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 |

| | | |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download