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State of New Jersey

Department of Treasury

Division of Purchase & Property

Declaration of Removal of all Hard Drives and

Other Data Storage Devices on Surplus

Computer and Other Electronic Devices

_____________________________________________________________________________

Department __________________________________________________________

P.O. Box # ____________

Contact Name _____________________________________ Phone # _________________

Fax # ___________________

Requirements:

Completed forms must be sent to the Treasury Bureau of Special Services (B.O.S.S.) warehouse by fax (609) 588-0483 or

boss.warehouse@treas.state.nj.us

to obtain approval to ship.



Each Department must “sanitize” all equipment capable of storing data by physically removing all hard drives, storage

disks, memory sticks and any other devices capable of storing data.



Each Department will remain responsible for sanitizing and disposing of these data storage devices in full compliance with

the Office of Information Technology Policy Standard 09-10-NJOIT, Information Disposal and Media Sanitization.



This form applies to all desktop and laptop computers, copiers, multifunction devices (print/fax/scan/copy), servers, cell

phones, PDA’s, notebooks and any other electronic device with data storage capabilities that is to be declared surplus.



No arrangements may be made to drop off or have picked up any covered equipment until after approval by, and in

coordination with, the B.O.S.S. warehouse staff.



This form must be filled out completely and authorized/certified by the Department and its Chief Technology Officer.

Incomplete or unsigned forms will be returned to the department contact.



The original signed form must accompany the shipment to the warehouse or be given to the driver at time of pick-up.



Any discrepancy between the count on this form and the physical count will result in refusal of the entire shipment. The

discovery of any storage device in a shipment will result in refusal of the entire shipment. Should a drive be discovered in a

shipment after delivery has been accepted, that entire shipment will be segregated and must be picked up by the owning

agency within 48 hours.



This is a joint Division of Purchase & Property, Division of Property Management, and Office of Information Technology

initiative to protect all confidential, personal and sensitive data from unauthorized access.

I hereby approve the surplus declaration of _____ pieces of equipment meeting the above criteria:

Departmental/Agency approval _________________________________________________ Date ______________

(Signature)

Print Name __________________________________________ Title _______________________________________

I hereby attest that all _______ pieces of equipment meeting the above criteria have been properly sanitized by physical

removal of all storage devices/media.

Information Technology Certification _________________________________________________ Date ______________

(Signature)

Print Name ____________________________________________ Title ____________________________________________

To be completed by owning Department/Agency and B.O.S.S. personnel at time of transfer. These signatures attest to count only, not to

absence of data storage devices.

Date Equipment Picked Up/Delivered __________ # of Pieces _____ Department Signature ___________________________

Date B.O.S.S. Accepted Equipment ____________ # of Pieces _____ B.O.S.S. Signature _______________________________

Form DSS-180 Rev 6/16

Form Dss-180 - Declaration Of Removal Of All Hard Drives And Other Data Storage Devices On Surplus Computer And Other Electronic Devices - New Jersey Department Of Treasury

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