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Completing a Certificate of Records Destruction - RM3 Form

Line # Contents
1 - Agency University of Virginia - This is already entered in the "Word" version.
2 - Department Name The name of your department.
3 - Department Code The code which defines your functional area within your department. To easily find this, access your directory information by entering your name in the "Search UVa" field, with "People" selected off the main UVa web page.
4 - Organization Code A five digit numeric code that uniquely identifies a department or school within the University. This is the last set of numbers contained in your PTAO (omitting the Expenditure Type).
5 - Person Completing Form The name of the person completing the RM3 form.
6 - UVa Computing ID The UVa Computing ID of the person completing the RM3 form.
7 - Messenger Mail Address The UVa Messenger Mail address where the form should be returned after approval by the University Records Officer.
8 - Phone The telephone number of the person completing the RM3 form.
9 - Records to Be Destroyed List the records you wish to destroy:

a)

Using the information of the Records Retention and Disposition Schedule, enter the general schedule number and records series number that apply to the records to be destroyed, e.g. GS 101 (schedule number), 001036 (records series number). Your entry would appear as GS 101-001036. ENTER ONLY ONE SCHEDULE AND SERIES COMBINATION PER LINE. Retention schedules are available at: http://www.virginia.edu/recordsmanagement/schedules.html

b)

Enter the Records Series Title from the schedule and other names of the records commonly used (if applicable) to provide more detail on records being destroyed.

c)

Enter the date range of the records to be destroyed. Use month/year to month/year (e.g., 7/86 to 6/92). The date range must match the retention period listed in the schedule

d)

The location where the records are currently being stored (include room, building or server designation).
e)

Enter the total volume of the records to be destroyed as cubic feet (cu. ft.) or number of boxes (including box size). Common calculations are:

  • Storage Box 15"x10"x12" = 1.0 cu. ft.
  • File cabinet drawer = 2 storage boxes or 2.0 cu. ft.
f) Enter the method of destruction: i.e. UVa Recycling, shredding, secure deletion (electronic data); only one method per line.
10 - Approving Official The department Records Administrator or department official with the authority to approve the destruction of departmental records. Print their name, sign and date.
11 - Designated Records Officer DO NOT COMPLETE. The University Records Officer will sign this when destruction is approved.
12 - Records Destroyed By Complete AFTER the form is returned with approval of the University Records Officer. This is signed upon destruction by the person who can certify the records were properly and legally destroyed and the date of their final destruction.

Send the completed Certificate of Records Destruction - RM3 with original signatures to:

Records Management Office
Attn: Caroline Walters
University Records Officer
PO Box 400898