Fillable FORM GORA 02 ORR Reimbursement Sheet (West Georgia College)

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FORM GORA 02 ORR Reimbursement Sheet (West Georgia College)

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Open Records Reimbursement Sheet
(GORA – 02)
For IEA Use Only:
Payment:
APPROVED
Amount $
DENIED Initials:
Office of Institutional
Effectiveness and Assessment
Carrollton, Georgia 30118-4500
Complete and return this sheet along with records requested.
Name of Person and/or Organization,
and Address Requesting Records:
Records Requested:
(description)
Per the Georgia Open Records Act OCGA 50-18-71(c) (1-3), the University may collect administrative fees for processing open
records requests. For departments/units to be eligible for reimbursement from monies collected in response to Open Records
Requests, the following conditions must be met:
1. Submit reimbursement sheet along with documents responsive to the request,
2. Total department/unit dollar amount to transfer is greater than fifty dollars ($50), and
3. Total dollar amount of the completed request is greater than fifty dollars ($50).
Department Information
Full Name of Department
Direct Campus Phone#
Chart of Accounts
Acct Code
Dept.
Prog.
Class
Cost to Produce
1. Paper Records
Report Time Spent in quarter hour increments for the lowest paid, full-time employee. The first 15 minutes for search and retrieval will be deducted by IEA.
Hourly rate calculation = annual salary divided by 2080.
# of Pages
x
0.10
each =
Search and Retrieval Time Spent
x
per hour =
Name of employee whose hourly rate is listed above
(paper records)
(lowest, full-time employee excludes student workers)
2. Digital Records
For IEA Use Only
# of CD-R Disk or DVD Disk
x
1.00
each =
# of USB
x
each =
(cost of device)
Search and Retrieval Time Spent
x
per hour =
Name of employee whose hourly rate is listed above
(digital records)
(lowest, full-time employee excludes student workers)
3. Other Fees
# of boxes/files transferred
to/from an off-site storage facility
Total transfer charges incurred
Additional Costs Not Reported Above
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FORM GORA 02 ORR Reimbursement Sheet (West Georgia College)

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Completed 18 July 2020

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