Form Ss-5304 - Work Request/status Form
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1STATE OF TENNESSEE
DEPARTMENT OF STATE
DIVISION OF PUBLICATIONS
WORK REQUEST/STATUS FORM
1. DATE
2. REQUESTING DIVISION
3. CONTACT PERSON
4. PHONE
5. ALLOTMENT CODE
6. COST CENTER
6.A. ANTICIPATED
6.B. FUNDING
7. TITLE OF WORK REQUESTED
COST
State
PUBLICATION (Go to 8.A. and C.)
Federal
FORM (Go to 8.B. and C.)
PUBLICATION
FORM
12. TYPE OF WORK REQUESTED
(check appropriate items)
NEW
PREVIOUSLY PRINTED Date of Last Publication and Authori-
NEW
REVISED
REPRINT
8. A.
8. B.
A.
Planning...............................
zation No. _____________________
8. A.1. HOW OFTEN PRINTED
B.
Research .............................
Date of Last Revision _____________
___ 1-Daily
___ 6-Quarterly
Form Number ___________________
(four times a year)
C.
Layout/Design......................
___ 2-Weekly
___ 7-Semiannually
RDA Number ____________________
(twice a year)
D.
Creative Art..........................
___ 3-Semimonthly
___ 8-Annually
(twice a month)
(once a year)
___ 4-Monthly
___ 9-Biannually
8. B.1. ESTIMATED MONTHLY USAGE
(once a month)
(every two years)
E.
Typesetting ..........................
___ 5-Bimonthly
___ A-As required
(six times a year)
F.
Pasteup/Corrections............
___ B- One Time Only
8.A.2. TYPE OF PUBLICATION
8. B.2. PUBLIC ORIENTED
G.
Estimates....................
___ 1-Annual Report
___ C-Information Sheet
Yes
No
H.
Requisition...........................
___ 2-Magazine
___ D-List of Publication
(Subscription)
___ 3-Magazine
___ E-Map
I.
Printing.................................
(Free)
___ 4-Brochure
___ F-Plan
8. B.3. USAGE
(Informative-Educational)
J.
Binding/Folding, etc. ..........
___ 5-Brochure
___ G-Drawing
(Revenue/Tourism Producing)
Temporary
Permanent
K.
Other (Specify) ....................
___ 6-Manual
___ H-Pamphlet
(Training)
One-Time Only
Experimental
___ 7-Newsletter
___ I-Special Report
(Departmenta;)
___ 8-Newsletter
___ J-Directory
Other _______________________
(Outside)
13.
___ 9-Bulletin
___ K-Regulations-Laws
(Poster)
___ A-Booklet
___ L-Roster
8.B.4. PRINTED FORM COMPLETED BY:
Signature of Individual Requesting Work
___ B-Legislative
Typewriter
Hand
Printer
Other _______________________
Signature of Division Director
8.C. PURPOSE AND JUSTIFICATION WITH STATUTORY AUTHORITY
Signature of Director of Fiscal Affairs
9. FINISHED SIZE
10. QUANTITY
11. DATE NEEDED
Signature of Executive Assistant to Secretary of
State
14. SPECIAL INSTRUCTIONS
Signature of Director of Publications
FOR OFFICE USE ONLY
ESTIMATES
FIRST PROOF
SECOND PROOF
Date Requested
Date Received
Time
Amount
Released to
Date Released Date Returned
Date to
Released to
Date
Date
Date to
Printer
Released
Returned
Printer
Capitol Print Shop
Central Printing
Other (Specify)
Number of Pages:
1 side _______
2 sides _______
JOB SPECIFICATIONS
LOCATION OF FILES
PREPRESS
Stock:
Weight
Color
Ink Color
Original Artwork/Layout Filed:
BINDERY:
Fold _____ Collate _____ Perforate _____
Score _____ Trim _____ Size _____
Text:
PMT(s) ______
Filing Location for Data on Disk
Staple: Side
Corner
Saddle
Contact Print)s) _______
Cover:
Name of Disk: _________________________________
Drill
Number of Holes and Size
Halftone(s)
Numbering: Start ___________
Stop ___________
Location:
Name of File: _________________________________
__________/ __________ __________
Plate(s)
Ink: Black
Red
Number of Pages: _____________________________
BIND:
GBC
Tape
Adhesive
Stripping
Designated Printer: ____________________________
Other ______________________________
Negative(s)
NCR
Number of Parts __________________________
Pad/Book:
Sheets __________ Sets __________
Color: 1 ______ 2 ______ 3 ______
Address: ______________________ Phone _________
Artwork
Bluelines
5 ______ 6 _______
4 ______
Wrap
Box
Other ________________
Contact Person:
SS-5304 (Rev. 5/99)
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