RC Consignment (Transmittal) Number
Agency Name and Department
Enter your agency’s name and your department/office/division.
Contact E-Mail Address
Enter transferring person’s e-mail address.
Enter the mailing address from where the records come.
Title of the Records to be Transferred
Enter the title of the records as it appears in their records retention schedule, you may add more information for clarity (Accounting Records - Cancelled Checks).
Records Retention Schedule Number
Enter the schedule application number from the official records retention schedule in effect for the records.
Enter the destruction date based on the date of final disposition listed in the records retention schedule.
Total Number of boxes transferred to RC
Enter the number of boxes being transferred to the Records Center for that transmittal.
Enter each individual box number.
List the first and last file for each box.
Date Span Column
List the date span of the records to be transferred, the earliest and latest dates of the records in the box.
Location # Column
Leave blank. The Records Center will send a box verification report after the boxes have been shelved at the Records Center. The report will list the location of the boxes.
Approved for transfer by and Date
RMO or Records Custodian signs and dates the form.
Received for Storage by and Date
Records Center staff will sign and date after verifying the boxes against what those listed on the form.