Attachment 2_HHS-22 Form Rqt for Prop Action.pdf

PDF 158 KB Posted

Attached to
FDA Move and Labor Services Recompete Federal contract opportunity
Solicitation number
OC-2025-121191
Issued by
Department of Health and Human Services Food and Drug Administration Office of Acquisition and Grant Services

About this file

Written by GovTribe AI ·

This is Form HHS-22, a Department of Health and Human Services "Request for Property Action" form used for tracking and managing government property transfers, receipts, and dispositions. The form is used to document details of property items including serial numbers, descriptions, quantities, condition codes, and costs.

The form includes fields for initiating and receiving organizations, property location information, and action types (Transfer, New Receipt, or Turn-in). It contains specific condition codes for property status: 1=New, 4=Usable, 7=Repairable, X=Salvage, and S=Scrap. The form requires signatures from multiple officials including the Property Custodial Officer, Receiving Official, and Property Accountable Officer. Special processing requirements include IRM clearance certification for equipment free of commercial software/sensitive information. The form includes detailed instructions for completion and requires distribution of copies to various stakeholders including the Property Accountable Officer, Requester, PCO, and Transfer Receiving Office.

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Attachment 3_Labor_Category.pdf PDF
Attachment 5-FDA Daily Move Guidelines.pdf PDF
Attachment 4-Commitment To Protect NPI .pdf PDF
Attachment 1- NCR Metropolitan Area Site List.xlsx XLSX spreadsheet
Attachment 6- Move and Labor Services Menu.pdf PDF

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Serial Number

Date of Request:

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Action Requested (Check one)

REQUEST FOR PROPERTY ACTION

Condition Codes: (see FPMR 101-43.48 for definitions)

ZIP Code

Property Custodial File Update/Final Property Action

Barcode/Decal Number

7 = Repairable

Initials of Property Technical/Accountable Officer

Distribution

1 = New

X = Salvage

*IRM Equipment certified free of commercial software/sensitive information

Description of Property (Noun Name. Mfg Name, Model Number, Stock Number)

Created by: PSC Media Arts Branch (301) 443-2454

Property Voucher Control Number

Property Section Only

QTY

Unit of Issue

Unit Cost

Cond.

(see below.)

Total Cost

Date:

Signature of Receiving Official

DateSignature of Property Accountable Officer (PAO)

Signature of Property Custodial Officer/Initiator (PCO)

Date

Date

IRM Signature:

PO Signature:

EF

Location of Property

City State

Telephone No.

Mailing Address

Contact Name

Location CAN No.

Admin Code

CAN No.

Turn in

Yes

Receiving Organization

Disposition Instructions (Explain in Detail - Use reverse side of form.)Transfer

No

Date:

Custodial Code

Custodial Code

Special Processing Requirements:

New Receipt

Project Officer Assigned

*IRM Clearance

4 = Usable

S = Scrap

Yes No

Date

Original - Property Accountable Officer 1 Copy - Retained by Requester 1 Copy - Retained by PCO 1 Copy Transfer Receiving Office

Initiating Organization

HHS-22 (REV. 8/00)

(CDC Adobe Acrobat 4.0 Electronic Version, 1/2001)

Attachment 2 Form HHS 22

INSTRUCTIONS FOR COMPLETING HHS-22

HHS-22 (REV. 8/00) (BACK)

Disposal condition code

Condition Codes

Expanded DefinitionBrief Definition

1 New . . . . . . . . . . . . . . . . . . . . . Property which is in new condition or unused condition and can be used immediately without modifications or repairs.

4 Usable . . . . . . . . . . . . . . . . . . . Property which shows some wear, but can be used without significant repair.

7 Repairable . . . . . . . . . . . . . . . . Property which is unusable in its current condition but can be economically repaired.

X Salvage . . . . . . . . . . . . . . . . . . Property which has value in excess of its basic material content, but repair or rehabilitation is impractical and/or uneconomical.

S Scrap . . . . . . . . . . . . . . . . . . . . Property which has no value except for its basic material content.

Distribution:

Original and 2 - To Accountable Officer 1 Copy - To Receiving Office 1 Copy - Hold

1. Date of request.

2. Identify your organization, location, room number, and telephone number.

3. Custodial area / location code.

4. Common accounting number and your administrative / custodial code.

5. Specify what you want to have done.

6. Provide DATA on the recipient.

7. Serial number or local decal number. If neither, leave blank. DO NOT COMBINE MACHINES AND FURNITURE.

8. Complete nomenclature of the item(s) stock number, model number, etc. It is necessary to adequately describe the items to insure identification.

9. Number of units.

10. Unit of issue: each, set, pkg., etc.

11. Condition code. See below.

12. Acquisition cost or best estimate.

13. Name and signature of Custodial Officer.

14. Name and signature of individual receiving property.

15. Signature of Accountable Officer or authorized representative.

17. Certification by the Accountable Officer when action has been posted to appropriate account.

18. Number assigned by the Accountable Officer.

(CDC Adobe Acrobat 4.0 Electronic Version, 1/2001)

b:
INITIATOR:
CITY:
CONTACT_NAME:
WORKTELEPHONENO:
CUSTODIAL_CODE:
CAN_NO:
LOCATION_OF_PROPERT:
MAILING_ADDRESS:
ACTION_REQUESTED: Off
ORGANIZATION:
ADMIN_CODE:
CUSTODIAL_CODE_REC:
CAN_NO_REC:
ZIP_CODE:
LOCATION:
STATE:
QUANTITYNO1:
BARCODE1:
SERIAL1:
DESCRIPTIONNO1:
UNITISSUENO1:
COND1:
COSTUNITNO1:
COSTTOTALNO1: 0
BARCODE2:
SERIAL2:
DESCRIPTIONNO2:
QUANTITYNO2:
UNITISSUENO2:
COND2:
COSTUNITNO2:
COSTTOTALNO2: 0
BARCODE3:
SERIAL3:
DESCRIPTIONNO3:
QUANTITYNO3:
UNITISSUENO3:
COND3:
COSTUNITNO3:
COSTTOTALNO3: 0
BARCODE4:
SERIAL4:
DESCRIPTIONNO4:
QUANTITYNO4:
UNITISSUENO4:
COND4:
COSTUNITNO4:
COSTTOTALNO4: 0
BARCODE5:
SERIAL5:
DESCRIPTIONNO5:
QUANTITYNO5:
UNITISSUENO5:
COND5:
COSTUNITNO5:
COSTTOTALNO5: 0
BARCODE6:
SERIAL6:
DESCRIPTIONNO6:
QUANTITYNO6:
UNITISSUENO6:
COND6:
COSTUNITNO6:
COSTTOTALNO6: 0
BARCODE7:
SERIAL7:
DESCRIPTIONNO7:
QUANTITYNO7:
UNITISSUENO7:
COND7:
COSTUNITNO7:
COSTTOTALNO7: 0
BARCODE8:
SERIAL8:
DESCRIPTIONNO8:
QUANTITYNO8:
UNITISSUENO8:
COND8:
COSTUNITNO8:
COSTTOTALNO8: 0
BARCODE9:
SERIAL9:
DESCRIPTIONNO9:
QUANTITYNO9:
UNITISSUENO9:
COND9:
COSTUNITNO9:
COSTTOTALNO9: 0
BARCODE10:
SERIAL10:
DESCRIPTIONNO10:
QUANTITYNO10:
UNITISSUENO10:
COND10:
COSTUNITNO10:
COSTTOTALNO10: 0
BARCODE11:
SERIAL11:
DESCRIPTIONNO11:
QUANTITYNO11:
UNITISSUENO11:
COND11:
COSTUNITNO11:
COSTTOTALNO11: 0
BARCODE12:
SERIAL12:
DESCRIPTIONNO12:
QUANTITYNO12:
UNITISSUENO12:
COND12:
COSTUNITNO12:
COSTTOTALNO12: 0
BARCODE13:
SERIAL13:
DESCRIPTIONNO13:
QUANTITYNO13:
UNITISSUENO13:
COND13:
COSTUNITNO13:
COSTTOTALNO13: 0
BARCODE14:
SERIAL14:
DESCRIPTIONNO14:
QUANTITYNO14:
UNITISSUENO14:
COND14:
COSTUNITNO14:
COSTTOTALNO14: 0
BARCODE15:
SERIAL15:
DESCRIPTIONNO15:
QUANTITYNO15:
UNITISSUENO15:
COND15:
COSTUNITNO15:
COSTTOTALNO15: 0
BARCODE16:
SERIAL16:
DESCRIPTIONNO16:
QUANTITYNO16:
UNITISSUENO16:
COND16:
COSTUNITNO16:
COSTTOTALNO16: 0
BARCODE17:
SERIAL17:
DESCRIPTIONNO17:
QUANTITYNO17:
UNITISSUENO17:
COND17:
COSTUNITNO17:
COSTTOTALNO17: 0
PROJECT_OFFICER: Off
DATE-OF-REQUEST:
DATE1:
IRM_CLEARANCE: Off
DATE2:
DATE3:
PROPERTY1:
DATE4:
PROPERTY2:
DATE5:
DATE6:
PROPERTY3:
VOUCHER-NUMBER:
Save Data:
Print:
Email Form:
Retrieve Data:
Reset Form:
DISPOSITION_INSTRUCTIONS:

File details come from the government source that posted it. Updated .