BPA F 4431.02e Returned Materials Receipt

U.S. DEPARTMENT OF ENERGY – BONNEVILLE POWER ADMINISTRATION (BPA)

BPA F 4431.02e
(04-2023)
Page 1 of 2

OMB Control Number: 1910-5190
Expiration Date: xx/xx/xxxx

RETURNED MATERIALS RECEIPT

INSTRUCTIONS: 1) Do not include returns from more than one WO on a document. 2) Return new, original issued condition, or determined reusable materials. 3) Catalog Numbers must be
marked on or attached to return materials. If returning large quantities of same item, at least one item must have catalog number attached. 4) Materials being returned for scrap value must be
coordinated with IRC prior to delivery. 5) Do not return deteriorated cardboard freight. 6) Distribution for Construction Contractors Only: submit electronic copy to Acquisition Analyst (AA) and
Construction Manager (COTR) at least two working days prior to desire drop off date and contact AA to schedule an appointment.
Received From (Name)

Work Order Number

ABM

Date

Number

Stock Number
Quantity
Returned

Unit

Catalog
Number

Description of Returned Materials

Received load of material, subject to inspection.
Name

Department ID

Material
Request
Number

Quantity
Received

IRC Use Only
Disposition
Fully
Repairable
Reusable

Scrap

Full value creditable to contractor for quantities indicated above.
Date

Name
Date

File Code: PB-1205; Retention: Destroy 6 years after final payment or cancellation, but longer retention is authorized if required for business use.

BPA F 4431.02e
(04-2023)
Page 2 of 2

RETURNED MATERIALS RECEIPT

OMB Control Number: 1910-5190
Expiration Date: xx/xx/xxxx

Paperwork Reduction Act Burden Disclosure Statement
This data is being collected to ensure stewardship of BPA’s purchased materials. The data you supply will be used by BPA to ensure that credit is appropriately provided and materials are used
economically and efficiently. Public reporting burden for this collection of information is estimated to average 5 minutes (or .08 hours) per response, including the time for reviewing
instructions, searching existing data sources, fathering 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,
Enterprise Policy Development & Implementation Office, IM-22, Paperwork Reduction Project (OMB control number 1910-5190), 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 (OMB control number 1910-5190), Washington, DC 20503.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty for failure to comply with a collection of information subject to
the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB control number.
The Paperwork Reduction Act (PRA) of 1995 requires each Federal agency to seek and obtain approval from the Office of Management and Budget (OMB) before undertaking a collection of
information directed to 10 or more persons of the general public, including persons involved in or supporting the operations of Government-owned, contractor-operated facilities.
Submission of this data is voluntary, however failure to submit the information could result in non-reimbursement of funds.

File Code: PB-1205; Retention: Destroy 6 years after final payment or cancellation, but longer retention is authorized if required for business use.