State of Texas

Office of the Governor

Public Safety Office

Equipment Disposition Request

This form is used to collect information when required to request disposition instructions for equipment acquired under Federal assistance awards, including disposition of state-contolled assets. You may request disposition of multiple, like, items at the same time if they were acquired at the same time under the same federal award.

Based on your responses, it may not be necessary to complete the entire form. If this is the case, simply follow the instructions that appear on your screen and close your browser.

Additional information on equipment disposition may be found in the HSGD FAQs located at: https://egrants.gov.texas.gov/updates.aspx under "Forms and Guides".

For questions please contact Kim Hild, with the Public Safety Office (PSO), at: 512-463-8570 or kimberly.hild@gov.texas.gov.

General Information

Click on the (?) buttons to see detailed instructions for each item.

Agency Name *

Federal Grant Number *

Brief description of item(s). *

Serial number(s) or other identification number(s). *

Acquisition date *

Is the equipment more than three(3) years old? *

Yes

Acquisition Cost (per unit). *

Current per unit fair market value (FMV). *

Is the current per unit FMV less than $5,000? *

Yes

Stop, no further action is required!

You may retain, sell, or otherwise dispose of the equipment with no further obligation to the PSO.

Ensure your equipment inventory list is updated to include the date of disposition, method of disposal (i.e. destroyed, transferred, sold, etc.), and sale price or fair market value. Methods used to determine fair market value must be documented, kept on file, and made available upon request.

Please print a copy of this documentation for your records by following these steps, and then close your browser:

1. Right click your mouse

2. Select "Print"

3. Select the appropriate printer

4. Click the "Print" button

Disposition Information

Are you reporting the loss, destruction or theft of grant-funded property? *

Yes

Date of the incident *

Does the agency intend to: *

Retain and use the equipment in the program for which it was originally acquired, regardless of whether or not the program is still receiving grant funds.

Retain and use the equipment in other activities currently or previously supported under a FEMA grant or sub-grant.

Retain and use the equipment in other activities currently or previously supported under a non-FEMA federal grant or sub-grant.

Retain and use the equipment in other projects (non-federally supported).

Trade in or sell the equipment with proceeds used to off-set the cost of replacement equipment.

Sell with the PSO entitled to a share of the proceeds.

N/A (Only select this when reporting lost, stolen, or destroyed equipment)

Stop, no further action is required at this time!

In the future, should you no longer need the item for the purpose or program for which it was acquired, you must request disposition instructions. Please refer to the General HSGD FAQs for additional information.

Please print a copy of this documentation for your records by following these steps, and then close your browser:

1. Right click your mouse

2. Select "Print"

3. Select the appropriate printer

4. Click the "Print" button

In the space below, provide specific details about the equipment including: 1) a general description of the item(s); 2) why the equipment is being disposed of; 3) how the equipment is being disposed; and 4) general information on replacement equipment, if applicable. If equipment is being traded or sold with proceeds used to off-set the cost of replacement equipment, please indicate if the replacement equipment will be used for the same project/purpose and what that project/purpose is. If reporting the loss, destruction or theft of grant-funded property include: 1) a description of the circumstances; 2) indicate how the incident was investigated and documented; and 3) a description of the safeguards in place to prevent the loss, destruction or theft of property.

Comments *

(i) Estimate of sale proceeds or current fair market value *

(ii) Percentage of Federal Participation *

(iii) Estimated selling and handling allowance *

(iv) Estimated Amount owed to the PSO:

$0.00

Point of Contact

Submitter First and Last Name: *

Submitter Phone: *

Submitter Email Address *

Confirm Email *

By submitting this form you certify that:

1. You are authorized to coordinate disposal of equipment for your agency.
2. To the best of your knowledge, the information provided in this form and any supporting documentation is accurate and complete. *

Acknowledge