Form Hud-58-A - Clearance For Separation Of Employee - 2000 Page 2
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2Part IV. Administrative Clearances
Instructions for the Clearance Official: Indicate clearance of chargeable items by signing your name, date, and telephone number in the
appropriate blocks. Note in Part III the reasons why any chargeable item was not accounted for or returned and indicate the dollar value of
the unaccounted item to be collected from the employee's final salary payments.
Item
Room
Cleared by
Date
Telephone
(Signature)
1. Financial Disclosure Statement (SF-278)
2130
Office of Ethics
2. Procurement Official's Certification
2130
Office of Ethics
3. Post-employment Memorandum
2130
Office of Ethics
4. Security Termination Statement (HUD-70029)
2150
HR, Labor & Employee Relations Div.
5. Library Books and Periodicals: Library and
8141
Office of Administration Comptroller
5284
6. U.S. Government Bank Card
5284
Office of Administration Comptroller
7. Telephone Equipment (Cellular Phone,
5162
Pager, Calling Card)
OAMS, Space Management Division
8. Personally Charged Property
5162
OAMS, Space Management Division
9. Parking
5180
OAMS, Facilities Management Div.
10. Transit Subsidy
5284
Office of Administration Comptroller
11a. Records (Program Office)
varies
Program Records Manag't. Liaison Officer
11b. Records (Departmental Records Officer)
B-100
OAMS, Records and Directives Branch
1 2. Computer Access (ID's, Passwords, etc.)
4180
IT, ADP Security Staff
1 3. Travel Advance
3104
Office of CFO
1 4. Travel Charge Card
3104
Office of CFO
1 5. Training Obligations
2180
Training Academy
1 6. Building Pass
South
East
Lobby*
* Ask Guard for the Security Command Center
form HUD-58-A (12/2000)
Page 2 of 2
Previous editions are obsolete
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