GSA Form 1440: Clearance Record and Worksheet

GSA Form 1440, Clearance Record and Worksheet, is a General Services Administration form, GSA FORM 1440 (REV. 10-84), hosted in GSA's forms library. GSA's page lists OAD P 5410.1 as its authority or regulation.

The header takes who it is assigned to, the directive identification number or other designation, the number of pages, the subject, who initiated it, the office correspondence symbol, telephone number and date received. A Dates grid then tracks Internal Clearance in nine blank columns and Regional Clearance in columns 1 to 10 and W, with rows for submitted, due and returned, then revisions and resubmitted, due and returned. The Regional Clearance heading says Allow 30 days for return. The rest of the front, and the whole back, is an Action Record with a date column. The form prints no instructions, OMB number or privacy statement.

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Top of page 1 of GSA Form 1440: Clearance Record and Worksheet, as printed by GSA

What's on GSA Form 1440

Header

Assigned To, Directive Identification No. or Other Designation, Number of Pages and Subject.

Initiator block

Initiated By, Office Corres. Symbol, Telephone Number and Date Received.

Internal Clearance grid

Nine columns with blank heads and rows for Submitted, Due and Returned, then Revisions and Resubmitted, Due and Returned.

Regional Clearance grid

Columns 1 to 10 and W, with the same rows and the note Allow 30 days for return.

Action record, front and back

Date and Action Record lines on the front, continued on the back under Clearance Record and Worksheet (Continued).

How to complete GSA Form 1440

1
Fill in the header
Enter who it is assigned to, the directive identification number or other designation, the number of pages and the subject.
2
Record the initiator
Enter who initiated it, the office correspondence symbol, telephone number and date received.
3
Head the internal columns
The nine Internal Clearance columns have blank heads to fill in.
4
Track each round of clearance
Enter the Submitted, Due and Returned dates in each column, and again under Revisions and Resubmitted for a second round.
5
Log actions by date
Write each action with its date in the Action Record, continuing on the back.

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What the form says

Regional clearance time

The Regional Clearance heading says Allow 30 days for return.

Edition and authority

The front reads GSA FORM 1440 (REV. 10-84) and the back GSA FORM 1440 (REV. 10-84) BACK. GSA's page lists OAD P 5410.1 as its authority or regulation and a current revision date of 10/1984.

Instructions

The PDF prints no instructions, address, OMB number or privacy statement, and it does not explain the W column.

Who uses GSA Form 1440?

The person assigned
Assigned To names who the clearance is assigned to.
The initiator
Initiated By, with the office correspondence symbol and telephone number, records who started it.
Internal clearance
Nine Internal Clearance columns with blank heads, each with submitted, due and returned dates.
Regional clearance
Columns 1 to 10 and W under Regional Clearance, with the note Allow 30 days for return.

The form does not say who keeps it. Its blocks name these roles.

Official sources and the blank

Official GSA form page
The agency’s own page for Form GSA1440.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form GSA1440

Who issues GSA Form 1440?

The footer reads GENERAL SERVICES ADMINISTRATION and GSA FORM 1440 (REV. 10-84). GSA's page lists OAD P 5410.1 as its authority or regulation. GSA hosts it in its forms library.

Is there a time frame on GSA Form 1440?

The Regional Clearance heading says Allow 30 days for return. The form gives no other time frame.

What dates does the grid track?

Submitted, Due and Returned, then Revisions and Resubmitted, Due and Returned, under both Internal Clearance and Regional Clearance.

What goes on the back of GSA Form 1440?

The back, Clearance Record and Worksheet (Continued), has more Date and Action Record lines.

Does GSA Form 1440 have instructions?

The PDF prints none, and no OMB number or privacy statement.

GSA Form 1440: Clearance Record and Worksheet