ❑ Other ❑ Optical disks Electronic Records Filing a. What is the name of the system ? b. Who owns the system ? c . What operating system is needed to retrieve and view files? d. What application software is needed to retrieve and view files ? e. What is the file format? ( .doc, .xIs, .tif, . rtf, etc. ) f. What is current age of media on which records are stored? ( 1 year, 5 years , etc.) g. How quickly is this information usually needed? (within minutes, days , weeks, etc . ) h . How often is this information accessed? (daily, weekly, monthly, etc . ) Is What business activity do these records support? Jo Are there any records related to these records? k. Do you need more assistance with assessing these records? Current Holdings Year Paper Electronic ( Inclusive Dates) Cubic Feet Bytes/Item Type Filing Equipment Used Quantity Count 1 file drawer 1 / 2 y How active are these records ? Who uses these records ? ❑ Active (accessed frequently ; weekly or immediately) Not used - no administrative ❑ Semi -active (accessed periodically ; monthly or less often ) value ® Inactive (no need to retain in the active office area ) Place an "X" in the proper column (If the answer is "yes " , explain on the below.) YES NO 1 . Is this Department the official record holder? ® ❑ 2. Are there copies of this record series or major portion of it in this Department? ❑ z 3. Are there copies of this record series or major portion of it in another Department? Li 4. Does this record series contain information exempt from public access? ❑ 5. Is there any legal requirement affecting disposal of this record series ? ❑ 6. Does this record series contain information subject to regulatory requirements ? ❑ 7. Does this record series contain information subject to legal requirements? ❑ Be Does this record series contain information used in the subject to audits? ❑ 9 . Is this record series needed because of archival or historic interest? ❑ 10. Are these vital records ? ❑ Responses to Questions and Additional Comments longor used by Staff Re ratiVe value Retention Recommended Retentio Inventoried By Date Reviewed By Date