FORM: REQUEST FOR AUTHORIZATION TO RETAIN OR DESTROY QUESTIONABLE RECORDS
Agency: CIA
Originator: CIA
From: DDS&T/OTS/GAD/A
To: C/INFO SYSTEMS ANALYSIS STAFF, DDA
Document date: 5/4/78
Document type: PAPER-TEXTUAL DOCUMENT

## Page 1

104-10534-10100

• SUBST ORIGINAL AND A COPIES TO ISAS

REQUEST FOR AUTHORIZATION

TO RETAIN OR DESTROY QUESTIONABLE RECORDS

, DESTRUCTION AUTHORIZATION NO. (ASSi

y RAB

TO : Chief, Information Systems Analysis Staff, DDA

THRU: Component Records Management Officer

Directorate Records Management Officer

Records Administration Branch, ISAS/DDA

Office of General Counsel

FROM:

(OFFICE DESIGNATION OF ORIGINATOR)

2. DATE PREPARED

THE RECORDS IDENTIFIED BELOW ARE SCHEDULED FOR IMMEDIATE DESTRUCTION; HOWEVER, THEY MAY BE SUBJECT TO ACTUAL C

IMPENDING LEGAL OR INVESTIGATIVE REQUIREMENTS. AUTHORIZATION IS REQUESTED EITHER TO RETAIN THE RECORDS OR TO

DESTROY THEM AS SCHEDULED. THE RECORDS ARE BEING HELD PENDING RECEIPT OF AUTHORIZATION. IF FURTHER RETENTION

REQUIRED, REVISED DISPOSITION INSTRUCTIONS MUST BE PROVIDED TO RECORDS ADMINISTRATION BRANCH, ISAS.

3. OFFICE

IDENTIFICATION OF RECORDS

4. SCHEDULE NO.

5, ITEM NUMBER

16. INCLUSIVE DATES

7. VOLUME feu. 1

8. PROVIDE DETAILED DESCRIPTION

AND LISTING OF RECORDS AND/OR ATTACH COPY OF FORM 140 AND 140A, MARKED TO INDICATI

WHICH RECORDS ARE

QUESTIONABLE.

EXPLAIN BASIS FOR DETERMINING THAT RECORDS ARE QUESTIONABLE.

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9. TYPED NAME AND SIGNATURE OF CUSTODIAN OF RECORDS

I CONTINUED ON SEPARATE PAGE

EXTENSION

DATE

10.

TYPED NAME AND SIGNÄTURE OF COMPONENT RECORDS MANAGEMENT

OFFICER

TYPED NAME AND SIGNATURE OF DIRECTORATE RECORDS MANAGEMENT

OFFICER...

EXTENSION

DATE

EXTENSION

DATE

AUTHORIZATION TO RETAIN OR DESTROY RECORDS

12.

TYPED NAME AND SIGNATURE QE-GENERAL COUNSEL REPRESENTATIVE

RETAIN ALL

RETAIN PARTIAL

DESTROY ALL

L1

Liez

EXTENSION

DATE

13.

TYPED NAME AND SIGNATURE OF CHIEF INFORMATION SYSTEMS ANALYSIS STAFF

DATE

APPROVED

14. LL PROVIDE JUSTIFICATION FOR CONTINUED RETENTIÓN. ALSO PROVIDE PROPOSED NEW DISPOSITION INSTRUCTIONS.

LINDICATE UNDER SECTION 8 ABOVE WHICH RECORDS ARE TO BE RETAINED. THOSE NOT INDICATED FOR RETENTION ARE AUTHE

IZED FOR IMMEDIATE DESTRUCTION.

[CONTINUED ON SEPARATE PAGE

FORM 141C

9-77

115-38

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