+------------------------------+------------+---+-------+-----------------+
| **REQUEST FOR RECORDS        |            |   | **    |                 |
| DISPOSITION AUTHORITY**      |            |   | LEAVE |                 |
|                              |            |   | BLANK |                 |
| *(See Instructions on        |            |   | (NARA |                 |
| reverse)*                    |            |   | use   |                 |
|                              |            |   | on    |                 |
|                              |            |   | ly)** |                 |
+------------------------------+------------+---+-------+-----------------+
|                              |            |   | JOB   |                 |
|                              |            |   | N     |                 |
|                              |            |   | UMBER |                 |
+------------------------------+------------+---+-------+-----------------+
| TO: NATIONAL ARCHIVES and    |            |   | DATE  |                 |
| RECORDS ADMINISTRATION (NIR) |            |   | REC   |                 |
|                              |            |   | EIVED |                 |
| WASHINGTON, DC 20408         |            |   |       |                 |
+------------------------------+------------+---+-------+-----------------+
| 1\. FROM (Agency or          |            |   | NO    |                 |
| establishment)               |            |   | TIFIC |                 |
|                              |            |   | ATION |                 |
|                              |            |   | TO    |                 |
|                              |            |   | A     |                 |
|                              |            |   | GENCY |                 |
+------------------------------+------------+---+-------+-----------------+
|                              |            |   |       |                 |
+------------------------------+------------+---+-------+-----------------+
| 2\. MAJOR SUBDIVISION        |            |   |       |                 |
|                              |            |   |       |                 |
|                              |            |   |       |                 |
+------------------------------+------------+---+-------+-----------------+
| 3\. MINOR SUBDIVISION        |            |   |       |                 |
|                              |            |   |       |                 |
|                              |            |   |       |                 |
+------------------------------+------------+---+-------+-----------------+
| 4\. NAME OF PERSON WITH WHOM | 5\.        |   | DATE  | ARCHIVIST OF    |
| TO CONFER                    | TELEPHONE  |   |       | THE UNITED      |
|                              |            |   |       | STATES          |
|                              |            |   |       |                 |
+------------------------------+------------+---+-------+-----------------+

+------+----------------------------+----------------------------------+
| 6.   |                            |                                  |
|   AG |                            |                                  |
| ENCY |                            |                                  |
|      |                            |                                  |
|    C |                            |                                  |
| ERTI |                            |                                  |
| FICA |                            |                                  |
| TION |                            |                                  |
|      |                            |                                  |
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| to   |                            |                                  |
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| the  |                            |                                  |
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| ted. |                            |                                  |
+------+----------------------------+----------------------------------+
| DATE | SIGNATURE OF AGENCY        | TITLE                            |
|      | REPRESENTATIVE             |                                  |
|      |                            |                                  |
|      |                            |                                  |
+------+----------------------------+----------------------------------+

+---+-----------------------------------------+-------------+---------+
| * | **8. DESCRIPTION OF ITEM AND PROPOSED   | 9.  **GRS   | 10. *   |
| * | DISPOSITION**                           |     OR      | *ACTION |
| 7 |                                         |     S       |         |
| . |                                         | UPERSEDED** | TAKEN** |
| * |                                         |             |         |
| * |                                         | > **JOB     | > **(   |
|   |                                         | >           | > NARA  |
| * |                                         |  CITATION** | > USE   |
| * |                                         |             | >       |
| I |                                         |             | ONLY)** |
| T |                                         |             |         |
| E |                                         |             |         |
| M |                                         |             |         |
| * |                                         |             |         |
| * |                                         |             |         |
|   |                                         |             |         |
| * |                                         |             |         |
| * |                                         |             |         |
| N |                                         |             |         |
| O |                                         |             |         |
| . |                                         |             |         |
| * |                                         |             |         |
| * |                                         |             |         |
+---+-----------------------------------------+-------------+---------+
| * | **     **                               | **     **   | **      |
| * |                                         |             |      ** |
|   |                                         |             |         |
|   |                                         |             |         |
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|   |                                         |             |         |
|   |                                         |             |         |
| * |                                         |             |         |
| * |                                         |             |         |
+---+-----------------------------------------+-------------+---------+
| * | **     **                               | **     **   | **      |
| * |                                         |             |      ** |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
| * |                                         |             |         |
| * |                                         |             |         |
+---+-----------------------------------------+-------------+---------+
| * | **     **                               | **     **   | **      |
| * |                                         |             |      ** |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
| * |                                         |             |         |
| * |                                         |             |         |
+---+-----------------------------------------+-------------+---------+
| * | **     **                               | **     **   | **      |
| * |                                         |             |      ** |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
| * |                                         |             |         |
| * |                                         |             |         |
+---+-----------------------------------------+-------------+---------+
| * | **     **                               | **     **   | **      |
| * |                                         |             |      ** |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
| * |                                         |             |         |
| * |                                         |             |         |
+---+-----------------------------------------+-------------+---------+
| * | **     **                               | **     **   | **      |
| * |                                         |             |      ** |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
|   |                                         |             |         |
| * |                                         |             |         |
| * |                                         |             |         |
+---+-----------------------------------------+-------------+---------+

109. NSN 7540-00-634-4064 STANDARD FORM 115 (REV. 3-91)

PREVIOUS EDITION NOT USABLE Prescribed by NARA

36 CFR 1228

+---+-----------------------------------------+--------+---+-------------+---+---+
| # |                                         | JOB    |   | PAGE        |   |   |
| # |                                         | NUMBER |   |             |   |   |
|   |                                         |        |   |       OF    |   |   |
| R |                                         |        |   |             |   |   |
| E |                                         |        |   |             |   |   |
| Q |                                         |        |   |             |   |   |
| U |                                         |        |   |             |   |   |
| E |                                         |        |   |             |   |   |
| S |                                         |        |   |             |   |   |
| T |                                         |        |   |             |   |   |
|   |                                         |        |   |             |   |   |
| F |                                         |        |   |             |   |   |
| O |                                         |        |   |             |   |   |
| R |                                         |        |   |             |   |   |
|   |                                         |        |   |             |   |   |
| R |                                         |        |   |             |   |   |
| E |                                         |        |   |             |   |   |
| C |                                         |        |   |             |   |   |
| O |                                         |        |   |             |   |   |
| R |                                         |        |   |             |   |   |
| D |                                         |        |   |             |   |   |
| S |                                         |        |   |             |   |   |
|   |                                         |        |   |             |   |   |
| D |                                         |        |   |             |   |   |
| I |                                         |        |   |             |   |   |
| S |                                         |        |   |             |   |   |
| P |                                         |        |   |             |   |   |
| O |                                         |        |   |             |   |   |
| S |                                         |        |   |             |   |   |
| I |                                         |        |   |             |   |   |
| T |                                         |        |   |             |   |   |
| I |                                         |        |   |             |   |   |
| O |                                         |        |   |             |   |   |
| N |                                         |        |   |             |   |   |
|   |                                         |        |   |             |   |   |
| A |                                         |        |   |             |   |   |
| U |                                         |        |   |             |   |   |
| T |                                         |        |   |             |   |   |
| H |                                         |        |   |             |   |   |
| O |                                         |        |   |             |   |   |
| R |                                         |        |   |             |   |   |
| I |                                         |        |   |             |   |   |
| T |                                         |        |   |             |   |   |
| Y |                                         |        |   |             |   |   |
| - |                                         |        |   |             |   |   |
| C |                                         |        |   |             |   |   |
| O |                                         |        |   |             |   |   |
| N |                                         |        |   |             |   |   |
| T |                                         |        |   |             |   |   |
| I |                                         |        |   |             |   |   |
| N |                                         |        |   |             |   |   |
| U |                                         |        |   |             |   |   |
| A |                                         |        |   |             |   |   |
| T |                                         |        |   |             |   |   |
| I |                                         |        |   |             |   |   |
| O |                                         |        |   |             |   |   |
| N |                                         |        |   |             |   |   |
+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **8.** **DESCRIPTION OF ITEM AND        | **9.** | * |             |   |   |
| * | PROPOSED DISPOSITION**                  | **GRS  | * |             |   |   |
| 7 |                                         | OR     | 1 |             |   |   |
| . |                                         | SUPERS | 0 |             |   |   |
| * |                                         | EDED** | * |             |   |   |
| * |                                         |        | * |             |   |   |
|   |                                         | **JOB  | . |             |   |   |
| * |                                         | CITA   | * |             |   |   |
| * |                                         | TION** | * |             |   |   |
| I |                                         |        | A |             |   |   |
| T |                                         |        | C |             |   |   |
| E |                                         |        | T |             |   |   |
| M |                                         |        | I |             |   |   |
| * |                                         |        | O |             |   |   |
| * |                                         |        | N |             |   |   |
|   |                                         |        | T |             |   |   |
| * |                                         |        | A |             |   |   |
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|   |                                         |        | * |             |   |   |
|   |                                         |        | * |             |   |   |
|   |                                         |        | ( |             |   |   |
|   |                                         |        | N |             |   |   |
|   |                                         |        | A |             |   |   |
|   |                                         |        | R |             |   |   |
|   |                                         |        | A |             |   |   |
|   |                                         |        | U |             |   |   |
|   |                                         |        | S |             |   |   |
|   |                                         |        | E |             |   |   |
|   |                                         |        | O |             |   |   |
|   |                                         |        | N |             |   |   |
|   |                                         |        | L |             |   |   |
|   |                                         |        | Y |             |   |   |
|   |                                         |        | * |             |   |   |
|   |                                         |        | * |             |   |   |
+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
| * |                                         |     ** |   |             |   |   |
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| * |                                         |        |   |             |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
| * |                                         |     ** |   |             |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| * | **     **                               | **     |   | **     **   |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+
| 2 |                                         |        |   |             |   |   |
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+---+-----------------------------------------+--------+---+-------------+---+---+

**INSTRUCTIONS**

**GENERAL**

Use Standard Form 115 to obtain authority for the disposition of
records. Submit two signed copies to the National Archives and Records
Administration (NIR), Washington, DC 20408 and retain one copy as your
suspense copy. NARA will later return one copy as notification of the
items approved for disposal or archival (permanent) retention. This copy
will also indicate any items withdrawn or disapproved. GAO\'s written
approval must either accompany each SF 115 requiring Comptroller General
concurrence or be requested prior to the submission of the SF 115 to
NARA. The SF 115 may be accompanied by Standard Form 115A, or by pages
formatted to conform to the agency\'s published records disposition
schedule.

**SPECIFIC**

*Entry 1* should show the name of the Executive Branch department or
independent agency, Legislative Branch agency, or the Administrative
Office of the U.S. Courts for the Judicial Branch that is submitting the
request.

*Entries 2 and 3* should show the major and minor organizational
subdivisions that create or maintain the records described on the form.
If more than one subdivision maintains records described in the
submission, the various office names should be specified in entry 8.

*Entries 4 and 5* should provide the name and telephone number of the
person to be contacted for information.

*Entry 6* must be signed and dated by the agency official authority to
certify that the retention periods for records proposed for disposal are
adequate to meet the agency\'s needs, and that GAO requirements have
been met (Check appropriate box).l Unsigned SFs 115 will be returned to
the agency.

*Entry 7* should contain the item numbers of the records identified on
the form in sequence, beginning with \"1\". Lower case letters and
numbers may be used to designate subdivisions of an item (1a, 1b,

1b(1), 1b(2), etc.). Agency file numbers should not be entered in this
column, but may be included in entry 8.

*Entry 8* should describe the records to be scheduled. Follow these
steps in describing the records:

\(a\) Include centered headings for groups of items to indicate the
office of origin if all records described on the form are not those of
the same office, or if they are records created by another office or
agency such as, for example, records inherited from a defunct agency.

\(b\) Identify separate collections of nontextual records, such as
photographs, sound recordings, maps, architectural drawings, or magnetic
tapes or disks, as separate and distinct items. If such records are
interspersed with textual records, as in case files, their presence
should be noted in the description of the textual file.

\(c\) Describe completely and accurately each series of records proposed
for disposal or transfer to the National Archives requirements. See 36
CFR 1228 for more detailed requirements. Failure to comply with
provisions of the regulation will result in the return of the SF 115 for
corrective action.

\(d\) Provide clear disposition instructions for each item and subitem.
These instructions should include file breaks; the time after which
records will be retired to Federal records centers, if applicable; for
temporary records, the time after which they may be destroyed; and

for archival (permanent) records, the time after which they will be
transferred to the legal custody of the National Archives.

\(e\) If immediate disposal or transfer tot he National Archives is
proposed for non-recurring records, indicate the volume and inclusive
dates of the records and the Federal records center accession and box
numbers, if applicable.

\(f\) If future or continuing disposition authority is requested, state
the retention period in terms of years, months, etc. or in terms of
future actions or events. Ensure that any future action or event that
must precede final disposition is objective and definite.

\(g\) If records are converted to electronic form, schedule both the
original records and the electronic media, unless covered by the General
Records Schedules.

\(h\) If permanent for unscheduled records are converted to microform,
the disposition for both the original and microform copies must be
approved on an SF 115. The SF 115 covering the microform must contain
the certifications required by 36 CFR 1230. Approval is not required for
the disposition of microform copies of records authorized for disposal
as specified in the regulation cited above.

*Entry 9* must include the previous NARA disposition job and item
numbers; General Records Schedule and item numbers, if applicable; and
agency directive or manual and item numbers, if applicable, as required
by 36 CFR 1228. If such information is missing from column 9, the SF 115
will be returned without action. Leave column 9 blank only if the
records are being scheduled for the first time.

*Entry 10* is for NARA use only and should be left blank.