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Records Management Related Forms

Forms and documents are in Adobe PDF unless otherwise indicated. Alternative formats may be in Microsoft Word or Micosoft Excel. Forms are listed by function and section.

Records Officer Designation

  • Records Officer Designation Form SSARC-940 
  • Please Note: To renew your agency's records officer designation due July 1 of each year,  please use the records officer designation form SSARC-940. There is no renewal form. The form mailed to agencies from our office is designed to verify information in our computer system and allow agencies to complete their designation at the same time. This may not occur annually.
  • Role Designation Form SSARC-941 (use this to change records center coordinators or to identify other coordinators or contact other than Agency Records Officer).

Records Retention Schedule Development

  • Records Management Inventory Form SSARC-960     
  • Records Retention Schedule SSARC-932 (Available in MS Word only).
  • Records Retention Schedule Sample SSARC-932 Sample (See Records Retention Update below for further information).
  • Records Retention Schedule Update 

Imaging Exception Application Process

  • Imaging Exception Application Form SSARC-970 
  • Imaging Exception Application Form Instructions SSARC-970I 
  • Imaged Records Series List Form SSARC-972 
  • Agencies List Worksheet Form SSARC-971 
  • Request for Use of Expedited Disposal Request Process for Converted Documents Form SSARC-930e 

Records Disposal

  • Request for Authority to Dispose of Records Form SSARC-930 
  • Request for Authority to Dispose of Records Form Sample SSARC-930-Sample 
  • Request for use of Expedited Disposal Request Process for Converted Documents Form SSARC-930e
  • Certificate of Destruction Form SSARC-933
  • Certificate of Destruction Form Sample SSARC-933-Sample 

Records Center (Temporary) Storage

Records Transfer to State Archives (Permanent Records)

  • Louisiana State Archives Records Transmittal Form (For records being transferred to Archives Acquisition Section) F-AS-4.  Also available in Excel F-AS-4 

Damage Assessment for Records

Form Updates

To assist your agency in verifying that you are using the most current version of our forms we have provided a chronology of when we have updated them since July 2010.  If the form is listed below and the revision date on the form you have been using is before July 2010 it needs to be updated.

March 2013

  • SSARC 940 - Records Officer Designation Form

January 2012

  • SSARC 932 - Record Retention Schedule
  • SSARC 930e - Application for Expedited Process for Request for Authority to Dispose of Records
  • SSARC 930 - Request for Authority to Dispose of Records

July 2010

  • SSARC 970 - Imaging Exception Application
  • SSARC 970I - Imaging Exception Application Instructions
  • SSARC 971 - Agency List Worksheet (for Imaging Applications)
  • SSARC 972 - Imaged Records Series List (for Imaging Applications)

The Records Management program has released its Imaging Exception Application process and related forms as of July 1, 2010. A new class on imaging and the imaging exception application process for interested agencies is included in the classes we offer. Information on this new class can be found on our Get Records Management Training Page.

For more information or questions, please Contact the Records Management program via fax at 225.922.1220 or via email. Please include your phone number in email correspondence.