Location:
Inventory Custodian (Name):
Asset Number (if known) or Description:
Serial Number (or other unique identifier):

I request that the identified equipment item(s) be removed from our inventory list.

Select reason for removal from active inventory:

Top of Form

1. / Excess/Surplus (in reasonable working condition)
Equipment is no longer needed at this location. May be useful for other parties.
2. / Trade-In
Equipment will be used as a trade-in for credit against a new purchase. / See attachment
(details of order, vendor quote, etc.)
3. / Stolen/Lost/Missing
Provide police report or other supporting document with details of loss. / See attachment
(police report, etc.)
4. / Transfer to other IRIS location/custodian
Equipment is being transferred to other location: / Identify location/
contact person.
5. / Transfer to Outside Institution
Equipment is being transferred to another institution. / See attachment
(identify organization, contact person, purpose of transfer)
6. / Cannibalization
Equipment is being taken apart for parts to be used in other equipment.
7. / Broken/Damaged/Obsolete/Beyond Repair
Equipment is broken/damaged or obsolete, with no reasonable value remaining. Recommend for disposal/scrap. / Identify disposal method:
8. / Other (describe):

*Attach a written explanation/supporting documentation for any items marked "See attachment."

Signature (Program Manager) / Date

For Office Use Only:

Received Date / Initials / NSF Notification Date
NSF Approval Date / Inventory Update Date / Disposal Date

Equipment Change of Status Notification Form

Instructions

This form should be used to communicate changes in equipment status to IRIS Financial Services when equipment is no longer being actively used by the location and should be removed from the custodian's active inventory report.

Location: The physical location or facility associated with the equipment item (e.g., DMC, PIC, HQ, ASL, UCSD)

Inventory Custodian (Name): Print name of the inventory custodian responsible for the equipment (person filing this report)

Asset Number: Identify the assigned Deltek asset number associated with the equipment item from the Financial Services inventory report, if known, or provide a brief description of the equipment item.

Serial Number: Provide the serial number of the equipment item.

Reason for Removal from Active Inventory: Select from the list the primary reason for a change in status (# 1 – 8)

Excess/Surplus: Equipment items are no longer needed for the program. This equipment should be offered to other programs/locations.

Trade-In: Equipment will be returned to the vendor for credit against a new purchase.

Stolen/Lost/Missing: Equipment is unavailable to the program. Documentation should include details on when, where, and how the instance occurred, including police reports, an explanation of steps taken to locate or recover the equipment, and a description of security procedures in effect at the time the instance occurred.

Transfer to other IRIS location/ custodian: The physical location and accountability of the equipment will be transferred to a new location and custodian.

Transfer to Outside Institution: Identify details of transfer to another organization.

Cannibalization: Equipment will be dismantled and used for parts.

Broken/Damaged/Obsolete/Beyond Repair: Equipment is outdated and/or cannot be economically repaired. Has no value other than basic material content. Identify disposal method.

Other: Describe a change in status not identified above.

Signature (Program Manager): The inventory custodian should route this form to the applicable IRIS Program Manager for submission to IRIS Financial Services.

For Office Use Only: IRIS Financial Services will note the date this notification form was received, and process the appropriate request to NSF, or other funding agency, as applicable, within three business days.