State of Tennessee                                                                              TSLA Form RDA 2002

RECORDS DISPOSITION AUTHORIZATION

FOR COUNTY GOVERNMENT RECORDS*

County: _______________________________________________________________________

Office or Agency:__________________________ Phone:________________________________

Address:  ______________________________________________________________________

Agency Head/Officeholder:  _______________________________________________________

Signature:______________________________________ Date: ___________________________

Action Requested:

□ Continuing Records Disposition Authority (Records Disposition Schedule) ¹

□ One-Time Records Disposition Authority ²

□ Revision of/Exception to Existing Records Disposition Authority³ ______________________________________________________________________________

□ Other Disposition (explain in attached memorandum) ⁴

Title/Description of Records:⁵  _____________________________________________________

CTAS Code:⁶ ___________________________________________________________________

Date Span of Records (e.g. 1988-1998): _______________________________________________

Volume of Material (e.g. 25 cubic feet, 3 banker’s boxes, 1 Hollinger box): ____________________

Proposed Disposition: ⁷

□ Retain ____ months/years, then destroy.

□ Retain ____ months/years, then film and destroy paper copy (or erase from computer record).

□ Retain ____ months/years, then transfer to archives.

                        □ Approved                                     □ Not Approved

_______________________________________      ________________________

Chairperson, Public Records Commission                   Date   

*For the disposition of additional records, please use the supplemental form provided.       

Please use the following instructions to correctly fill out the RDA form.

¹ A Continuing RDA is used for a type of record(s) that an office continually creates and, thus will continually need to destroy. Once a Continuing RDA has been approved, this record type can be destroyed after its retention period without having to submit another request.

² This is a one-time request for records that an office does not typically or continually create. If an office wants to destroy the same type of records at a later date, another request must be submitted.

³ This option allows for a change to an existing RDA that an office has submitted, due to legal or historical or other reason. Be sure to include an explanation for the change.

⁴ Use this option in circumstances where an office needs to destroy a record sooner that CTAS prescribes or that no CTAS disposition is provided at all and the office would like to create one. Be sure to include an explanation of your actions.

⁵ Please write the name or a brief description of the type of record you are requesting action on (e.g. warrants, ballots).

⁶ Use the five-digit CTAS code that corresponds with the record type listed in the Records Management for County Government manual.

⁷ This information can be found in the CTAS manual next to the five-digit code and description of record, telling how long an office should keep the record (based on the legal retention schedule) and what an office will do with the record after that period has expired.

For any questions concerning this form or the procedures for using this form, please contact

Dr. Wayne C. Moore, Assistant State Archivist

Tennessee State Library and Archives

(615) 253-3458

Wayne.Moore@state.tn.us

SUPPLEMENTAL REQUESTS FOR ADDITIONAL RECORDS DISPOSITIONS

(Page ___ of ____)

Action Requested:

□ Continuing Records Disposition Authority (Records Disposition Schedule)

□ One-Time Records Disposition Authority

□ Revision of/Exception to Existing Records Disposition Authority

_____________________________________________________________________

□ Other Disposition (explain in attached memorandum)

Title/Description of Records: ____________________________________________________

CTAS Code: __________________________________________________________________

Proposed Disposition:

□ Retain ______ months/years, then destroy.

□ Retain ______ months/years, then microfilm and destroy original.

□ Retain ______ months/years, then transfer to archives.

Action Requested:

□ Continuing Records Disposition Authority (Records Disposition Schedule)

□ One-Time Records Disposition Authority

□ Revision of/Exception to Existing Records Disposition Authority

_____________________________________________________________________

□ Other Disposition (explain in attached memorandum)

Title/Description of Records: ____________________________________________________

CTAS Code: __________________________________________________________________

Proposed Disposition:

□ Retain ______ months/years, then destroy.

□ Retain ______ months/years, then microfilm and destroy original.

□ Retain ______ months/years, then transfer to archives.

Action Requested:

□ Continuing Records Disposition Authority (Records Disposition Schedule)

□ One-Time Records Disposition Authority

□ Revision of/Exception to Existing Records Disposition Authority

_____________________________________________________________________

□ Other Disposition (explain in attached memorandum)

Title/Description of Records: ____________________________________________________

CTAS Code: __________________________________________________________________

Proposed Disposition:

□ Retain ______ months/years, then destroy.

□ Retain ______ months/years, then microfilm and destroy original.

□ Retain ______ months/years, then transfer to archives.