VA Records

Center & Vault

Users’ Guide

Instructions for using RC&V records storage

and management services

Revised January 2009

 Table of Contents
Part I: Introduction Page

1. How to use this guide.............................................................................. 1

2. Key records management terms ............................................................... 1
3. General information................................................................................. 2
4. Points of contact ..................................................................................... 4

Part II: Making Requests for VA Records Center & Vault Services

1. How do new customers request services from the RC&V? .......................... 5

2. How do I obtain a Records Retrieval System (RRS) login id to submit
electronic requests for services? ............................................................. 5
3. What information is required to establish my RRS login id? ....................... 5
4. What should I do if I forget my RRS login id or password? ........................ 6
5. How do I update my RRS user profile or change my password?.................. 6

Part III: Shipping Procedures

1. How are records sorted and grouped for storage? ..................................... 6

2. What is an accession number and how do I request it?.............................. 6
3. Where do I find information to complete VA Form 0244, Records Transmittal
and Receipt? .......................................................................................... 7
4. What is the size limit for one accession of records and how many boxes can
be shipped at one time?.......................................................................... 7
5. How do I prepare and transfer detailed shipment inventories?.................... 7
6. How do I prepare records for shipment?................................................... 8
7. What information must be included on boxes sent for storage? ................. 10
8. Can damaged records be transferred to the RC&V? .................................. 11
9. How does my agency account for and report shipment damage and
shortages? ............................................................................................ 11

Part IV: Recall Procedures

1. How do I recall records?......................................................................... 12

2. How long will it take for recall requests to be processed? .......................... 12
3. How do I ensure my records are sent only to authorize staff?.................... 13
4. Can requested information be faxed to me? ............................................. 13
5. Can other offices within my agency recall records owned by my facility and
can I request records owned by my facility be shipped directly to other
offices within my agency? ...................................................................... 13
6. What do I do if I alter or remove contents of a previously retired box of
records during a recall?.......................................................................... 13
7. What happens if recalled records are lost in transit? ................................. 14

Part V: Re-File and Interfile Procedures

1. How do I return previously recalled folders for re-filing? ........................... 14

2. How do I forward single-sheeted documents to be interfiled within an
existing folder?...................................................................................... 14

Part VI: Records Destruction Procedures

1. How are facilities notified when records become eligible for destruction?.... 15
2. How are records destroyed? ................................................................... 15
3. What happens if my agency does not provide written authorization to destroy
records exceeding their expiration date?.................................................. 15
4. How can my agency keep records disposal costs to a minimum? ............... 15

Part VII: Appendices

Appendix A: Standard Supply Items for Packing and Shipping Records

Appendix B: Pallet Diagrams: 60 boxes per pallet design
Appendix C: Pallet Diagrams: 48 boxes per pallet design
Appendix D: Sample VA Form 0244 - Records Transmittal and Receipt with
Instruction Sheet for Completion
Appendix E: Sample VA Form 0245 - VARC&V Reference Request
Appendix F: Sample Pallet Sequencing Tag
Appendix G: Request for Re-file and Interfile Services
Appendix H: Notice of Eligibility to Destroy Records
Part I: Introduction

In this part:
 How to use this guide
 Key records management terms
 General information
 Points of contact

1. How to use this guide

This guide explains in question and answer format the procedures to follow when
requesting services from the VA Records Center & Vault (RC&V). The guide has seven main
parts: I. Introduction, II. Making Requests for Records Center & Vault Services,
III. Shipping Procedures, IV. Recall Procedures, V. Re-file and Interfile
Procedures, VI. Records Destruction Procedures, and VII. Appendices. We
recommend reviewing the entire document first for general understanding then referring
back to the guide to locate answers to specific questions or issues. For the latest
information, go to the Records Retrieval Web site (RRS) at
https://vaww.aac.va.gov/vault/rrs/. On the home page, click on the “Records Center &
Center & Vault Help Guide” link.

Instructions on how to electronically create and submit requests for accession numbers and
to create, submit, and manage recall requests, including instructions on how to use search
filters, can be found at:
https://vaww.aac.va.gov/vault/rrs/CustomObjects/RRSUsersGuide.htm

2. Key records management terms

Agency Records Officer – Person generally at the agency level, delegated oversight for
the entire records management program in the agency. Responsibilities include developing
and implementing recordkeeping requirements for the agency, reviewing recordkeeping
practices for compliance with recordkeeping requirements, interpreting policy for field
personnel, and working directly with National Archives and Records Administration (NARA)
to develop and maintain their agency’s official records control schedule(s).

General Records Schedule (GRS) – General records schedules provide retention and
disposal requirements for temporary administrative records common to multiple agencies
within the Federal government. GRS are created and maintained by NARA. All GRS are
available for viewing on NARA’s Web site at http://www.archives.gov/records-mgmt/ardor/.

National Archives – Record storage centers operated by NARA that eventually take
custody and store the permanent records offered to them by Federal agencies. Permanent
records are deemed by NARA to have historical or other value beyond the time needed for
agencies to address administrative, legal, fiscal issues, etc.

National Archives and Records Administration (NARA) – The Federal agency that
oversees record keeping policies and practices of all Federal government agencies to ensure
agencies maintain records sufficient to document organization, functions, policies,
procedures, operations, etc., to conduct public business. Some other areas where NARA
provides service to agencies include guidance/training on disaster recovery, records
preservation and restoration, and records management practices. NARA also establishes
government standards that agency and commercial records storage centers must adhere to
if they wish to store Federal records, and inspects those agency/commercial centers for
compliance to the published government standards (36 CFR 1228 Subpart K).

Records – 44 United States Code {USC} 3301, Definition: Includes all books, papers,
maps, photographs, machine-readable materials, or other documentary materials,
regardless of physical form or characteristics, made or received by an agency of the United
States Government under Federal law or in connection with the transaction of public
business and preserved or appropriate for preservation by that agency or its legitimate
successor as evidence of the organization, functions, policies, decisions, procedures,
operations, or other activities of the government or because of the informational value of
data in them.

Records Control Schedule (RCS) – Official manual(s) drafted by an agency records

officer and reviewed and approved by NARA. The RCS provides requirements for storing
and destroying records no longer needed for current agency business, includes official
record series names and item numbers, tells who creates each series of records, who is
responsible for maintaining it, and length of time each series must be held before records
can be destroyed.

Records Cut-Off or Calendar Date – Inclusive period of time records were created.

Records Officer – Person generally at a local, district, or regional office level, delegated
responsibility to ensure offices within their jurisdiction are properly identifying, maintaining,
safeguarding, storing, and disposing of records in accordance with agency regulations,
policies, directives, procedures, all Federal laws, statutes, etc.

Records Retention (also known as Disposition) – Official period of time a series of

records must be maintained before they can be legally destroyed by an agency or
transferred to the National Archives for permanent storage.

Record Series – A group of records having similar characteristics, being of the same age
and format (i.e., all paper, all fiche, all film, etc.,) and maintained together because they
relate to the same subject, function, activity, etc.

Schedule and Item Number – “Schedule” refers to the official name or number an
agency gives to a specific RCS. “Item” is an official unique agency name or number
assigned to a group (series) of records having the same characteristics.

Transferring Official – Records officer or his/her designee, who has jurisdiction over
facility records and approves destruction once records exceed their required retention
period.

3. General information

The RC&V, managed by the Department of Veterans Affairs, is approved by NARA to

operate as a storage facility for Federal records.* The RC&V offers secure, climate-
controlled storage of Federal records at the box level until records either become eligible to
be destroyed or are transferred to the National Archives for permanent retention in
accordance with Federal law.

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The RC&V can store records on paper, film or electronic media:

 General and inactive records. Note to Veterans Health Administration (VHA)

facilities: RCS 10-1, Item Number XLIII/1D, paper portion of the medical record file
folder. Both the paper and electronic portions of veteran medical records must be
inactive a minimum of 3 calendar years from date of last patient care or veteran
date of death before RC&V can accept the paper portion of the of series for
storage.

 Records frozen by an agency or court-ordered records freeze. This includes

records in process of having their disposition (retention period) re-appraised by
NARA.

 Records with a permanent retention period until the creating agencies offer them
to the National Archives. The records owning agency remains responsible for
conducting all information integrity reviews, records preparation, and presentation
requirements leading up to National Archives accepting the permanent records for
storage.

 Unscheduled records, which are records not yet listed on any agency-approved
RCS or GRS. Unscheduled records may be stored at the RC&V while they are in
process of being appraised by the agency records officer and the National Archives.
Facilities shall notify the RC&V in writing of the official series name, item number,
and retention period when the appraisal process concludes.

 Vital records, which are essential government records needed to meet operational
responsibilities under national security emergencies or other emergency or disaster
conditions, or to protect the legal and financial rights of the government and those
affected by government activities. VA vital records transferred to the RC&V must be
listed in a Vital Records Schedule (see VA Handbook 6300.2 for more information.)

 System backups, and records on film or other non-tex media such as CD Rom,
Optical Disc, DLT cartridge, etc. The records owning agency remains responsible
for conducting all storage device reviews to verify continued data integrity, and for
ensuring information is migrated onto new storage media as technology evolves to
meet retention requirements of the applicable agency records control schedule.

Storage and reference services are available to any VA or other Federal Government agency
(OGA) on a fee-for-service-basis. Information regarding cost or to establish customized
agreements for storage and services can be obtained by contacting Cynde Bays, RC&V
Program Analyst, at 512-326-6576 or by emailing aacvarc&v@va.gov.

*The Department of Veterans Affairs also manages a second records storage facility known as the Records
Management Center (RMC) located in St. Louis, Missouri. The RMC provides open shelf storage and
maintenance of VBA records and military medical records. This Users’ Guide is applicable to services
offered by the RC&V only.

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4. Points of contact

If you have any questions or need additional information, the following RC&V points of
contact can assist:

Records Center and Vault (RC&V) Operations:

Kim Tuggle, RC&V On-site Manager, at 417-451-4967, or email aacvarc&v@va.gov

RC&V Information Security Officer

Robert Davis, RC&V Information Security Officer (ISO) at 417-451-4967

RC&V Privacy Officers

Amy Howe, Privacy Officer, at 512-326-6217 or Cynde Bays, Alternate Privacy Officer at
512-326-6576

Electronic Records Retrieval System (RRS) Access and Usage:

Robert Davis, RC&V ISO at 417-451-4967

Shipment and Reference Processing Services for VA Facilities:

Charlie Reed, VA Warehouse Services Coordinator, at 417-451-4967

Shipment and Reference Processing Services for Other Government Agency

(OGA) Facilities:
Lloyd Adams, OGA Warehouse Services Coordinator, at 417-451-4967

Destruction of Records:
Robert Davis, RC&V ISO at 417-451-4967

Overall Program Information:

David Kubacki, RC&V Chief Operating Officer, at 512-326-6408 or
Cynde Bays, RC&V Program Analyst, at 512-326-6576, or email aacvarc&v@va.gov

Service Level and Franchise Agreements for Service and Billing Inquiries:
Cynde Bays, RC&V Program Analyst, at 512-326-6576, or email aacvarc&v@va.gov

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Part II: Making Requests for Records Center & Vault (RC&V) Services

In this part:
 How do new customers request services from the RC&V?
 How do I obtain a Records Retrieval System (RRS) login id to submit
electronic requests for service?
 What information is required to establish my RRS login id?
 What should I do if I forget my RRS login id or password?
 How do I update my RRS user profile or change my password?

1. How do new customers request services from the RC&V?

Agencies with VA Intranet access shall request shipment accession numbers and recall
records electronically utilizing the Records Retrieval System (RRS) found at
https://vaww.aac.va.gov/vault/rrs/. Non-VA facilities may fax their requests for service to
417-455-9106.

2. How do I obtain a Records Retrieval System (RRS) login id to submit

electronic requests for service?

Login ids are requested by visiting the RRS home page at

https://vaww.aac.va.gov/vault/rrs. Click on the “Don’t Have an Account, Click Here to
Register” link located underneath the login block on the right-hand side of the RRS home
page.

3. What information is required to establish my RRS login id?

The following information is required to be present at all times within a user’s login profile.
Users deleting any of the following after account set-up, risk having their login id
deactivated by the RC&V Facility ISO.

 User’s first and last name with agency working job title.
 Verify if new user will enter forms for more than one facility. If the answer to this
question is yes, RC&V staff will contact the new user to verify identity of all stations
serviced before the user id is activated.
 First and last name of user’s current supervisor and supervisor’s job title.
 Facility records officer name and working job title (this person can also be referred
to as a transferring official.)
 User’s duty station mailing address, mail stop, direct phone number with area code
and extension, and fax number. NOTE: The fax number provided should be for a
machine located in a secure area. Also, do not include post office (PO) box numbers
in the mailing address since express mail carriers are unable to deliver to them.
 User’s MS Outlook email address assigned by their duty station.

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4. What should I do if I forget my RRS login id or password?

Do not enter a second request for a login id. Instead, please contact a VA RC&V staff
member at 417-451-4967 who will be happy to verify your login id or reset your password.

5. How do I update my RRS user profile or change my password?

Log into the RRS. Click on the “Edit Profile” link found in the “Current User Profile” block
located on the RRS Welcome Page. When finished editing information, click the “Submit”
link to save your changes.

Part III: Shipping Procedures

In this part:
 How are records sorted and grouped for storage?
 What is an accession number and how do I request it?
 Where do I find information to complete VA Form 0244,
Records Transmittal and Receipt?
 What is the size limit for one accession of records and how many boxes can
be shipped at one time?
 How do I prepare and transfer detailed shipment inventories?
 How do I prepare records for shipment?
 What information must be included on boxes sent for storage?
 Can damaged records be transferred to the RC&V?
 How does my agency account for and report shipment shortages?

1. How are records sorted and grouped for storage?

Prior to requesting an accession number and transferring records for storage, facilities must
use their agency’s Records Control Schedule (RCS) or a General Records Schedule (GRS) to
identify and sort records into like groups consisting of same materials (all paper, all film, all
fiche, etc.) same records series, and same records cut-off date. Each series of records
having the same disposition authority (record series and item number) and same disposition
(retention) date is transferred as a separate accession.

2. What is an accession number and how do I request it?

An accession number is a unique alphanumeric code the RC&V assigns to each shipment of
records received for storage. It consists of 9 to 13 characters. The first 3 to 6 characters
identify the agency, the next 2 to 3 characters identify the year records are shipped, and
the remaining 4 characters designate the RC&V assigned shipment number.

Agencies with VA intranet access shall request accession numbers electronically via the
Records Retrieval System (RRS) found at https://vaww.aac.va.gov/vault/rrs/. Instructions
for submitting an electronic VA Form 0244 are available on the RRS’s Welcome Page by
clicking on the applicable “RRS User Guide” link. Non-VA agencies may complete either the
VA Form 0244 or the SF 135 to request an accession number and fax their requests for
approval to 417-455-0481.
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RC&V staff will promptly email the station point of contact when an accession number is
assigned for requests that are adequately completed. The VA Form 0244 shall be printed
from the RRS by the requesting station and form signed in block #2 by the station records
officer and included with the records at the time they are transferred to RC&V for storage.

Please note: Accession numbers are only good for 90 DAYS FROM DATE OF ISSUE.
All accession numbers older than 90 days where records have not been received at the
RC&V will be automatically canceled without further notice to the requesting facility unless
prior arrangements have been made directly and timely with RC&V staff.

3. Where do I find information to complete VA Form 0244, Records Transmittal

and Receipt?

Instructions for completing VA Form 0244 are provided in Appendix D. Instructions for
completing the SF 135 used by non-VA agencies are provided at Internet Web site
http://www.archives.gov/frc/forms/sf-135-instructions.html.

The transferring office will ensure two signed copies of the completed VA Form 0244 (or SF
135 for non-VA agencies) accompanies each shipment of records to the RC&V in either the
first or last box of each accession. Both forms will be date stamped, signed by a RC&V
representative with one signed copy returned to the transferring office. The transferring
office shall retain their copy as proof of receipt and for use if future reference service is
required. For offices with VA intranet access, confirmation of shipment receipts can be
verified electronically on the RRS VA 0244 List View Screen that is updated once the
accession is shelved and the RC&V verifies it has a VA Form 0244 signed in block #2 by the
owning facility’s transfer official.

For VA facilities, the records officer or his/her designee who has jurisdiction over the records
will sign the VA Form 0244 as the transferring official. Non-VA offices will determine the
responsible party to sign as transferring official on either the VA Form 0244 or the SF 135.
Disposition of VA Form 0244 will be in accordance with NARA’s GRS 16, Item Number 2a.

4. What is the size limit for one accession of records and how many boxes can be
shipped at one time?

The size limit for one accession of records is a minimum of one standard-sized 1-cubic foot
box to a maximum of 240 standard-sized 1 cubic foot boxes. The box sequence number
range to be used for each accession shall always begin with the #1 and end with #240. A
maximum of 480 boxes are eligible to transfer per shipment. Additional accession numbers
may be requested for future shipments once prior accessions are received for storage.

5. How do I prepare and transfer detailed shipment inventories?

The transferring office shall also prepare a detailed inventory for each accession of records
to be retired to the RC&V and will maintain the inventory until the records are destroyed
(for VA agencies this requirement is addressed in Handbook 6300.1). A back-up photocopy
of the inventory specifying contents of each container shall be securely placed INSIDE
either the first or last box of each accession and transferred with the shipment. Individual
inventory sheets shall be marked with their assigned accession number and box sequence
number at the top of each sheet.
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As the inventory is used to perform random checks of individual box contents before the
accession can be placed in warehouse storage, the inventory must be transferred to arrive
ahead of or with the load. If facilities are not comfortable including the inventory with the
records shipment, prior to shipping the records, they may express mail inventories to the
RC&V under separate cover or they may email electronic inventories to the RC&V ONLY if
they have Public Key Infrastructure (PKI) capabilities. PKI is an encryption tool that uses
digital signatures to ensure confidentiality between multiple users.

6. How do I prepare records for shipment?

Use standard size or special purpose boxes and supply items shown in Appendix A when
packing records for shipment. Facilities having special requirements to ship records in other
types of boxes shall contact VA RC&V staff at 417-451-4967 to make prior arrangements.

When packing records in cartons, preserve the existing arrangement of the files. Pack
folders upright, with letter-size folders facing the front of the container and legal-size folders
facing the left side of the box. Leave approximately two inches of space in each box to
allow room to remove files, add additional documents, and to allow use of box handles.
Leave all guides and tabs in the records if they will help RC&V personnel service the
records. Records will remain in their original shipping containers while stored at the RC&V.

Do not over pack the boxes. Never add additional files on the bottom, side, or top of
the paper records in the box. Only add additional packing materials to boxes that are not
completely full where additional support is needed on the lower tiers to maintain pallet
structure.

For offices shipping sensitive information, ensure items contain no information that can be
viewed from the box hand holds. If boxes contain small items that could slip out of hand
holds, tape hand holds closed prior to shipping.

Close all box flaps so that seams meet (smooth top, no 4-corner folds) and secure top using
CLEAR, 2-INCH PACKAGING TAPE. Avoid using other types of tape such as filament or
tamper evident tape to seal boxes because their adhesives are not suitable for long term
storage and will disintegrate.

Use half-size boxes for microfilm, index cards, CD-ROMS, diskettes, tapes or other odd-size
material. Mark all boxes or packages containing computer tapes or other magnetic media
shipped by non-freight carrier as follows: "FRAGILE - MAGNETIC MEDIA - KEEP AWAY
FROM ELECTRONIC MOTORS, SCANNING DEVICES AND MAGNETS."

Use of standard 40" W x 48" L, 4-way entry Grocery Manufacturer’s Association pallets is
required. Load boxes onto pallets as shown in Appendix B or Appendix C to minimize
movement during shipment and to allow access to information written on the front of boxes.

The most economical and preferred method of shipping records is on pallets of 60 boxes
each as diagramed in Appendix B. The first pallet will contain boxes 1 through 60. If
additional pallets are used, the second pallet will contain boxes 61 through 120, etc. If
more than one pallet is used, each pallet must be labeled in sequential order; e.g., 1 of 3, 2
of 3, 3 of 3, by affixing sequencing tags to the front of each pallet. A sample of the
sequencing tag is provided in Appendix F.
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Always load boxes in ascending box sequence numerical order, with the lowest numbered
box being the first box placed onto the pallet and the highest numbered box being the last
box placed onto the pallet.

An alternate method of shipping that allows the face of all boxes to remain visible once
palletized is to ship 48 boxes in an interlocking pattern as diagramed in Appendix C. The
first pallet will contain boxes 1 through 48. If additional pallets are used the second pallet
will contain boxes 49 through 96, etc. If more than one pallet is used, each pallet must be
labeled in sequential order; e.g., 1 of 3, 2 of 3, 3 of 3, by affixing sequencing tags to the
front of each pallet. A sample of the sequencing tag is provided in Appendix F.

With either method of shipping, place two copies of VA Form 0244 (or SF 135 for non-VA
agencies) completed and signed by the records officer in the first or last box of each
accession transferred.

After the pallet is loaded, use instructions below to shrink-wrap boxes for transit.

When making shipping arrangements, be sure to instruct carrier that pallets can not be
double-stacked.

Please note: Stations must email a completed VA Form 134a that includes the accession
numbers being transferred in the description field to the RC&V for approval to ship. RC&V
will notify VA Transportation when a Bill of Lading can be issued to the requesting facility.

Accession numbers are no longer valid beyond 90 days from date of issue. Stations are
responsible for follow-up with their warehouse to ensure records are picked up by the
carrier before accession numbers expire.

Pallet Stacking

 Repair boxes showing signs of damage or stress with clear, 2-inch packaging tape or re-
box before staging.
 For accessions shipping with 60 boxes per pallet, load boxes onto pallets in ascending
numerical order from left to right (60 boxes, 10 boxes per layer, 6 layers high) to avoid
movement in transit. An assembly diagram is available as Appendix B.
 For accessions shipping with 48 boxes per pallet, load boxes onto pallets in ascending
numerical order from left to right in an interlocking fashion (48 boxes, 8 boxes per layer,
6 layers high). An assembly diagram is available as Appendix C.
 Securely shrink wrap pallets (see shrink-wrapping techniques below) and band (if
necessary) to prevent shifting during transit.
 For safety reasons and to allow ease in identifying missing or damaged boxes, use
shrink wrap that provides visibility of pallet contents. Accession and box sequence
information should be readable through any wrap selected for use.
 To better secure pallets against unauthorized access, it is highly recommended that
tamper evident tape, minimum 2-inches wide, be applied after pallets are shrink
wrapped for less than load (LTL) shipments.
 Instruct carrier not to double stack pallets. Load all pallets onto the trailer floor.

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 Shrink Wrapping

 Secure the end of the film to the load or pallet by:

 Tying the end off around the base of the pallet

(or)
 Placing the end of the film between the pallet and a box or between two boxes near
the base of the pallet.

 Walk around the pallet once to apply film to all sides of the base of the pallet. Attempt
to wrap the pallet to the first layer of boxes.

 After this initial wrap, release about 2 feet of film, apply tension, and stretch it to about
4 feet in length.

 Turn the corner and release tension. Roll out about 2 feet of film.

 Continue to release and stretch the film to about twice its length on each side to create
a tight stretched wrap (stretch wrap is designed to shrink and tighten up after being
stretched).

 Important: Make two passes at the same level around the pallet.

 For each layer, position the film to a height that allows the film to overlap the previous
layer by approximately 4 inches.

 Again, apply two layers of stretched film on each level.

 Cap the top level of the load by allowing 1/2 the width of the film to be stretched over
and around the top layer. Stretching will cause the film to "hug" the boxes.

 Use your finger to break a hole in the center of the film near the roll. Pull the film apart.
Press the loose end against the wrapped pallet to prevent it from unraveling.

7. What information must be included on boxes sent for storage?

Provide agency contact information (agency name, address, and phone number) on the top
or side of each box using a hand-stamp or in writing via permanent ink or marker. This is
recommended to increase chances a box separating from a pallet or losing its express mail
shipping label while in transit will be promptly returned to the owning agency.

Write the RC&V assigned accession number and box sequence numbers onto the front face
of each box with a wide, black felt-tip permanent marker. Ensure numbering is
approximately 1-1/2 inches high. Do not use pre-printed labels to supply this information
as no adhesive is effective in long-term storage.

Provide any additional identifying locator aides onto the outside of each container in the
same manner. Ensure all markings comply with current Federal privacy laws (i.e., do not
write full social security numbers on the outside of containers).

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8. Can damaged records be transferred to the RC&V?

Damaged/contaminated records/boxes cannot be transferred to the RC&V. RC&V staff

perform inspection of random boxes of records at the time of receipt to ensure records are
free of mold, water damage, insects, pests, etc. Records arriving damaged will be returned
to the owning facility at their expense for cleaning and/or repair by a professional document
restoration company before they can be returned for storage.

9. How does my agency account for and report shipment damage and
shortages?

Upon arrival at the RC&V, visual inspection and a count of actual cubic feet received is made
and compared to information provided on the corresponding VA Form 0244. All overages,
shortages and damage are immediately documented, and the VA Form 0244 point of
contact is notified via telephone with an e-mail follow up to the facility point of contact and
the facility records officer. Where shortages and excessive shipment damage occur to VA
records, the agency records officer located in VA Central Office (19E1) is also notified.

It is critical that all stations appoint someone knowledgeable of shipment condition and
contents to be available on the day their shipment delivers to the RC&V so that
damage/shortages (if they occur) can be immediately addressed and resolved. All damage
and shortage issues unable to be resolved by the originating station at time of delivery must
be reported to the freight company before driver departure and to VA Security Operations
Center (VA-SOC) within an hour of discovery.

Tracing records lost in transit to the RC&V is the responsibility of the owning facility.
Reporting requirements for damaged, lost, or unauthorized destruction of records is
pursuant to 36 CFR 1228.104. VA agencies may find additional information to complete the
reporting requirements in VA Handbook 6300.1 or by contacting their agency records
officer. Reference sources for non-VA agencies should include their local and agency
records officers and/or the official designated as “security officer and primary contact
regarding breach of security situations” listed in their franchise agreement with the RC&V.

Part IV: Recall Procedures

In this part:
 How do I recall records?
 How long will it take for individual recall requests to be processed?
 How do I ensure records are sent only to authorized staff?
 Can requested information be faxed to me?
 Can other offices within my agency recall records owned by my facility and
can I request records owned by my facility be shipped directly to other offices
within my agency?
 What do I do if I alter or remove contents of a previously retired box of
records during a recall?
 What happens if recalled records are lost in transit?

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1. How do I recall records?

Boxes or files are retrieved from the RC&V by providing information as requested on VA
Form 0245, VA Records Center & Vault (RC&V) Reference Request. A sample of a
completed VA Form 0245 is provided as Appendix E.

VA facilities with intranet access shall request return of boxes or files electronically via the
Records Retrieval System (RRS) found at https://vaww.aac.va.gov/vault/rrs/. Instructions
for utilizing the RRS are available on the RRS’s Welcome Page by clicking on the “RRS User
Guide” link. Non-VA facilities may fax their completed and signed requests to the RC&V at
417-455-0481. VA Form 0245 provides the RC&V with an accession number, box sequence
number, file title, and file number to locate records in storage.

NOTE: Supply sufficient information on the VA 0245 for RC&V to make positive
identification of requested items, while adhering to agency privacy mandates. Forms
received without adequate identifier information will be marked accordingly and returned to
the station as a negative reply (or no find).

Emergency requests initially reported to the RC&V by phone must be followed up in

writing, with VA agencies inputting the emergency request electronically into the RRS, and
non-VA agencies faxing a completed and signed hard copy of the VA Form 0245 to the
RC&V at 417-455-9106 before records can be shipped.

2. How long will it take for individual recall requests to be processed?

Routine requests containing valid locator information (correct accession and box sequence
numbers) are processed in 1 business day. Requests received on a Friday afternoon may
not be processed and shipped until the next business day.

However, to comply with VHA requirements to avoid record recalls being held in mail
carrier’s shipping facility over weekends/holidays, when possible RC&V will use the following
mail schedule:

 Monday and Tuesday routine recall processing: Packages ship by Federal Express
saver (3-day) service.
 Wednesday routine recall processing: Packages ship by Federal Express 2-day
service.
 Thursday routine recall processing: Packages ship by Federal Express overnight
service.
 Friday routine recall processing: No shipping occurs. Packages are held on-site and
shipped next business day.

Shipments will be made by an agency-approved mail carrier service with tracking

capabilities.

Emergency requests containing valid locator information (correct accession and box
sequence numbers), received by 12:00 noon CST will be processed by close of business
same day. Emergency requests received after 12:00 noon CST will be processed as the
next day’s business.

12
3. How do I ensure my records are sent only to authorized staff?

To prevent unauthorized access to records, arrangements can be made with the RC&V to
maintain a list of the transferring office staff authorized to recall records. The transferring
office will need to contact the RC&V to establish this list. If such a list is provided, the
transferring office will be responsible for keeping the list updated.

4. Can requested information be faxed to me?

RC&V will fax recalled agency records up to five single-sided sheets of 8 ½ x 11” paper in
cases of extreme emergency only. The reason for the extreme emergency must be
documented in the Remarks section of the VA Form 0245. Requests for a copy of DD214 to
expedite veteran burial would be considered an extreme emergency. Requests for faxed
documents for administrative purposes such as research, processing a claim, updating
records, etc. are not considered emergencies and will be processed for return of the paper
file to the requesting office using overnight express mail service.

In the case of extreme emergencies, unless otherwise directed, information will be faxed
using fax number identified in Box #7 of electronic VA Form 0245. Requester is responsible
for ensuring fax number provided is correct, is not accessible to the general public, and
requester will take receipt of faxed information.

5. Can other offices within my agency recall records owned by my facility and
can I request records owned by my facility be shipped directly to other offices
within my agency?

Requests for recalls can only be made by the facility owning the records unless the RC&V is
notified in writing by the facility’s records officer that the file rooms of multiple facilities
have been consolidated into one health care system.

The RC&V will ship records owned by your facility to other offices in your agency if it is
notified in writing by the authorizing facility’s records officer that this is acceptable practice
at your site. The facility owning the records must submit the recall request and in the
remarks section of the form, request that files be shipped directly to the other site. The
recipient’s first and last name, phone number with area code, department routing symbol or
mail stop code, and valid agency address must be provided before files will be transferred.
If recall form VA 0245 is missing any component of the required contact information,
records will be returned to the owning station.

6. What do I do if I alter or remove contents of a previously retired box of

records during a recall?

If a facility requests recall of records at the box level (i.e., request box #20 in the accession
be returned) clearly identify records when they are returned to the RC&V for re-filing.

 Do not obscure the original box markings upon return. Box contents are assumed to be
the same as when withdrawn. If records are added or removed, forward a revised box
inventory listing inside the returned box.

 Ensure the original of VA Form 0245, or a completed copy of Appendix G, Request for
Re-file and Interfile Services, is returned with the box.

13
 If it is necessary to replace damaged containers before returning to the RC&V, copy all
original markings and writing from the original container onto the new one.

7. What happens if recalled records are lost in transit?

The RC&V ships all recalled records via an express mail carrier offering electronic tracking
capabilities. Record recall processing and tracking data is entered by RC&V staff into the
RRS no more than 72 hours after packages are picked up for shipment. Express mail
tracking numbers to check delivery status of packages is available to VA offices with access
to the RRS by viewing the VA Form 0245 l List View Screen. To locate a specific form, enter the
accession number and veteran last name using the “ACNO” and “FILE TITLE” search filters
found at the top of the VA 0245 List View screen. Then click “SUBMIT.” For example,
entering 015-96-0001 in the “ACNO” search filter, and BROWN in the “FILE TITLE” will
return all forms a station has submitted for accession number 015-96-001, where BROWN
was part of a file name.
RC&V staff verify delivery status of packages shipped with express mail carriers on a daily
basis. When packages are not delivered as scheduled, RC&V staff contact the express mail
carrier to determine the reason for delay. If the undeliverable status has occurred because
the package cannot be located by the carrier, the RC&V will initiate a trace, and contact the
requesting office by phone to advise of status. The call will be immediately followed up by
email to the requesting official and the facility and agency records officers, to advise of the
unknown whereabouts of the package and provide a list of package contents.

The RC&V Privacy Officer (PO) and Information Security Officer (ISO) will continue the
investigation until either the missing records are located or all possible resources have been
exhausted. At that point, RC&V staff will work with the owning facility's records officer and
agency records officer to complete the reporting requirements process per 36 CFR
1228.104. VA agencies may reference the reporting requirements in VA Handbook 6300.1
or by contacting their agency records officer. Reference sources for non-VA agencies
should include their local and agency records officers and/or the official designated as
“security officer and primary contact regarding breach of security situations” listed in their
franchise agreement with the RC&V.

Part V: Re-file and Interfile Procedures

In this part:
 How do I return previously recalled folders for re-filing?
 How do I forward single sheeted documents to be interfiled within an
existing folder?

1. How do I return previously recalled folders for re-filing?

Attach a copy of the original VA 0245 request used to recall the records. If the original VA
0245 used to recall the record(s) is not available, complete items #1 through 7 on Request
for Re-file and Interfile Services (Appendix G) and attach to each recall to be re-filed.

Only those folders removed from the accession at the time of recall are eligible for return as
re-files. Stations are to retain any additional folders discovered or created for a veteran
“after” an accession is transferred to the RC&V for storage to retire in a new accession at a
future date.

14
2. How do I forward single-sheeted documents (interfiles) to be filed within an
existing folder?

The RC&V offers drop filing services only of individual documents 10 pages or less in size
into existing folders provided field offices fully complete items #1 through 6 on Request for
Re-file and Interfile Services (Appendix G) and attach to each document to be processed.
Please note: If there is insufficient space in the requested box to return previously recalled
folders or to add new interfile documents, items will be returned to the requesting station to
retire in a new accession at a future date.

Refile or interfile items arriving without the Request for Re-File and Interfile Services form
completely filled out will be returned to the sender for further action.

Part VI: Records Destruction Procedures

In this part:
 How are facilities notified when records become eligible for destruction?
 How are records destroyed?
 What happens if my agency does not provide written authorization to destroy
records exceeding their expiration date?
 How can my agency keep records disposal costs to a minimum?

1. How are facilities notified when records become eligible for destruction?

Destruction of non-vital records exceeding their required retention period as outlined in an

agency RCS or NARA GRS is not automatic and requires written approval by the owning
facility’s records officer. The RC&V will forward a “Notice of Eligibility to Destroy” (Appendix
H) for each accession of records approximately 90 days before records become eligible for
destruction. If the records officer verifies no agency or legal restrictions exist to postpone
destruction after the 90-day period expires, he/she should execute the form and return the
signed original to the RC&V before the 90-day period elapses.

2. How are records destroyed?

Destruction of records is performed in accordance with 36 CFR 1228.58.

3. What happens if my agency does not provide written authorization to destroy

records exceeding their expiration date?

Non-vital records will continue to incur storage charges until a completed, signed and dated
original of the Notice of Eligibility to Destroy is received from the owning facility records
officer.

4. How can my agency keep records disposal costs to a minimum?

Suggestions include:

 When sorting records for storage, do not combine records of multiple destruction
dates within one accession. Records stored at the RC&V are maintained at the box

15
 level. All boxes of an accession cannot be destroyed until the most recent folder in
the accession reaches its destruction date.

Avoid mixing multiple media types (combining paper, microfiche, X-ray, CDs, etc., in one
container.) Mixing of multiple media types require hand sorting to separate media types to
adequately destroy in accordance with Federal law. Facilities will incur additional charges if
non-standard services (hand sorting) are required.

16
VA RC&V Guide Appendix A: Standard Supply Items

Standard Supply Items for Packing and Shipping Records

The following supply items can be ordered from the General Service Administration’s
Federal Supply Service via Internet at www.gsaadvantage.gov.

Item GSA Stock Item No.

Standard Record Storage Box NSN 8115-00-117-8249

(for letter and legal-size paper
records) size: 14-3/4” x 12” x 9-1/2”
white exterior, lock bottom

Special-purpose boxes:
Half-size box NSN 8115-00-117-8338
Size: 14-3/4” x 9-1/2” x 4-7/8”

Microfiche Box NSN 8115-01-132-1923

Size: 14-3/4” x 6-1/2” x 5”

X-ray Box NSN 8115-00-290-3386

Size: 18” x 15” x 5-1/2”

Clear Packaging Tape, 2” Wide NSN 7510-01-425-6768

Tamper-Evident Tape, 2” Wide Query for tamper evident tape

options through GSA
Advantage at Internet address
www.gsaadvantage.gov. One
available stock number is S-9926,
sold in 2” wide x 110 yard rolls.

Felt Tip Marker (Black) NSN 7520-00-973-1059

A-1
VA RC&V Guide Appendix B: Pallet Diagrams
(60 boxes)

B-1
VA RC&V Guide Appendix C: Pallet Diagrams
(48 boxes)

41 48 42 48

IN S T R U CT IO N S
1 . S ta c k b o x e s in n u m e r ic a l o rd e r o n p a lle t.
2 . E a c h p a lle t c o n t a in s 4 8 b o x e s , 8 b o x e s p e r
33 48 34 48 la y e r, 6 la y e rs h ig h .
3 . E n s u re th a t b o x e s a re s ta c k e d w h e re b o x
in fo rm a tio n fa c e s o u tw a rd .
4 . S h rin k w ra p b o x e s o n t o p a n d o n a ll s id e s .
5 . U s e s lip s h e e ts b e tw e e n la y e rs if a v a ila b le .
25 48 26 48

17 48 18 48
TOP FRO NT TOP FRONT

TOP FRONT
9 48 10 48

TOP FRONT
48 48

TOP FRONT
1 2

* B e g in a ll
TOP FRONT even
F R O N T V IE W la y e rs
h e re

TOP FRONT TO P FR O N T

T O P V IE W
43 48 44 48
(E v e n L a y e rs 2 ,4 ,6 )

35 48 36 48

TOP FRONT TOP FRONT

TOP FRONT

27 48 28 48
TOP FRONT

19 48 20 48

TOP FRONT

11 48 12 48

* B e g in a ll
TOP FRONT

o d d la y e r s
h e re
3 48 4 48

TO P FR O N T TOP FRONT

T O P V IE W
(O d d L a y e rs 1 ,3 ,5 )
S ID E V IE W

C-1
VARC&V Guide Appendix D: VA Forms 244 and 244a

PAGE OF

Department of Veterans Affairs RECORDS TRANSMITTAL AND RECEIPT 1 1

INSTRUCTIONS: Complete and send original and two copies of this form to the address shown in item 1 "TO". See specific instructions on reverse.

1. TO VA Records Center and Vault (RC&V) 5. FROM (Enter the name and complete mailing address of the office that owns the records and the office shipping
the records, if different.)
11693 Lime Kiln Drive
Neosho, MO 64850-1959 RECORDS OWNING FACILITY: RECORDS SHIPPING FACILITY:
TRANSFERRING FACILITY OFFICIAL (Signature and title) DATE
2. TRANSFER
JASON SMITH 11/06/2006 VA OUTPATIENT CLINIC VA MEDICAL CENTER
AUTHORIZATION
CHIEF, HIMS FILE ROOM (045) HIMS, MAIL STOP 045
TRANSFERRING FACILITY LIAISON OFFICIAL (Name, office and telephone No.) 10,000 VETERAN AVE 10,000 HOSPITAL WAY
3. POINT OF JOHN BROWN SOMEWHERE, USA 12345-5678 ANYWHERE, USA 01244-9244
CONTACT
VA OUTPATIENT CLINIC FILE ROOM (888) 998-6688, EX 5215
(888) 998-6688, EXT 5215 (PHONE) (888) 398-6207, EXT 4208 (PHONE)
RECORDS RECEIVED BY (Signature and title) DATE
4. RECORDS (NOTE: RC&V executes as proof of shipment receipt once VA 0244 (888) 998-9550 (FAX) (888) 398-6277 (FAX)
CENTER AND signed by records owner in Block #2 is received, # boxes shipped is
VAULT RECEIPT verified, and shipment contents pass random inspection for damage.)

6. ACCESSION NUMBER (NOTE: Assigned by RC&V upon receipt of a properly completed form. Assigned accession number is faxed back to Point of Contact listed in #3 above.)

7. CATEGORY OF RECORDS TRANSFERRED 8. PLANNED SHIPMENT DATE

Vital Records X Other Records 11/30/2006

a. TYPE AND VOLUME OF RECORDS

9b. MICROFILM VOLUME (No. of 9c. MICROFICHE VOLUME (No. of 9d. TAPE VOLUME (No. of Tapes) 9e. PAPER VOLUME (Cubic feet) 9f. OTHER VOLUME (Specify below)
Reels) microfiche) 4

10. 11.
12. 13. 14. DATE RECORDS TO BE
RECORDS SCHEDULE AND RECORD TITLE/SERIES DESCRIPTION
RESTRICTIONS DISPOSAL DATE RETURNED
ITEM NO. (Show inclusive dates of records)

10-1 / XLIII-1D INACTIVE MEDICAL RECORD FOLDERS FOR CALENDAR YEAR 2003, W 01/2079
ARRANGED IN TERMINAL DIGIT ORDER
Box Number(s) – Last 4 of SSN:
1. 0000 - 8725
2. 8825 - 9950
3. 0051 - 2171
4. 2271 - 5283
“RECORDS ARE SUBJECT TO THE PRIVACY ACT”
PRIOR TO SHIPPING: Use VA 0244a as continuation page where needed. Ensure the signed VA Form 0244 and a detailed inventory listing of all box contents is transferred by express mail, or
placed in the first or last box of each accession prior to shipment transfer. Do not include actual detailed information protected by the Privacy Act on the VA 0244/0244a Forms, only Include a
statement of “Records Subject to Privacy Act” where applicable.
VA FORM
APR 2002(R) 0244
D-1
 VARC&V Guide Appendix D: VA Forms 244 and 244a

INSTRUCTIONS FOR COMPLETION OF VA FORM 0244

FOR COMPLETION BY THE TRANSFERRING FACILITY

Item 1. Self-explanatory.
Item 2. Signature and date of the Records Officer is required if the records are being transferred from a VA field facility/office. If non-VA, an authorized official as designated by the head of the
agency must sign and date. Shipment is not considered complete until a VA 0244 (or SF 135 for non-VA agency) signed by the authorized agency records officer is received.
Item 3. Show the facility point of contact name, commercial telephone including area code, and extension number (list the person most knowledgeable of actual “contents” of the shipment.)
Item 4. RC&V staff member will execute and return a signed copy of the VA 0244 to the submitting agency as proof of shipment receipt once the actual number of containers is verified and records
pass a random inspection of contents to ensure no mold, insects, water damage, etc., is present. Records arriving damaged will be returned to the owning agency (at their expense) for professional
cleaning/restoration. Once free of contaminants, records may be returned to the RC&V for storage.
Item 5. Provide owning agency address, phone & fax number. Include applicable shipping address, phone and fax number where owning and shipping information are different.
Item 6. A separate accession number is required for each series of records listed on the form. A series consists of records having the same disposition authority (records schedule & item number) and
disposition (disposal) date. The RC&V will assign this number upon receipt of the completed form.
Item 7. Place an “X” in the appropriate box to indicate the category of records to be transferred.
Item 8. Show the anticipated date the records will be transferred to the RC&V.
Item 9b – 9f. Transfer only one media type per accession (e.g., all paper, all fiche, all film, etc.) for a maximum of 240 boxes per accession. A standard size box of paper records equals one cubic
foot.)
Item 10. Use a current agency-approved records schedule or the applicable NARA General Records Schedule to locate a valid records schedule/item number reference.
Item 11. Include a description of the records, the records’ calendar year cut-off date, and identify type filing method used to package records for storage (alphabetical, chronological, terminal digit,
etc.) A detailed listing of all box contents for each accession is required. The detailed listing may be provided in one of two ways: 1.) Offices may use the VA 0244 and
VA 0244a to list individual box contents (ensure information entered onto the VA 0244/0244a forms do not violate Federal Privacy Laws,) or 2.) Agencies may complete a separate
detailed shipment inventory list transferring it ahead of the shipment by express mail service or with the accession inside the first or last box of the shipment. If actual records
themselves contain protected information, include statement of “RECORDS SUBJECT TO PRIVACY ACT” on page 1 of VA Form 0244.
Item 12. Enter one of the following codes to indicate whether the use of the records is restricted. Explain any special restrictions at the bottom of the form:
Code Restrictions
Q Security Classification R Restricted use – witnessed disposal not required.
T Top Secret W Restricted use – witnessed disposal required.
S Secret N No restrictions
C Confidential
Item 13. Consult applicable agency records control schedule or NARA general records schedule to calculate a valid retention period.
Item 14. For use with cyclical records only (such as computer tape back-ups that are not destroyed, but returned to sender once new back-ups are received for storage.)
Use VA Form 0244a, Records Transmittal and Receipt Continuation when additional space is required for listing records information. Instructions for completion of VA Form 0244 apply.

D-2
 VA RC&V Guide Appendix E: Sample VA Form 0245

Department of Veterans Affairs

VA Record Center and Vault (RC&V) Reference Request

NOTE: Use separate form for each request.

TO ACCESSION NUMBER BOX NUMBER
VA Records Center and Vault
11693 Lime Kiln Drive VHA-05-1964 23 OF 240
Neosho, MO 64850-1959

DESCRIPTION OF RECORDS OR INFORMATION REQUESTED

File Title: WHITE, MARK
File Number: 5299
File Description: Med 1 & 2, Admin 1

(Note: Ensure information entered into this block complies with Federal Privacy Laws.)

REMARKS
NEEDED ASAP FOR HOMELESS VETERAN

(Note: Use this block to document need for expedited request, special shipping, processing, or delivery requirements.)

NATURE OF SERVICE
__Furnish Copy of Record(s) Only __Permanent Withdrawal _X_Temporary Loan of Records __Review
__Other(specify)
NAME OF REQUESTER COMMERCIAL TELEPHONE NO DATE
(Include Area Code) 12/05/06 1:55pm CT
JOHN DOE 888-123-4567
TRANSFERRING FACILITY OFFICIAL (Signature DATE
and Title) (Note: Complete this block when submitting by mail or fax.)
(Note: Sign this block when submitting by mail or
fax.)

NAME AND ADDRESS OF OFFICE/AGENCY (Include street address, building, mail stop. and ZIP Code)
JOHN BROWN, ROI CLERK
VA MEDICAL CENTER
MAIL STOP: 136D1
1234 HOSPITAL WAY
ANYWHERE, USA, 12345-6789
888-123-4567 (phone)
888-234-5678 (fax)
FOR USE BY RC&V
REMARKS
RECORDS DESTROYED

RECORDS NOT IN RC&V CUSTODY

WRONG BOX NUMBER – PLEASE RECHECK

ADDITIONAL INFORMATION REQUIRED TO IDENTIFY RECORDS

REQUESTED

MISSING (Neither record(s) or information found in container(s) specified)

RECORDS PREVIOUSLY CHARGED OUT TO (Name, office/agency and

date):

SERVICE TIME
SEARCHER’S INITIALS
DATE PERFORMED REQUIRED

VA FORM 0245

E-1
VA RC&V Guide Appendix F: Sample Pallet Sequencing Tag

PALLET # ___ OF ____

Transferring Agency : ______________________________________________
Shipping Address: ________________________________________________

Shipper Point of Contact: ____________________ Phone: __________________

F-1
 VA RC&V Guide Appendix G: Re-file/Interfile Request

REQUEST FOR RE-FILE AND INTERFILE SERVICES

Complete Items 1 through 7 for each request submitted for drop filing and securely attach to request. Requests with
missing, illegible, or incorrect information will be returned to the requesting station for further action.

RE-FILES: Submit only folders that remain in inactive status that were originally retired with accession at the time it was
shipped for storage. Retire overlooked or new volumes not part of original shipment in a new accession. Records recalled
for patient activity that convert over to active record status must be retained and retired when they reach inactive status.

INTERFILES: Submit only documents containing 10 pages or less for drop filing into an existing folder. Retain documents
larger than 10 pages to retire under a new accession number at a future date.

1. Date: ____________________
2.

Requesting Station Name and Station Number

Requesting Station Mailing Address and Routing Symbol (Do not use post office boxes)

City, State Zip

Point of Contact Name and Phone Number with Area Code

3. Accession Number: _____________________________________ 4. Box Sequence Number: ______ of ________

5. File Name or Title:__________________________________________ 6. File Number: ___________________

7. If folders, identify volume numbers being returned: ______________________________________________________

Ship documents containing personal identifiable/protected health information using mail services with tracking capabilities to:
VA Records Center and Vault Phone: 417-451-4967
11693 Lime Kiln Drive
Neosho, MO 64850-1959

---------------INFORMATION BELOW THIS POINT TO BE COMPLETED BY RC&V STAFF--------------

Processing Date, Warehouse
Time, and Filer Initials: ___________________________________ Location: ______________________

RETURNED TO REQUESTING STATION FOR FURTHER ACTION FOR REASON(S) CHECKED BELOW:

_____ Request does not provide a valid filing reference (the accession and/or box sequence number is/are not accurate).

_____ Request does not identify the folder name and folder number items are to be filed in.

_____ Referenced box is completely full. Retire item(s) in a new accession.

_____ No charge out slip exists in referenced box to verify the attached was part of the shipment at the time the accession
was originally transferred for storage. Retire the additional volume(s) in a new accession.
_____ No such named folder exists in box to place interfile document(s).

_____ Other: ______________________________________________________________________________________

___________________________________________________________________________________________________

G-1
 VA RC&V Guide Appendix H: Notice of Eligibility to
Destroy Records

11693 Lime Kiln Drive, Neosho, MO 64850

Phone: (417) 451-4967

DATE PREPARED

TO: Facility Records Officer

Facility Records Officer Official Mailing Address

NOTICE OF ELIGIBILITY TO DESTROY RECORDS

This notice is to inform you the VA Records Center and Vault (RC&V) is storing an accession of records belonging to your facility that
appears eligible for destruction, or may become eligible for destruction by January 1, _____________.

Accession Number #: ______________________________________

Box Volume: ______________________________________________
Record Series & Item #:______________________________________
Record Description: _______________________________________
Disposition Date: ___________________________________________

Please review the information provided above to determine if this accession can be destroyed in accordance with 36 CFR 1228.58, or
whether legal proceedings and/or agency policy requires the accession be retained. Use the bottom portion of this form to respond no later
than December 31, 20____. Your facility will continue to be billed for storage of this accession until your written approval to destroy is
received by the RC&V.

----------------------------------------------------------------------------------------------------------------------------
AGENCY WRITTEN AUTHORIZATION TO DESTROY
OR RETAIN RECORDS BEYOND THEIR SCHEDULED DISPOSITION DATE

I, ____________________________________________________, have been delegated authority by my employer to approve

(Print name & working title)
destruction of official Government records for _______________________________________________________________
(name and address of facility owning records)
once said records have reached their disposition date as outlined in my agency’s records control schedule.

 By checking this box I certify the aforementioned records ARE NOT part of an existing Federal agency records freeze or court
litigation proceedings, and may be destroyed in accordance with 36 CFR 1228.58.

 By checking this box I certify the aforementioned records ARE part of an existing agency records freeze, court litigation
proceedings, or must be retained by my agency at this time. The reason for retention is

________________________________________________________________________________.

Please extend this accession’s destruction date to ___________________________________________________.

(show month and year of revised disposition date.)

________________________________________________ _________________________
(Signature of Destruction Authorization Official) (Date)

H-1