Chief Financial Officer - HUD
Administrative Adjustment Form
|U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT |Transaction Request Number |
|WASHINGTON, DC 20410-3000 | |
| | |
|OFFICE OF CHIEF HUMAN CAPITAL OFFICER | |
|1. Addition Type |
| |
|New Acquisition Inventory Adjustment Other |
|(Describe) |
|Descrip|Equipment Standard |Description |
|tion | | |
| |Manufacturer |Model Number |Serial Number |
| | | | |
| |Barcode Number |Type of Property [pic] [pic] |DOCS Code |
| | | |OCHCO |
|Locatio| |
|n |Building Number Room Number Suite Number |
| | |
| |Street Address |
| | |
| | |
| |City County State Zip |
|Account|Document Type (Check One) |
|ing |[pic] [pic] [pic] [pic] [pic][pic]________________________ |
| |(Form Number) |
| |Document Number |Line Item # |Acquisition Cost |Acquisition Date |Receipt Date |
| | | | | | |
| |Project Number |Object Class |Org. Code |FSC |Condition Code |
| | | | | | |
|Condition Codes | | |
|A- Serviceable – New |C- Serviceable – Minor Repairs |G- Unserviceable – Incomplete |
|B- Serviceable – Used/Good |F- Unserviceable – Repairable |S- Scrap |
|Multiple Adds (Use this section to record multiple “adds” of the same item procured on the same document or attach appropriate documentation.)|
|Barcode No. |Serial No. |Bldg. No. |Room No. |DOCS Code |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
|Remarks |
| |
|Signature of Custodian (Print Name) |Date |Telephone |
| | | |
| |Transaction Request Number |
|2. Change Request (must be approved by the Approving Official) |
|Barcode Number |Item to be Charged |Old Data |New Data |
| |(Cost, Condition, etc.) | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
|Signature of Approving Official |Date |Telephone |
| | | |
|3. Transfer Request (PC releasing the property must send this form to the gaining PC for completion and signature) |
| | | |New Location |
|Number |Serial Number |Gaining PC |(Street Address, City, County, State, Zip) |
|Description | | |
| | | | |
| | | |
| | | | |
| | | |
| | | | |
| | | |
| | | | |
| | | |
|Signature of Gaining PC |Date |Telephone |
| | | |
|4. Deletion Request (must be approved by Approving Official) |
|TYPES: |A- Abandon/Destroy B- |E- Lost |
|(attach supporting documents, e.g., Report of Survey form) |Cannibalize |F- Stolen |
| |C -Scrap |G- Transfer (GSA) attach Standard Form |
| |D- Sold | |
|Barcode No |Type |Number |Type |Number |Type |
| |(see above) | |(see above) | |(see above) |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
|Signature of Custodian (Print Name) |Date |Telephone |
| | | |
|Signature of Approving Official |Date |Telephone |
| | | |
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