GSA Form 2401: Record of Sample Submittals

GSA Form 2401, Record of Sample Submittals, is a one-page General Services Administration (GSA) form, printed as GSA FORM 2401 (4-68). GSA hosts it in its forms library, and GSA's page lists APD 2800.12A as its authority or regulation, with a current revision date of 04/1968.

The form is a log with 18 rows and a SHEET and OF box in the top right corner. Each row records the specification section, a description of the material sample by material and supplier, dates for the first submittal and the 2 and 3 submittals with a rejected date under each, and the date approved.

The form prints no instructions, signature line, OMB number or privacy statement, and it does not say who keeps the record. You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of GSA Form 2401: Record of Sample Submittals, as printed by GSA

What's on GSA Form 2401

Sheet number

A SHEET and OF box in the top right corner, beside the title.

Specification Section

The first column, for the specification section.

Description of Material Sample

Two columns: Material and Supplier.

Submittal and rejection dates

A date grid. The first line holds the Submitted, 2 Submittal and 3 Submittal dates, and the second line holds a Rejected date under each.

Date Approved

The last column, for the date approved.

Layout

18 rows on one landscape page, with GENERAL SERVICES ADMINISTRATION and GSA FORM 2401 (4-68) in the footer.

How to complete GSA Form 2401

1
Number the sheet
Enter the sheet number and the total number of sheets in the SHEET and OF box.
2
Identify the sample
Enter the specification section, the material and the supplier.
3
Record the submittal dates
Enter the date submitted on the first line and, if rejected, the date rejected on the second line below it. The 2 Submittal and 3 Submittal columns repeat this for a second and third submittal.
4
Record the approval
Enter the date approved in the last column.

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Routing and what the form says

Where it goes

The form prints no address or routing. It does not say who keeps or receives the record.

Authority

GSA's page lists APD 2800.12A as the authority or regulation and gives the current revision date as 04/1968.

Edition

The footer reads GSA FORM 2401 (4-68). The form prints no instructions, OMB number or privacy statement.

Who uses GSA Form 2401?

No preparer named
The form prints no signature line, instructions or office name, so it does not say who keeps the record.
Material samples
Each row describes a material sample by material and supplier and tracks up to three submittals.
Suppliers named on it
The Supplier column sits beside Material under the Description of Material Sample heading.
Approval
The last column records the date approved. The form has no approval signature.

The form names no preparer or office. Its columns show what each row records.

Official sources and the blank

Official GSA form page
The agency’s own page for Form GSA2401.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form GSA2401

Who issues GSA Form 2401?

The footer reads GENERAL SERVICES ADMINISTRATION and GSA FORM 2401 (4-68). GSA hosts it in its forms library, and GSA's page lists APD 2800.12A as its authority or regulation.

What does each row of GSA Form 2401 record?

The specification section, the material, the supplier, up to three submittal dates with a rejected date under each, and the date approved.

How many submittals can one row track?

Three: Submitted, 2 Submittal and 3 Submittal, each with a Rejected date on the line below.

How many rows does GSA Form 2401 have?

18 on one landscape page. A SHEET and OF box at the top right numbers the sheets.

Are there instructions for GSA Form 2401?

The PDF prints none. GSA's page lists APD 2800.12A as its authority or regulation and gives the current revision date as 04/1968.

GSA Form 2401: Record of Sample Submittals