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 firstname.lastname@example.org.
(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
For additional information on records destruction, refer to the Virginia
Public Records Management Manual.
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
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
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
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:
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)”
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)
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
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