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Form per-6-s101.doc
U.S. Department
of Agriculture --- Trial
Form PER-6-S101
Natural Resources Conservation Service --- May
4, 2006
REQUEST
TO ADD OR DELETE
NRCS PARTNER PERSONNEL
FOR NRCS SPACE AND IT RESOURCES USE
(Upon
completion, file in Official ISSPOC Folder)
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1. County:
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2. City:
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3. Request Date:
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4. Employee Name:
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5. Position Title:
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6. Employing Agency:
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7. Space Needs:
Office space available: ____YES ____NO
If no; how many extra square feet are
needed:________________
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8. Furniture
and Equipment Available
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Desk/Workstation
___YES ___NO
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Chair
___YES ___NO
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Phone
___YES ___NO
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Computer: (CPU, Monitor, Keyboard, Mouse) ____YES ____NO
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Vehicle
_____YES _____NO If yes, justification:
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Other Furniture or Equipment Needs: (Specify)
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9. IT
System Access Needed
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Email:
___YES ___NO
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PROTRACTS:
___YES ___NO
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TOOLKIT:
___YES ___NO
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Specify any other IT Resource Needs:
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10. NRCS Requestor’s Name (District Conservationist): ( please print)
Phone:
( ) ________- _________
Area
Conservationist Concurrence: Yes
__ No __ Signature:
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11. FOR
STATE OFFICE OR
DIVISION OF CONSERVATION USE ONLY
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NRCS STATE
OFFICE
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DIVISION OF
CONSERVATION
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Approved _____ Disapproved _____
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Approved _____ Disapproved _____
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NRCS
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NRCS
Partner
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Agency:
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Signature:
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Signature:
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Name: (Print)
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Name: (Print)
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Title:
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Title:
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Phone:
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Phone:
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Date:
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Date:
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12.
DELETE NRCS PARTNER PERSONNEL
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Employee Name:
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Job Title:
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Date Employment Terminated:
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Routing:
1. NRCS Requestor (DC’s) Supervisor and
Division of Conservation (Katrina Beckley),
2. NRCS State
Administrative Officer (Billye Haslett),
3. AC (if required),
4. NRCS ISSPOC (Lori Baker)
INSTRUCTIONS FOR PREPARING
TRIAL FORM PER-6-S101
REQUEST TO ADD OR DELETE NRCS
PARTNER PERSONNEL
FOR NRCS SPACE AND IT RESOURCE USE
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County
where service center is located.
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City
where service center or office is located.
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Date
of request.
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Employee
Name – Name of NRCS partner employee proposed to use space, equipment, and
IT resources.
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Position
Title – Job title for NRCS partner employee.
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Employing
Agency - Name of NRCS partner employing the employee.
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Space
Needs – Indicate if space is currently available under the NRCS lease for
this person to use to perform their job functions. If there is not NRCS
space available, indicated the square footage needed for this person and
if it is available from another agency or in the current facility
(building).
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Furniture
and Equipment Available – Indicate what furniture and equipment is
currently available for this person to use to perform the job functions.
If not available, specify needs in the space provided. For a vehicle to be made available work
to be accomplished must be predominantly NRCS workload.
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IT System
Access Needed – Indicate what system access this person will require in
order to perform their job functions. If not listed, specify additional IT
system access needs in the space provided.
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Requesting
DC – Must sign in the signature block and provide their name printed, job
title, and office phone number.
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Approval
– The DC will send this form concurrently to the NRCS and the Division of
Conservation. Each agency official must indicate their approval or
disapproval of this request. Each official must sign and list their name
in print, title, phone number and the date approved or disapproved. The
requestor will then be notified of the approval/disapproval.
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Delete an Employee – This section is to notify
NRCS and partner agency of the termination of space needs and/or IT resource
needs for a departing NRCS partner employee. Provide the employee’s name, job
title, and the date of their termination/retirement/etc.
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