Records Retention Disposition Authorization

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					STATE OF WISCONSIN                                                                                 
PRB-001 (R 04/2010)                              Records Retention / Disposition Authorization

 Instructions for completion are provided on pages 2-3.                                    1.   Retention/Disposition Authorization # (RDA)
 In accordance with s.16.61, Wis. Stats, this form must be completed and            Sequential Number                  Suffix
  approved by the Agency and the Public Records Board (PRB) within one year
  of creation of the records series and prior to disposition of any public record.
 Field #1 - Agency Records Officers generally assign sequential RDA numbers          2. Agency Number                   3. Unit Number
  which are subject to PRB approval. If the agency does not assign an RDA
  number, leave this field blank and the PRB will assign the number.                  4. RDA Status               New            Amended
 Agency Records Officer:       Review & approve RDA; Assign RDA #, if
  applicable. Forward original only to the PRB. Maintain an agency copy during                   Sunset/Renewal                  Closed/Superseded
  the Board's review process.
5. Agency Name

Division Name                                                                 Subdivision Name

 6. Record Series Title

7. Record Series Life Cycle Dates                                    8. Medium for Records Storage – Check all appropriate categories
Year Created Year Discontinued Year of Final Disposition
                                                                       Electronic/Digital               Microform                  Paper

                                                                       Other (Specify)
 9. Retention Time Period - Specify Actual Period                    10. Event that Initiates the Start of the Retention Time Period
   Yrs        Mo         Wks         Days       Permanent           Creation    Fiscal        Other (Specify)
                                                                       (CR)           (FIS)
11. Disposition
   Destroy                    Transfer to State Archives (WHS)            Transfer to Other Location (Specify)
  Destroy Confidential    Transfer to UW Archives
12. Records Series Description

 13. Records Contain Personally           14. Name of Agency Program Contact or Records Officer – Select appropriate title.
     Identifiable Information (PII)
         Yes           No                                                                                   Program Contact            Records Officer
                                          Telephone                                      Email
 15. Records Series is Confidential or Access is Limited            Yes       No (If yes, enter Statute/Code)

Agency Official                                    Date (mm/dd/ccyy)            Agency Records Officer                              Date (mm/dd/ccyy)

PUBLIC RECORDS BOARD APPROVAL - Contingent on restrictions to record destruction contained in s. 19.35(5), Wis. Stats., (Open Records Law),
and that no records are destroyed if litigation or audit involving these records has commenced.

State Archivist                                      Date (mm/dd/ccyy)           Executive Secretary – PRB                         Date (mm/dd/ccyy)

                       This document can be made available in alternate formats to individuals with disabilities upon request.
Public Records Board
PRB-001 (R 04/2010)
Page 2 of 3
                                INSTRUCTIONS: Records Retention/Disposition Authorization
1.       Retention/Disposition Authorization (RDA) #:                        6.  Records Series Title:
         Prior to submission to the Public Records Board (PRB) for             - Assign a descriptive title to the records series. Be certain that
         approval, every RDA must have a unique, sequential number.              agency employees will be able to accurately identify the records
         Agency Records Officers generally assign this number which              series from its title. Do not use abbreviations or acronyms.
         is subject to PRB approval. If the agency does not assign an        7. Records Series Life Cycle Dates: Identify the following:
         RDA number, leave this field blank and the PRB will do so.            - YEAR CREATED: This is the year the agency first began
     -   SEQUENTIAL #: Agency RDAs advance in numerical                          creating or receiving records in this series. If the precise year
         order. The Records Officer must review past RDAs and then               is unknown, then provide an estimate.
         assign the next sequential number to a new RDA.                       - YEAR DISCONTINUED: Only complete this section if the
     -   SUFFIX: The Suffix is not used for most records series. It is           series is closed or the authority no longer has a legal
         an optional alphabetical character that may be used to                  obligation to create or receive records in this series.
         indicate different retention periods, media, or dispositions for      - YEAR OF FINAL DISPOSITION: Only complete this
         all or portions of the same records series.                             section of the life cycle if there is a year discontinued. The
2.       Agency #: Use the following:                                            year of final disposition is the year that the agency stopped
     -   State Agency: Use the three-digit agency appropriation code             creating or receiving the records within the series plus the
         assigned by Wis. Stats. § 20.                                           retention time period left for remaining records (see #9).
     -   University of Wisconsin: Use the three-digit statutory code (285)   8. Medium for Records Storage: Indicate all the media on
         together with the alphabetical code assigned to the institution.        which the records are stored such as paper, electronic/digital,
     -   Local Units of Government, Other Entities: Please contact               microform, or other, e.g. audio, film, or video. For electronic
         PRB Staff.                                                              media, describe the application or file format in #12, e.g. MS
     -   Board/Commission: The Records Officer may assign an                     Office Suite. If the original medium of an official record is
         additional alphabetical character to autonomous entities that           converted, for example from paper to electronic, then the
         are attached to an agency.                                              original may be destroyed and replaced by the new one, but
3.       Unit #: Use the following:                                              only if the new medium meets all legal requirements,
     -   Use a 3-digit field to further indicate entity with ownership           including those set forth in Adm 12: Electronic Records
         and financial responsibility for records in this series.                Management-Standards and Requirements.
     -   University of Wisconsin: Use the 6-digit UDDS # that the                The weblink to Adm 12 is: Administrative Rule 12
         UW uses for accounting and budgetary purposes.                
 4.      RDA Status: Check only one box:                                         0nkid=127&locid=0
  -      NEW: Request for approval of an RDA that has never been             9. Retention Time Period: SPECIFY AN ACTUAL TIME
         submitted to the PRB.                                                   PERIOD. Enter the number of years, months, weeks, or
     -   AMENDED: Request for approval of a change to an RDA                     check "Permanent" to indicate period of time for retaining the
         that previously was approved by the PRB. Any revision to                records. “Permanent” means that the records need to be
         an RDA triggers amended status with the exception of                    maintained permanently by the creating agency.
         SUNSET/RENEWAL. Use existing RDA number.                                - In # 12, provide specific justification to the PRB for the
     -   SUNSET/RENEWAL: The RDA has sunset and is being                            proposed retention time period. Examples of appropriate
         renewed without amendments. RDA’s automatically sunset                     justification include, but are not limited to: citation of
         every 10 years, per Wis. Stats. § 16.61(4)(c).                             controlling statutes or administrative rules, consistency
     -   CLOSED/SUPERSEDED:                                                         with related retention schedules, audit or fiscal
          CLOSED: The agency no longer creates or receives records                 requirements, or end of business need.
            in this series. Be certain to also complete # 7, Year                - If a retention time period is required by law, cite the
            Discontinued and Year of Final Disposition.                             relevant statute or administrative rule in #12. If the record
                                                                                    series is closed, specify the event that closed the file.
          SUPERSEDED: The RDA replaces an existing RDA,
                                                                             10. Event: Use this field to indicate the specific event that must
            which is being superseded. If applicable, please provide             occur in order to initiate the retention time period. Identify
            the prior RDA number.                                                this event using one of the following terms:
5.       Agency Name:                                                            - CR: If creation of the record initiates the retention time
     -   Identify the entity that has legal custody of the records, using           period, mark the checkbox “CR.”
         correct names. Do not use acronyms or abbreviations.                    - FIS: If the retention time period is initiated by the end of a
     -   Identify the division and/or subdivision that creates and                  fiscal year, mark the checkbox “FIS.” These records must
         receives the records. Do not use acronyms or abbreviations.                be kept through the end of the Fiscal Year.
                                                                                 - Other: If a specific event other than “CR” or FIS initiates
                                                                                    the retention time period, mark the checkbox “Other
                                                                                    (Specify) and briefly describe the event. You may also
                                                                                    provide a detailed description of the event within the
                                                                                    Records Series Description.
Public Records Board
PRB-001 (R 04/2010)
Page 3 of 3
                    INSTRUCTIONS: Records Retention/Disposition Authorization continued

11. Disposition: Check the appropriate category to indicate            14. Agency Program Contact or Records Officer: Provide the
    disposition of the records after the retention time period has         name, telephone number and email address for the agency’s
    expired. Only one disposition may be checked. Mark as                  statutorily-designated Records Officer or other program
    “Destroy Confidential” any record containing personally                contact, who may be contacted for further information
    identifiable information (PII, see # 13, below), or information        regarding the record series.
    to which access is restricted by law (see # 16, below). If a       15. Records Series is Confidential or Access is Limited:
    record is marked as “Destroy Confidential,” then the record        - Check “yes” only if a specific statute or administrative rule
    destruction shall comply with all relevant legal requirements.         requires that information in the record series be kept
12. Records Series Description:                                            confidential or protected from public access. If “yes” is
    - The description is the most important section of the RDA.            checked, identify the relevant statute or code.
      It informs the PRB, and others who are unfamiliar with the       - If access to the record series is limited only to certain
      records series, what information is contained in the series,         employees, provide written justification for limited access
      the business purpose for the information, and the reasons            and identify titles of the employees who have access to the
      why the series was created and/or received by the agency.            records.
    - Include relevant statutory or rule citations in order to         - NOTE: Some, but not all, personally identifiable information
      clarify the content of the records and the authorization to          (PII) is confidential. At the same time, records that do not
      create them. Additional information may be included as               contain PII may be required by law to be kept confidential.
      needed for employees to manage the records, such as                  For purposes of record retention and destruction, Wisconsin’s
      providing guidance regarding who is custodian of the                 Public Records Law and related statutes govern public access
      records within the series or conditions that must be met             to records, not the designation of confidentiality.
      prior to disposition, as well as the relationship to any other   16. Approval Signatures: The Agency Records Officer, and at
      record series.                                                       least one other agency official, such as the Agency Program
    - “Record series” is defined by Wis. Stats. § 16.61(2)(c).             Manager, Risk Manager, Legal Counsel, and/or the Legal
13. Records Contain Personally Identifiable Information:                   Custodian of Records, must review, approve, and sign the
    Check YES or NO. Wisconsin law requires authorities to                 RDA before submitting it to the PRB for approval. Prior to
    specifically identify records series that contain personally           implementation, PRB approval and signature by the State
    identifiable information (PII). PII is defined as information          Archivist are both required.
    that can be associated with a particular individual through        17. Contact Information: For records management training and
    one or more identifiers or other information or circumstances.         assistance, please contact the Wisconsin Department of
    Despite this broad definition, the law specifies that record           Administration, Records Management Section, by telephone
    series containing the following information need not be                at: (608) 266-2995. Many records management resources are
    identified as PII: a) mailing lists; b) the results of certain         available at the Wisconsin Department of Administration
    computer matching programs; c) telephone or email                      website. Here are three helpful documents:
    directories; d) record series pertaining exclusively to agency      Statewide General Records Schedules
    employees; and e) those relating to procurement or                 
    budgeting.                                                             atid=678&locid=165
                                                                        Electronic Records and Administrative Rule 12
                                                                        Frequently Asked Questions

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