443-2055 Cln J•• A..iJ ~A~ flu Archlv,st the...cording to a formula established by th~ basic...

)

-LEAV BLANI

REQUEST l AUTHOR~TY bull DATI ltEIVED JOB NO

TO DISPOSE OF RECORDS aCT 9 1975 (See Instructions on Reverse) 7 ~~ 9d NC- 90 -76-1TO GENERAL SERVIC middotES ADMINISTRATION

NATIONAL A~clVES AND RECORDS SERVICE WASHINGTON DC 20408 NOTIFICATION TO AGENCY

1 FROM (AGENCY OR E TABLISHMENT) In accordancewith the prOVISionsof 44 usc 33031 the dis ~partm~~t 0 f Hea lth Education and Welfare pCIll request Including Imendments I approved except for

Items that may be stamped dISposal not approved or wllh drlwn In column 10

2 MAJOR SUBD IISIOl

Public 1ea h ServiceIt 3 MINOR SUBDISION

Pub lic Hea 1t h Service Regional Offices 4 NAME OF PERSON VII bull H WHOM TO CONFER TEL EXT bull

Carl E Hanr 15

443-2055 J1-J-71 Cln JbullbullL AiJ ~A~ flu 6 CERTIFICATE OF AGEl CY REPRESENTATIVE (Date) I Archlvst of the UMited States

Date (Signature of Agency Representative) (TItle)

97 8 DESCRIPTION OF ITEM 10SAMPLE ORITEM NO (WIth lnclusive Dates or Retention Periods) ACTION TAKENJOB NO

RECORDS CONTROL SCHEDULE FOR USE BY THE PUBLIC HEALTH SERVICE REGIONAL OFFICES DREW REGIONS

Each tHS Regional Office is responsible for directing PHS programs and activities within aSSigned area of re-sponsibility in order to assure a coordinated effort in tune with PHS and national policies and State and local needs The PHS Regions interprets PHS and national poli-cies 3nd guidelines establishes regional goals and ob-jecti~es monitors progress and accomplishments and re-view~ and redirects the regional effort accordingly de-velors the overall regional budget proposal based on na-tional priorities and regional work plans determines types of personnel needed recruits and selects and eval-uatef performance of regional staff awards decentralized health grants and contracts in accordance with PHS and national policies and guidelines and State and local need~ and assures program implementation and continuityEach PHS Regional office is headed by a Regional Health Admitistrator who reports to the Assistant Secretary for Heallh Each Regional Office is comprised of the Office of Planning and Evaluation Office of Management Support Office of State Coordination Division of Financing and Real~h Economics Division of Quality and Standards Di-vision of Health Services Division of Resource Develop-ment and Division of Prevention

STANDARD FORM 115 ~~ Revised January 1973 ~ Prescribed by General Services

Admlnlstratlon FPMR (41 CFR) 101-11 4

- - - --- - - - ~ -~ - - ----~-~----~ --

HII11tlhtl ~ Hdl -nh n

j rri J f tl 1-) hv CCli =1 Job No PSiC _ ~ __lI ~tlmlutltrutJmiddottl T1lc atlc bulllImiddotmiddotlgtI3 or ~pllt

REQUESTiOR AUTHORITY TO DISPOSE OC RpoundCORDS-Conunuotion Sh(I~t

-----------------------------------------------------~----------~--------~------------~ r DtSCflllICN OF ITtM 107 SAMPLE ottITEM 1i0 (HlI IhCIVSI~middotE011 en flE1LiTtOH PEllI005) ACTlON T(N J09 tiO

PART I GRANT AND CONTRACT PROGRAM RECORDS t

The most common type of program in PHS is the disburse-ment of Federal monies through various contract and grantprograms Some grants are approved at the PHS Headquar-ters and some by the Regional Health Administr~tors PHS Rag Lons The office of record for grant ma t erLals is the office having approval authority

CONTRACTS See Item 4 of Schedule 3 GSA Genf~ral Re-cords Schedules for disposition to be taken on re-cord materials pertaining to contracts for Health Ser-vices The GSA General Records Schedules are includ-ed in the HEW Records Management Manua 1 as Append Ix A

GRANTS Formula grant programs distribute monies ac-cording to a formula established by th~ basic legisla-tion of each program The formula may be b~sed on population ethnic distribution presence o~ Federal activities etc In discretionary grant programs PHS determines the grantee and the dollar amoun~ of the specific grant more subjectively Certain records pertaining to construction grant programs are accord-ed longer retention periods due to specific legal re-quirements to retain written guarantees made by States or institutions

1 Discretionary Grant Programs These grants are made in support of an individual project in ac-cordance with legislation which pe~mits the grant- I or agency to exercise judgment in selecting the project the grantee and the amount of award PHS components administering discretionary grantprograms are required to generate two distinct types of records as follows

a General Program Information File - The office of record for this file will normally be the PHS Agency program office These records must include -

(1) Program announcement program managementprocedures (regulations) and terms and conditions of the grants prog18m

Authorized Disposition All offices - De-stroy when superseded or rescinded

1

-----_- ~___r_~----__r_~--- - - ------ - ~- ~ - rtII-~~

1 fjIYJJhmiddot tmiddot 1 I Job No _ JILfC __ J _I

O middott r-t Imiddot AnlllJlion ttl J a~ I nb of --1l It-

RE0UES ron AUThORITY 10 DISPOSE OF RCCORDS-Continuat)on Slcot

I 9 108 OEXHIPTlC~ OF IITM SAMPLE en ACTION TAKUl7 (WITK INCLUSIVE [Irs OR RIlTlW PEruoc-i) JO~ hO_lIT NO - 1

(2) Lists of application evaLuators and instruc~ions to evaluators

Authorized Disposition All offices -Destroy when superseded

(3) These records may also include -

(a) Authorizing legisiation

Authorized Disposition All office -Destroy when superseded or expires

(b) Federal Register documents

Authorized Disposition All office Destroy when resc~nded or obsolete

(c) General counsel and court opinions

Authorized Disposjtion All office -Destroy when obsoLete

b Official Grant File This file is main~ained for each grant awarded These records must include official file copy of application evaluation documentation (irc1udingdocuments concerning review of applLcctLons and progres reports) financial reports award notice grant closeout documents (including progress reports) and correspondence These records may also include assurances and certification (for civil rights protection of human sub-jects animal welfare and invention state-ments) records of required clearances site visit reports and audit reports

Authorized Disposition Ofice of record -Transfer to FRC 2 years after final closeout or upon resolution of any adverse audit find-ings whichever is later Earlier transfer t

-r r--- --- I~ - - ~ -- ~--r --~r--~ - --- --- ~ r1

2

~~I~1 t~14t (h ~ II middotbull ~ I ~ A ~ r lIe ~Itl Job No _ Po A__ 1 U (_~ ~I 3

of ~L rJl~-

REQUrs~rmiddotFOR AUTHORITY TO DISOSE OF RECORDS-Continuation Shoot

7 I1(M NO

---------~-----------~ a DESCr-iP flCl1 OF ITEM Iii SA~PLE OR (WITH llUS~E DHES or HEHKTlOII (PJOl3) ACTON T~r-iJOB NO

FRe is authorized if there are no adverse au-dit findings~outstanding Destroy 4 years after transfer to FRe

All other offices - Destroy3 years after final closeout

Formula Grant Programs A formula grant is one in which funds are provided to specified grantees on the basis of a specific formula prescribed in legislation or regulation rather than on the basis of an individual project review The for-mula is usually based on such factors as popula-tion per capita income enrollment mortalityanc morbidity These grants are generally manda-tory PHS components administering formula grantprograms are required to generate two distinct types of records as follows

a General Program Information File - The office of recotd for this file will be the awarding component grants management activity These records must include -

() Program management procedures (regula-tions) terms and conditions and State plan check lists

Authorized Disposition All offices -Destroy when superseded or rescinded


(a) Au~horizing legislation

Authorized Disposition All offices Destroy when superseded or expires


Authorized Disposition All offices Destroy wren rescinded or obsolete


Authorized Disposition All offices Destroy when obsolete

(f _

Fo coopl lneJuoUnlJ OIIN 0 bo -oill~ to 41 1ioiuCll kc)U

I

7

3

c hI aralll)I~Jh (fI

T~ -~middotI_1J rrLis

RrOUEST FO~ IU1 JHITY TO DISPOSE OF RECORD~~ Jontinuation Sheet

9 IJ8 OEXIlIOlIO1 0 lIT SA-IrlE OR 1cT1-~ Tmiddotpound(WITH IClU~IVE DAHS 0 R~UtTlH Ppoundll~)rrra NO XU liO

b Official Grant File This file is maintained for each annual f orn-ula grant awarded These records must include official file copy of application or State plan and certification documents (as applicable) budget informationState plan checklist award notice progress reports annual expenditure reports and correspondence These records may also includ site visit reports and audit reports

Authorized Disposition Office of record -Transfer to FRC 2 years after final closeout or upon resolution of any adverse audit find-ings whichever is later Earlier transfer to FRC is authorized if there are no adverse audi findings outstanding Destroy 4 years after transfer to FRC All other offices - Destroy3 years after final closeout

Construction Grant PrograTIs Construction grantsare awarded to provide support for building ex-panding and modernizing ~ealth facilities Con-struction grants mdY be ~ither discretionary project grants or formula grants depending uponthe legislative authority of the individual grantprogram Two distlnct types of records are generated a general program information file and an ofiicial grant file The contents will varyso~ewhat dependinE on whether the program is a discretionary or formula grant program

a General Prograr Information File The office of record for this file will normally be the PHS Agency Program Cffice These records must include -

(1) Program announcement program managementprocedures (regulations) and terms and conditions of the grant program

--------~---------------------------------~~--------------------------~--------~-----------Jamp--6f04Jgt-1 ro pJu luduUDI rill nl 10 bo mJlte4 to 11 Nat_cl AnbJ e4

7

J ~~ u~1 l-oj lj l1(j _~ n 1 Illlfd~trnlv Job No Psge v 1lc ~~J- bullbull a J It ~Ii

of ~ t-gc

REQULST xOR AUTIfORI-fY TO DISPOSE OF RECORDS-Continuation Shcot --------------------~----------------------------~------~--------9e orrltlIPTiO-l OF ITEM 10 SAMPLE OR

ITEM hO (WITH PCLUSloE ()~middotrs on HlElmOli PLruOOS) JOB 10 ACTICN 1rIN

Authorized Qisposition All offices -Destroywhen superseded or rescinded

(2) Lists of application evaluators and instructions to evaluators



(a) ~uthorizing legislation

Authorized Disposition A110ffice-Destroy when superseded or expires


Authorized Disposition All officel-Destroy when rescinded or obsolete


Authorized Disposition All officeE-Destroy when obsolete

b Official Grant File This file is maintained for each grant awarded by PHS

(1) These records must include official file copy of application evaluation documen-tation (including documents concerningrevieu of applications and progress reports) financial reports award noticegrant closeout documents (includingprogress reports) and correspondence environmental impact statementsinspection reports equipment lists bidlists and (ocuments and performanceand other bond documents

--------~-------------middot-------------~~~--------------------~---------I----------Fowr cltgtplu IochIu1 01l1l0I Mgt -bmlHd ubullbull N tloAcJ IUdJv 1lt-60L3-1 bull

--~ _- --~-- ~ - ~

t II bullbull - _ ----

lcrlllJf1t It ~l--tllly Oro 1( II1It~rat1tJl Job No 11 tloamp1 ArchYlt3

RLQULST FOP AUTHORITY TO DISPOSE OF RECORD~-ContinuQtion ~heet

--------------------------------------------------------------~-----------------97 8 D[XRIPrION OF ITEM SAMPLE OR ImM NO (WtTH IKCUJSIH DAlES OR IUiOHlO PEfuOOS) MTlI)middot~O TAKEI JOU NO ---------1----------------------------------------------------------1---------------------

Authorized Disposition Office of record ~ After last payment is made tranpound-fer to FRC Destroy when 20 years old



(a) Authorizing legislation

Authorized Disposition All office~-Destroy when rescinded or obsolete


Authorized Disposition All office -Destroy when rescinded or obsolete


Authorized Disuosition All office -Destroy when obsolete

4 State Plans These plans are submitted ann~allyand describe what the States propose to do vith federal money for the upcoming year The plansoften recapitulate the previous year projections as compared to achievements problems encountered etc Grants and Contracts Hanagement Branch PHS Region is the office of record

Authorized Disposition Office of record - Transfer to FRC when 2 years old Destroy when 5 years old or after final payment to grantee or after resolution of any adverse audit findingswhichever occurs later

All other offices - Destroy when 2 years old or earlier if no longer needed

_ -_r - __ -~ _-_~ - _-- - bull - ~ - - bullbull --- fJIt--

j~~ilt1 1- J t yt-11 Inmiddot1 1~lmiddotluill1t)n Job No PnFC __ O__ l~~ lbl-lJ AcLhl5

(r~pah(~

REQUESTrOE lUTHORITY ro DIspose OF RlCORDS-ConUnuanon Sheot

------------------------------~---------------------------------------~----------------------97 e r[XRIPTION OF lIT 10 SAwlE ORITEM 110 (WITH I~CLUSE DATES CR nnrllil0i fUUOOS) ACTION T JYDiJOEl 110

5 Final Reports - Grants and Contracts Final reportare not required or furnished on all grants and con tracts ~hey are usually required on contracts and grants having pistorical or research value Final reports contain information such as authority backmiddot ground problems discussion findings co~clusions and recommendations

Authorized Disposition

Office of record -

J~~~~L~L~yd~~~ ~ -ear samples-af signifieant flool le(38Ifs W1Ul fe bull -iat-e~~-a-ampts AampRg Ms-te1ieal BRG ~ Offer to National Archives 5 years after final payment to grantees or after resolution

of any adverse findings whichever occurs later bull

10 aL VL CCL-I~lULLo LoU ~r~ WI YClL

old 8I1d-401esttoy 5 years-spoundter final flaymeft~ ~afltees or after resolution of any edvae-e atldit s bullbullbullbull Lmiddot bull

-- --b~ ~ -- bullbull--- - La L bull

$ All other offices -

Destroy when 2 years old or earlier if no longerneeded

6 Audit Reports These reports are primarily concern-ed with the grant and contract programs Audits arE conducted by HEW and GAO for detection of fraud mi~-representation illegal use of monies false certi-fication etc Any discrepancies are noted in the reports and are required to be resolved before the records are closed out

Authorized Disposition Transfer to the FRC when 1 year old unless needed for a longer perJod due to adverse audit findings Destroy when If years old or when any adverse audit findings are resolved whichever occurs later

PART II OTHER PROGRAM RECORDS

7 Foreign Quarantine Program The purpose 3f this program is to protect the nation against introduc-

ro eopl -CIIdIna orlllaoJ 10 be bull btnhted Iigt I NtloaollLrchivN

-~ - r - - ~ - - ~ ~~~

RlrLnf1nrtl I orn) ~u lHin Iromll 11 ~ l-Iq II (1(lIlrl) nirIO dIJlIIlIOijtr~llon llIl NattJIHLi Anhllc

Job No Page _9-_ of -lL pages

REQUEST FOR AUTHORITY TO DISPOSE OF RECORDS-Connnuation Sheet

97 8 DCrcmiddotlIPriON OF ITEM 10 ITEM 110 (WITH INCLLSIE [~TfS OF RUENTION PERIODS) ACTION TAKENSAMPLE OR

JOB NO

tion of diseases from foreign countries to include an overseas program for medical examination of im-migrants to the US exchange of quarantine infor mation with other Federal Government agencies Sta e and local hea lth departments and industries ex-change of liaison with international organizationsin order to develop international quarantine agreements and studies on health hazards prevention and disease i~troduction into the Us The office of record for these files is located at the PHS Headquarters The PHS Regions maintain workingcopies of these files The files consist of or re late to regulationr directives and guidelines fo~ day-to-day operations meetings periodic reportson border surveillnnce statistical reports on persons quarantined and reasons therefor reports on incidence distribution and control of diseases introduced into the US and general corresponden e

Authorized Disposition Destroy when 4 years old superseded or no longer needed

8 uS - Border Nations Public Health Associations These associations are established to promote impl -mentation of health agreements between the countri s concerned and International Health RegulationsThey exchange information on health matters take measures to resolve mutual problems and plan fu-ture actions in promoting better health relations The office ~f record for these files is located at the PHS Headquarters These are working files con sisting of or relatlng to agendas meetings work-shops recommendations summaries progress report~ agreements and general correspondence

Authorized Disposition Destroy when 3 years old ~r earlier if no longer needed

9 Research Materials - Disease Control These are I research materials published by activities outside the PHS Regions and used by the regions as generalinformation They consist of booklets pamphletsarticles summa~ies etc on such technical medica subjects as bot~lism cholera gastroenteritisdyptheria encephalitis hepatitis influenza Han sens disease ~alaria measles meningitiS mycosespoliomyelities rabies salmonella shigella smal~

-------~--------------------------------------------------------~------~---------- -- r

10

Atnn(tnrlaquol 1 Orin - 1) 1 1(1 rOnluk I(lt )~1-1 III Ornlrnl lt([ irrs AdLliulotr uon 01gt No _fhe N ntronnl AchI Plge~_

Or~pfgl

HLQUEST FOR AUTHORITY TO DISPOSE OF RECORDS-Connnuation Sheet

7 8 DEXIlIPTION OF ITEM 9 ITEM uo (WITH INCLUSIVE DAns Oft RETENTION PERIODS) SAMPLE OR ACTION TAKENJOB NO

pox and rebella

Authorized Disposition Destroy when no longerneeded or superseded

10 Professional Standards Review OrganizationsThese organizations are selected to carry out peer review of health services programs including Medicare and Medicaid The organizations are comprised of professionals from public and private activities qualified tn conduct utiliza-tion reviews relating to budgeting accounting statistical reporting auditing operations ap-d medical services The agreements for their services are funded by the Federal Government The PHS Headquarters is th(gtoffice of record The PHS Regions oversee implementation of the program

a Copies of agreements PSRO recommendationsevaluations reviews periodic reports and summaries and general correspondence

Authorized Disposition Transfer to the FRC when 2 years old Destroy when 6 years old 0

earlier if no longer needed

b Materials relating to selection of PSRO area I

boundaries by the PHS Regional staff such as agendas meetings minutes evaluations con-clusions recommendations general correspondence and maps and transparancies showing rec ommended PSRO area designations for PHS Head-quarters approval

Authorized Disposition Destroy when 4 years old or when PSRO area designations are approvedwhichever occurs later

c ~lailing lists of physicians and medical care providers of service located within the PSRO Regional area

Authorized Disposition Destroy when 2 years old or earlier if no longer needed

d Newspaper clippings~new releases and other Ibullbull publication media indicating local response t

~~ --- -- -- -- -

------------ ----

fUnnl1nr(1 lOrlll 0 Ilr1 ]t)lIIulr L1(~ ~1-~ fly O(nrrat HI- AJmlllftratiOn ib No _The NnllOlJIJ Arclme Pnr e 11

of --12 pngC_

REQUEST FOR AUTHORITY TO DISPOSE OF RECORDS-Continuation Sheet

7

ITEM UO (WITH

8 DEc-cnIPTIOfl or ITEM

I~ClUSIE DATlS OR RETEHTlOH PERIODS 9

SAMPLE OR JO[J NO

10 ICTON TAKEN

the PSRO program

Authorized Disposition Destroy when old or earlier if no longer needed

2 years

11 Nutrition This program is concerned with regu-latory approaches to improve nutrition advice to public and private entities on nutritional matter research and analysis determination of nutrition 1 value in various foods and liaison with inter-national national public and private nutrition 1 scientific communities The office of record is located at the PHS Headquarters These records consist of basic nutrition data research studies surveys and evaluations on nutrients standards policies conferences and workshops food program training surveys and general correspondence

Authorized Disposition Destroy when 5 years old or earlier if net needed Transfer to FRC when nplonger needed for day-to-day operations

12 PHS Region Annual Work Plan These plans reflect forecasted goals to be achieved by the PHS Region~ They are prepared and used along the cncept of Management By Objectives and are updatedperiodically They reflect the Regions national health strategies based on resources availability

Authorized or earlier

Disposition Destroyif no lqnger needed

when I3 years old

13 Provider Services - Quality and Standards This program is concerned with the review and certi-fication of health care providers (nursing facilities intermediate care facilities ambu- I latory X-ray units home health care agenciesuncertified hospitals independent laboratories and ambulatory centers) subject to the provisions of the Social Security Act The program is also concerned with the monitoring of State Agency performance on-the-job training in upgrading the quality of health care personnel improved provider certification at the State and local levels professional consultation to Professional Standards Review Organizations (PSRO) monitoring performance of PSROs and advising regional staff on implementation of appfoved PSRO recommendations

T bullbullbullbullbullbull I r ~ - 0 bullbull l1li 11 I

~- - -- - - _ - I ~~--- --or - -- -_ ~ ~~-- ~-~ - -

fUnnlnrd lorr1) 0 1Ifill ttlmuir 1111 )-ImiddotIj by CIrnrrll l Jrrr lmiddott1II1I~trILlon Job No _Ihe lon1011nl AhIC9 PSFC __ 1_2_

Or~pagc

REQUrST FOR AUTHORITY TO DISPOSE OF RECORDS--Continuation Sheet

7 8 DEXIlI[nON OF ITEM 9 ITEM NO 10

(WITII INCLUSIVE DutS CIl RETENTION PEIlIODSj SAMPLE OR JOB NO ACTION TAKEN

The provider service program subiects involved are - surveys utilization reviews certificationE ambulatory centers anesthesia budgets complain s emergency claims home nursing medicaid medicarEand nutrition These are short term programmonitoring files maintained and used w LthLn the PHS Regions These files consist of or r~late to working conferences and meetings trip reports on-site visits meetings consultations inspec-tions workshops and problem solving generalintraregional correspondence with other staff offices claims review and status and periodicreports for intraregional use

Authorized Disposition Destroy when no more tha 3 years old unless sufficiently significant to justify association with other files retained on these subjects for a longer period of timE

14 Regional Health Administrator The Regional Heal h Administrator is responsible [or dir~ctinL the PH~ Regional office programs and activities Lr order to assure a coordinated regional effort He reports to the Assistant Secretary for Heelth He provides input into the formulation anL analysis of national policies priority deter-mination and program plans and serves ab the principal health advisor to the Regional DirectorDepar tmen t of Health Education and WeILlre These records consist of or relate to memorandumsguidelines policies procedures directives and instructions issued by the Regional Health Admin-istrator relative to regional program responsi-bilities and operations Also included is correspondence with the Assistant Secretary for Health the PHS Headquarters staff DHEW Regionastaff State and local governments and ocher activities in carrying out his region31 responsibilities and significant speeches presentationEand briefings

Authorized Disposition Permanent Transfer to FRC when no longer needed for day-to-oayoperations but in any event when 5 years old Offer to the National Archives when 20 years old

t bull t I bullbull bullbull 1 11 r r 1 1 1 fI 1I

J

)ruf11J bull 11 -1 Job 10 _t l c J~ -1 - n l - 1ratvQ lirO_~-J

rLc hbtiJJampl AEltl3 or -1L ~~-

REQULST FOR AU1L-Ol~lTY TO DISPOSE OF RECORD~-ContinuC1lion Sheet

7 lTI1Il uo

8 [jCA~IPTlOrl OF ITI M ChIlH IhCLlSIf DAlES on PCfLOH rrn~)

9 SAlPLE OR

JOB 110

1-----I 0

ACTIOI TAKfN

PART III ADMINISTRATIVE RECORDS L

15 PHS Commissioned Officer Corps These are per-sonnel folders containing vorking copies of materi als such as annual and si~k leave Qualifications background health personnel actions and generalcorrespondence The offic3 of record for these files is the PHS Headquar t are

Authorized Dispositio~ D~stroy when leaves the Region or in any event no 2 years thereafter

the officer later than

16 Organizational Documents These include statutes and Executive Orders as well as drafts and supporting material relating to organization or reorgani-zation including the crea~ion discontinuance an consolidation of functions of various organizational elements budgets and budget planning recordsincluding justifications aid estimates of require-ments interpretations opinions and memoranda of law organizational and fu~ctional charts direc-tories correspondence and memoranda delegating or defining powers and responsibili~ies or showingworking relationships with Federal activities out-side the PHS Region State and local governmentsor industry or private org~nizations and staff studies and special reports relating to organiza-tional problems The office of record for these materials is the PHS Headquarters

Authorized Disposition D~stroy when 6 years old or sooner if no longer needed Transfer to FRC when 2 years old

17 Reports These include an~ual reports or other periodic progress reports vhether narrative or statistical transcripts of hearings and minutes of significant meetings and conferences

Authorized Disposition Destroy when 5 years old or sooner if no longet nee~ed Transfer to FRC when 2 years old

18 Office Services and Su~plies These files relate to ordinary supplies and equipment used by an of-fice office space and utilities communications

------ --------------------~-------------------------~---------

-

--P-T-- ----- __ ~_ __ -_- __ ~ _~_--A~ _

FHnnrlrrd 1or rn ~~I) lltin rOBiuli llr 0-1 tIll (Ifllrrll fr Il(~ dmIJlilr bulluon lhoNotIOUnfAhIH lob No Page -_4_

oC JL pages

REQUEST FOR AUTHORITY TO DISPCSE OF RECORDS-Continuotion Sheet

7 ITEM 110

8 DESClllPfiON OF ITE (WITH INCLU51YEDATE OR PET[HTIOI PERIODS)

transportation custocia1 or other services required by an office and to the general main-tenance of an office These records include but are not limited to

9 SAMPLE OR

JOO NO

10 ACTION TAKEN

19

a Requests for supplies receipts for supplies and equipment request s for disposal of equi p-ment and similar papers pertaining to officE supply matters

Authorized Disposition Destroy when 2 year~ old or earlier if no longer needed

b Requests for installation of telephonestelephone extensions requests for changes t telephone directories and similar papers

Authorized Disposition Destroy when 2 year old or earlier if no Longer needed

c Documents related to building facilities su h as floor plans space hurveys reports of need for additional space and related correspondence


Employee Accident Health and Loss or Theft of Property These documents relate to employee health projects such as blood dontationsprevention shots and related correspondenceIncluded is Form HEW-5l6 Accident Report which is submitted quarterly Also included is GSA Form 182 Report of Loss or Theft prepared aftlr each occurrence

20

Authorized Disposition File copies of Form HEW-5l6 - Destroy when 5 years old All other J Materials - Destroy when romore than 1 year 01]

Training Material These are copies of applica tions notices of training classes notices of completion notices of tnining required and related general correspondence The trainingprograms involved include STRIDE Upward Mobility and Staff Develupment

I

- ~I - -----r--- __ ~ ~~--

iHHn I I I lSbull r I I

1 -- I 1 c _ lL __

___ _________ _ 0 _

7 I e l ~fprlmiddot1CI Ilrl~ I ~ (~CTr )I-L L [r Cq fGUd-X lrJ~IlJ IIl L 01 I-i Ii t i

)JJ 110 I_11~1 l-------------Authorized Disposition Destroy when 1 year old or-ea rl tH if no longer needed I I

Printing and Reproduction ~eguests These record~ include correspondence relRting to copy prepara- I tion reproduction and distribution of publica-t ions

Authorized Disposition Destroy when 1 year old or earlier if no longer needed

22 Congressional Correspondence These relate to correspondence between members of Congress and PHS Included are the incoming correspondencePHS reg10nal input PHS reply and all support-ing documentation The PHS Headquarters is us-ually the office of record

23

s pertaining to iniormation - Transfe to FRC when

years d All when supersede

24 Records Man~~emcnt Files These re~ords include SF-lIS Request for Authority to Dispose of Re-cords SF-135 Records Transmittal and ReceiptGSA Form 7015 Notice of Intent to Dispose of Records and Record Control Schedules includingcorrespond~nce relating to approval and changesto the schedules

i I ------ -_- -----------------------------------------__------ ---- -- - ------ ----

-----------

t r 10 I I r - (l ~bull bull 1

f 1 bullbull bull bull ( ~1 I bull f l ~ r r I Iruc _J~ __ bullbull -) 11 r ~

of __17_ iC gt

--~------------~-----------~------------n vmiddot gt P I -~I CF 11

5111 E C~ (lllt1 1l~It r-vcs UP rrmiddotq(~ p r )lj JCIO

-------- --- --------------

Retain [01 20 year3 and ~heR reic~ fer f~r~heF Ie~eAtieA er eeetr~GtieR ~aIlSpoundeI to PRe when ofHeiBl eliBIOsitisll eetieA~ ~ll lneelFe~~~el on

~~ ~eAeK- --~ 1iIamp~~-~cent1~~~~ 25 Forms Files -records containHlHllt1ICment Thttse

data shmoJii-the inception and scope of the form the program or administrative purposes served bythe form and the related procedures institutedrevised superseded or cancelled

Authorized Disposition Destroy whenlO yearsold Transfer to Lnactive file when superseded or obsolete and to the FRC 2 years thereafter

26 Reports Management Files These records consist of l ist Lng s of int ercsency pub lac us e a nd in-ternal reports required and responded to A file folder is maintalned on each report and includes a copy of the report directive clearancescopies of reports mad0 background materials SF-360 Request for Clearance of an Interagency Re-porting Requirement OF-IOl Summary Worksheet I for Estimating Reporting Costs Form HEoI 614 He-quest for Clearance of Report and SF-B3 Clear-ance Request and Notice of Action

Authorized DisDositioli Listings of reports -Destroy when superseded File folders - Destroy no later than 2 years after report requirement is terminated

_______________ J 0_ _

HII11tlhtl ~ Hdl -nh n

j rri J f tl 1-) hv CCli =1 Job No PSiC _ ~ __lI ~tlmlutltrutJmiddottl T1lc atlc bulllImiddotmiddotlgtI3 or ~pllt

REQUESTiOR AUTHORITY TO DISPOSE OC RpoundCORDS-Conunuotion Sh(I~t

-----------------------------------------------------~----------~--------~------------~ r DtSCflllICN OF ITtM 107 SAMPLE ottITEM 1i0 (HlI IhCIVSI~middotE011 en flE1LiTtOH PEllI005) ACTlON T(N J09 tiO

PART I GRANT AND CONTRACT PROGRAM RECORDS t

The most common type of program in PHS is the disburse-ment of Federal monies through various contract and grantprograms Some grants are approved at the PHS Headquar-ters and some by the Regional Health Administr~tors PHS Rag Lons The office of record for grant ma t erLals is the office having approval authority

CONTRACTS See Item 4 of Schedule 3 GSA Genf~ral Re-cords Schedules for disposition to be taken on re-cord materials pertaining to contracts for Health Ser-vices The GSA General Records Schedules are includ-ed in the HEW Records Management Manua 1 as Append Ix A

GRANTS Formula grant programs distribute monies ac-cording to a formula established by th~ basic legisla-tion of each program The formula may be b~sed on population ethnic distribution presence o~ Federal activities etc In discretionary grant programs PHS determines the grantee and the dollar amoun~ of the specific grant more subjectively Certain records pertaining to construction grant programs are accord-ed longer retention periods due to specific legal re-quirements to retain written guarantees made by States or institutions

1 Discretionary Grant Programs These grants are made in support of an individual project in ac-cordance with legislation which pe~mits the grant- I or agency to exercise judgment in selecting the project the grantee and the amount of award PHS components administering discretionary grantprograms are required to generate two distinct types of records as follows

a General Program Information File - The office of record for this file will normally be the PHS Agency program office These records must include -

(1) Program announcement program managementprocedures (regulations) and terms and conditions of the grants prog18m

Authorized Disposition All offices - De-stroy when superseded or rescinded

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