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Fillable Printable Request For Clearance Or Cancellation Of A Standard Or Optional Form

Fillable Printable Request For Clearance Or Cancellation Of A Standard Or Optional Form

Request For Clearance Or Cancellation Of A
Standard Or Optional Form

Request For Clearance Or Cancellation Of A Standard Or Optional Form

REQUEST FOR CLEARANCE OR CANCELLATION OF A
STANDARD OR OPTIONAL FORM
INSTRUCTIONS:
For all actions to Standard and Optional forms, complete and submit a
separate set of clearance documents for each form (i.e., if one form is
being cancelled and replaced with another form, submit two sets of
documents; one set to cancel the old form and another set to establish the
new form). Then forward along with the items listed below to:
General Services Administration (Forms-XR)
1800 F Street, NW
Washington, DC20405
1. Supporting statement describing the situation or problem which
makes the initiation, revision, or cancellation of this form
necessary and desirable.
2. Copy of form for all requests except cancellations. This copy
should be both electronic and paper unless composition is being
requested.
3. List of potential user agencies and the projected annual usage.
4. Proposed implementing or cancelling regulation/directive (for
standard forms) or status announcement (for optional forms).
5. Printing specifications on Standard Form 1, or Standard Form
1C as appropriate.
6. Any other appropriate documentation.
If form will be used for public reporting (5 CFR 1320), include a copy
of OMB Form 83, supporting documentation, and OMB clearance
report. If form is an interagency report, include a copy of the approved
Standard Form 360 and one set of supporting documents.
1. REQUESTING DEPARTMENT OR AGENCY 2. REQUESTING BUREAU OR OFFICE
3. DATE REQUEST
INITIATED
4. TYPE OF ACTION (Check as applicable)
NEW
REVISION
CANCELLATION
OTHER (Specify below)
5. TYPE OF FORM
(Check one)
STANDARD (SF)
OPTIONAL (OF)
6. PROPOSED FORM TITLE
TITLE REVISED (Check if applicable)
7. PRESENT EDITION DATE
8. PROPOSED EDITION
DATE
9. PRESENT SF OR OF
NUMBER
10a. PROMULGATING REGULATION OR DIRECTIVE (Required for Standard Forms
Only)
10b. DATE OF REGULATION
11. OTHER CLEARANCES (Check only if applicable)
OMB NUMBER
EXPIRATION DATE
EXPIRATION DATE
INTERAGENCY RPT.
NO.
13. RELATED STANDARD OR OPTIONAL FORMS
14. OFFICIAL SUBMITTING REQUEST
15. AGENCY STANDARD AND OPTIONAL FORMS LIAISON REPRESENTATIVE
a. SIGNATURE
b. NAME
a. SIGNATURE
b. NAME
c. TITLE
d. TELEPHONE d. TELEPHONE
AREA CODE NUMBER
e. DATE SIGNED
e. DATE SIGNED
NUMBERAREA CODE
APPROVAL ACTION (GSA ONLY)
16a. SIGNATURE OF CLEARANCE OFFICIAL
16c. DATE SIGNED
16b. NAME OF CLEARANCE OFFICIAL
17. FORM NUMBER ASSIGNED 18. FORM DATE
AUTHORIZED FOR LOCAL REPRODUCTION
PREVIOUS EDITION NOT USABLE
STANDARD FORM 152 (REV. 11-2000)
Prescribed by GSA-FMR (41 CFR) 102-194
STOCK EVALUATION (Complete for old stock of form revised on this request.)
EXISTING STOCK
Obtain this information from GSA's Federal Supply Service (FSS). General Products Commodity Center, Forth Worth, TX and
evaluate against importance of revision in blocks 25-28b. Note that units are EA (Each). HD (Hundred), BX (Box), and PG
(Package)
19. QUANTITY (OF UNITS)
ON HAND AND DUE IN
20. MONTHLY DEMANDS
RATE
21. MONTHS OF STOCK
(20/21)
22. COST PER UNIT 23. ESTIMATED VALUE
OF STOCK (20 x 23)
24. DATE INFORMATION
OBTAINED
STOCK DISPOSITION (Complete for revised or canceled forms.)
25. FORM NUMBER
26. EDITION DATE
27. NATIONAL STOCK NUMBER OF FORM TO BE
PHASED OUT OR MADE OBSOLETE
28. DISPOSITION ACTION
a. CODE*
b. SUCCEEDING YEARS
*DISPOSITION CODES
1 -- Discontinue form immediately and dispose
of existing stock.
2 -- Discontinue form on date indicated and
dispose of stock at that time.
3 -- Continue to issue existing stocks, but do
not reprint.
4 -- Deplete existing forms before issuing
revised or modified edition.
5 -- Order new edition immediately; dispose of
existing forms upon receipt of revised
item.
6 -- Other (Explain in Item 41)
PROCUREMENT AND STOCKING OF NEW OR REVISED FORM
29. MANDATORY USE DATE
30. NATIONAL STOCK NUMBER (if assigned)
31. UNIT OF ISSUE
32. ESTIMATED GOVT-WIDE USAGE (No. forms)
a. FIRST YEAR b. SUCCEEDING YEARS
33. USAGE TYPE (Check)
CONSTANT
VARIABLE
(Specify in item 41)
34. STOCKING INSTRUCTIONS (Check one)
STOCK IN GSA SUPPLY
DISTRIBUTION FACILITIES
FOR SALE TO THE PUBLIC BY
SUPERINTENDANT OF DOCUMENTS
OTHER
(Explain in item 41)
NO COST DISTRIBUTION
(Give address in item 41)
ACCOUNTABLE ITEM, RECORD
ALL ISSUES OR SALES
LOCAL REPRODUCTION
Full size illusion of form available: (Specify
below)
ATTACHMENT AND DESCRIPTION (Check as applicable)
35. PRINTING SPECIFICATIONS:
SF 1 (Pad or Cut Sheet)
SF 1C (Unit Set)
GPO 1025a (Marginally Punched)
OTHER (Specify below)
36. ARTWORK AND GUIDES ATTACHED
PENCIL OR
OTHER DRAFT
CAMERA COPY
OTHER (Specify)
DUMMY
SAMPLE
PROOFS SAMPLES (Enter this information on printing req. Lines b and c are Agency use.)
37. NUMBER OF PROOFS
(Check one)
NONE (Camera copy
furnished)
NUMBER (Specify):
38. NUMBER OF DAYS
PROOFS WILL BE
HELD
39. SEND SPECIFIED NUMBER OF PRINTED FORM SAMPLES TO:
a.
b.
c.
40. ADDITIONAL REMARKS
STANDARD FORM 152 (REV. 11-2000) BACK
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