FSA Claim Form

Identification

• Title: FSA Claim Form
• Expanded Number: FORM/001171
• Date Created: Tuesday, December 24, 2024 at 8:28 AM
• Date Registered: Thursday, December 11, 2025 at 11:31 AM
• Accession Number: 0
• Record Class: Municipal
• Content Manager Barcode: R03000OWXR
• Record Type: Form (Blank) / Cheat Sheet
• Latest Version: FORM/1171

Parts

• First Part: FORM/1171
• Latest Part: FORM/1171
• Is Part: No

Archiving

• Retention Schedule: 040.130 Forms - Blank (TRIM rt); Notes: CMRRS RECORD DEFINITION: Blank forms are not considered to be records and should be separated from the records. However, a master forms file may be maintained to track the evolution of the form and instructions regarding use of the form.; CMRRS RETENTION: Until superseded, except retain 1 copy permanently if master forms file is maintained [Master forms file NOT maintained by City. mbc]; TRIM record type = Form (Blank) / Cheat Sheet; Action Summary: Destroy after Date Superseded / Replaced / Revised (Additional Field)
• Disposition: Active
• Disposal Schedule: Make Inactive: No Relevant Triggers; Destroy: Waiting on Trigger Date
• Date Due for Destruction: Waiting on Trigger Date
• Last Action Date: Wednesday, December 17, 2025 at 1:46 AM

Container

• Is a container: No