Box 006
Records Inventory Data VIJ orksheet
Iflstl'UClions in Publtcmion 1176, )nvemOl,Y and Planning, before completing lills rorrn.
lb. DEPARTMEN1/UNIT
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2,
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4, RECORDS SERIESDESCRIPTJON (Describe COOleOl ,mrJ chElracleristics of records)
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3.
5. ARRANGEMENT
o Alphabetical 0 Numerical
o Other (Specify):
6a. RETENTJON V.
o Not scl;eduJed !'(. Permanent
o Scheduled retention:
~ Chronological
o Alphanumeric
o Appraise for hiswrica) value
6b. SCHEDULE AND ITEM NUMBER, ORREASONPGRFROPOSEDREJ'ENJ10N
7.
o Electronic
8.
o Audiovisual 0 Micrographic
g, OThL QUANIITY (In cubic feet or number of items),
o Cubic feet:
o Items:
Type of items:
10. ANNUAL ACCUMULATION (In cubic feet Qrnumber of items),
o Cubjc feet:
o Items:
11, FREQUENCY OF USE,
o Daily 0 Weekly
12, RES1RJCTIONS ON USE
NJ\
o Never
o Momhly
RECORDS ARE
13, 0 IN POOR CONDITJON
14, 0 VITAL (EsseOlial to operations)
15, 11 OFFiClAL COPlES
16a NAME OF PERSON COMPLETING FORM ...t.
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16b. DATE
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New York Slale IIrchi 5
GRS-2 (1212002)
92-7992592-'.6 CDC