Personal Property Templates

OMB Control No: 1910-1000

Exp. Date:  XX/XX/XX

(Department Of Energy)

REPORT OF PERSONAL PROPERTY FURNISHED TO NON-FEDERAL RECIPIENTS

GSA /FMR 102-36.295

Fiscal Year 2016

RECIPIENT FSC ORIGINAL

Name Status GROUP ACQUISITION COST

(NOTE: For FSC Group 70 property furnished under EO 12999, in addition to the above data, agencies must include the city and State in which the recipient is located, as well as the total number and type of computer systems or components transferred. Agencies that do not transfer their computer equipment via the CFL website can complete and attach an electronic worksheet that is available through GSA’s point of contact for the Non-Federal Recipients Report (see par. 9b of this bulletin). Computer equipment transferred through the CFL website does not need to be included on this report. That data can be collected by GSA directly.)

Template for the non-Federal recipients report

Public reporting burden for this collection of information is estimated to average 150 hrs per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Office of the Chief Information Officer, Records Management Division, IM-23, Paperwork Reduction Project (1910-1000), U.S. Department of Energy, 1000 Independence Ave SW, Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (1910-1000), Washington, DC  20503.