Property Listing Form word version 10.20.22 (002) clean

U.S. DEPARTMENT OF LABOR Property Listing
Grant recipients must receive prior approval from the DOL/ETA Grant Officer to the purchase of any equipment with a per unit acquisition cost of $5,000 or more, and a useful life of more than one year. This includes the purchases of Automated Data Processing (ADP) equipment. Equipment must be made in accordance with 2 CFR 200.313 and 2 CFR 200.439
Grant Recipient Date Grant # Grant Period:
							Select one of the below option
Item No.	Item Description	Serial No.	Acquisition Date	Purchase Price	Current Fair Market Value	Condition	Retain for Current Grant Purposes	Retain for Other Fed. Sponsored Purposes	Retain for Non- Federal Use	Sell	Scrap
Remarks
Certified by:
Authorized Representative

O M B No.: 1205-0NEW      O M B Expiration Date: xx/xx/xxxx     O M B Burden Hours: 30 minutes

Paperwork Reduction Act Statement: These reporting instructions have been approved under the Paperwork reduction Act of 1995. Persons are not required to respond to this collection of information unless it displays a valid OMB control number. Public reporting burden for this collection of information includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Submission is mandatory under SSA 303(a)(6). Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office of Grants Management, Room N.4716, 200 Constitution Ave., NW, Washington, DC, 20210.