INSTRUCTIONS FOR COMPLETING CERTIFICATE OF RECORDS DESTRUCTION (RM

							      INSTRUCTIONS FOR COMPLETING CERTIFICATE OF RECORDS
DESTRUCTION (FORM RM-3 May 2007) AT THE UNIVERSITY OF VIRGINIA:
  [Please note that these Commonwealth of Virginia records management instructions
             have been specially modified for the use of UVA employees.]
Before any UVA (or other state agency or locality) can destroy any public records:
           Each state agency must designate a Records Officer who is then listed
              with the Library of Virginia. At the University of Virginia (Agency 207),
              for academic and administrative departments and the schools of Medicine
              and Nursing in their teaching functions, Professor Ervin L. Jordan Jr. is
              the University Records Manager. He may be contacted at the Special
              Collections Department, Harrison/Small Library, 4-4975 (this is the
              preferred means of initial contact) or by email at elj7t@virginia.edu.
           (If you contact Prof. Jordan by email, use “UVA Records
              Management” as your subject line.) The Records Officer for certain
              health care records created at the UVA Health System (Agency 209) is
              Mr. Abraham Segres (4-5595), P. O. Box 800503.
           The UVA Records Officer must approve, in writing, any and all
              records destruction, as documented on RM-3 forms, before any records
              may be destroyed/discarded/erased/recycled/shredded/trashed.
           A valid Records Retention and Disposition Schedule (an RM-3 form)
              must cover the records to be destroyed.
           Minimum time periods must have passed even if the records were
              converted to another format, i.e., microfilm or digital or electronic.
           All investigations, litigation and required audits (internal or otherwise)
              must be completed. If you are uncertain, contact: Ms. Barbara J. Deily,
              Director of Audits, Carruthers Hall, 924-4110 .

Prepare a Certificate Of Records Destruction form (RM-3) each time your
department/division/section seeks to destroy records. These instructions have been
specifically modified for the University of Virginia and are adapted, with
authorization, from “RM-3 Preparation Instructions (pdf),” at the Library of
Virginia‟s Records Management Services Division website
<http://www.lva.lib.va.us/whatwedo/records/forms/index.htm>.
     For additional information on records destruction, refer to the Virginia
        Public Records Management Manual.
        <http://www.lva.lib.va.us/whatwedo/records/manuals/00m-ch5.htm>
     Appropriate signatures must appear on each RM-3 form page that lists
        records to be destroyed.
     BE ADVISED THAT UPON COMPLETION AND SUBMISSION OF AN
        RM-3 FORM TO THE UVA RECORDS MANAGER THE PAPERWORK
        PROCESS MUST BE OFFICIALLY COMPLETED!

NOTE: The RM-3 form may be replicated on a computer or duplicated on a
photocopier; however, FAXED FORMS CANNOT BE ACCEPTED. The computer
copy/photocopy must look as similar as possible to the RM-3 form, be in the same
order, and contain the same information on each page. This form may also be
downloaded from the University‟s forms directory site at:
http://etg07.itc.virginia.edu/uvaforms/servlet/search/home; instead of „All
Departments‟ select “Records Management” (or “Library, UVA”) then click the
small white triangle on the right. This will take you to the “Certificate of Records
Destruction” (RM-3 form) site. A blank form is accessed by clicking its URL
address http://www.lva.lib.va.us/whatwedo/records/forms/rm3ia.pdf; the form may
then be filled out online (using Adobe Acrobat Reader 4.0 or higher) and then
printed; instructions for its completion are available by clicking “Procedure”;
detailed information about “Records Management at the University” is available at
“Policy.”

Each of the following numbered lines (nine) exactly apply to those on the Certificate of
Records Destruction (RM-3) form:
   1)     Agency/Locality: University of Virginia 207
   2)     Division/Department/Section: Enter the name of your division, department
          and/or section.
   3)     Person Completing Form: Enter the name and job title of the person
          completing the form (and responsible for the records).
   4)     Address: Enter the UVA Messenger Mail address of the person completing
          the form.
   5)     Telephone Number & Extension: Enter the UVA area code and telephone
          number of the person completing the form.
   6)     Records to be destroyed: List the records you wish to destroy:
          a) Enter both the general schedule and records series numbers that apply
               to the records to be destroyed, e.g. GS 101 (schedule number), #001036
               (records series number). ENTER ONLY ONE SERIES NUMBER PER
               LINE. (Note: All schedules have unique six-digit records series
               numbers.) Retention schedules are available at:
               http://www.lva.lib.va.us/whatwedo/records/sched_state/index.htm.
          b) Enter the exact records series title (name) of the records listed on the
               approved retention schedule. You may add detail to this title, if it is
               important to identifying the records. When using the interactive pdf format
               it may sometimes be possible to “cut and paste” series titles directly from
               the appropriate retention schedule to your form’s column 6b [Records
               Series Title]: “Blank RM-3 Form (Interactive pdf)”
               http://www.lva.lib.va.us/whatwedo/records/forms/rm3ia.pdf.
          c) Enter the date range of the records to be destroyed, from oldest to most
               recent; indicate starting month/year and ending month/year (e.g., 7/86 to
               6/92). Be certain the retention period stated in the applicable general
               schedule has passed; records cannot be destroyed before the end of the
               stated retention period nor should they be retained longer than the stated
               retention period unless needed for an investigation, litigation or audit.
          d) Enter the location where the records are currently and physically stored.
          e) Enter the total volume of records to be destroyed in cubic feet (cu. ft.).
               Refer to “Chapter 5, Procedures for Destroying Public Records,” Volume
               Estimation Table (pdf)
            http://www.lva.lib.va.us/whatwedo/records/forms/00m-ch5t.pdf convert
            boxes or drawers of paper or microfilm records to their cubic foot
            equivalents. If destroying electronic records, enter the approximate size
            of the files in megabytes, by type of media containing the data or by
            number of files.
       f) Enter the method of destruction as required by the specific general
            schedule(s) records series number and records series titles (see 6a & 6b
            above), i.e. trash, wiping (electronic data), recycling (pulping), shredding,
            burying (landfills), or burning; only one method per line.
7)     Approving Official: The department head/supervisor must print and sign
       their name and date this line.
8)     Designated Records Officer: Leave this entire line blank; the University
       Records Manager will complete it and is the only university official who can
       officially authorize records destruction.
9)     Records Destroyed By: Leave this entire line blank; the University Records
       Manager will later complete the name of the person who can certify the
       records were properly and legally destroyed and the date of their final
       destruction.
 Send the signed original and two (2) photocopies to Professor Ervin L. Jordan,
   Jr., University Records Manger for Agency 207, Special Collections
   Department, Harrison/Small Library, University of Virginia, P. O. Box
   400110; or, if your UVA agency number is 209, to Mr. Abraham Segres (4-
   5595), Director, Office of Risk Management, Health System (Agency 209), at P.
   O. Box 800503. If the request for permission to destroy records is approved, a
   copy of the officially approved RM-3 form will be sent to you; the UVA Records
   Manager will retain a permanent copy for UVA’s official records management
   files, and forward the original(s), in accordance with the Virginia Public Records
   Act and Code of Virginia, to the Records Management and Imaging Services
   Division, The Library of Virginia, Richmond.

           These instructions (Word document) revised: 2007 May 16