GSA Form 3396: Report of Compliance Activity

GSA Form 3396, Report of Compliance Activity, is a General Services Administration form, Rev. 12/2019, and GSA hosts it in its forms library. GSA's page lists FSS P 4025.5 CHGE 4 as its authority or regulation.

The one-page report records a compliance case: the case number and the date the case opened, the organizations and individuals involved, the type of case and its status, and the property involved, with its dates, acquisition cost and estimated fair value. It ends with an analysis or status of the case, the proposed action to be taken by the region and an estimated date for closing the case.

The form has a preparer and an approver, each with a signature and date. It prints no instructions, filing address or OMB number. 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 3396: Report of Compliance Activity, as printed by GSA

What's on GSA Form 3396

Header and blocks 1 to 3: the case

Who the report goes to, the date, the case number and the date the case opened.

Blocks 4 to 7: parties and case type

The organizations and individuals involved, the type of case, status boxes for New, Active, Inactive and Closed by this action, and the source of reference.

Blocks 8 to 13: the property

A description of the property involved, the dates it was acquired and placed into use, the date its period of restriction expires, its acquisition cost and its estimated fair value.

Block 14: analysis or status of case

A written analysis or status. The form says to attach copies of all pertinent correspondence and supporting documentation.

Blocks 15 and 16: proposed action

The proposed action to be taken by the region and the estimated date for closing the case.

Blocks 17 and 18: preparer and approver

Prepared by and approved by, each with a signature and a date.

The form has 18 numbered blocks on one page.

How to complete GSA Form 3396

1
Address the report and identify the case
Fill in the TO block, the date, the case number and the date the case opened in blocks 1 to 3.
2
Name the parties and the case type
List the organizations and individuals involved in block 4, the type of case in block 5, its status in block 6 and the source of reference in block 7.
3
Describe the property
Describe the property in block 8, then give its dates in blocks 9 to 11 and its acquisition cost and estimated fair value in blocks 12 and 13.
4
Write the analysis and attach the file
Give the analysis or status of the case in block 14. The form says to attach copies of all pertinent correspondence and supporting documentation.
5
Propose the next action
Enter the proposed action to be taken by the region in block 15 and the estimated date for closing the case in block 16.
6
Sign as preparer and approver
The preparer signs and dates block 17 and the approver signs and dates block 18.

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Where it goes and what the form says

Where it goes

The PDF gives no filing address. The report goes to whoever is named in its TO block.

Authority and edition

GSA's page lists FSS P 4025.5 CHGE 4 as the authority or regulation and 12/2019 as the current revision date. The footer prints GSA 3396 (REV. 12/2019).

What the form leaves out

The PDF prints no instructions, privacy notice, OMB number or burden estimate.

Who fills out GSA Form 3396?

The preparer
Block 17 names who prepared the report, with a line for the signature of the preparer and the date.
The approver
Block 18 names who approved the report, with a line for the signature of the approver and the date.
The office in the TO block
The TO block at the top names who the report is addressed to. The form does not say which office that is.
The region
Block 15 asks for the proposed action to be taken by the region, and block 16 for an estimated date for closing the case.
Organizations and individuals involved
Block 4 lists their names, addresses and telephone numbers. The form has no place for them to sign.

The form prints no instructions. These are the roles its blocks name.

Official sources and the blank

Official GSA form page
The agency’s own page for Form GSA3396.
Blank PDF
The official blank form, to print or fill by hand.

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Questions about Form GSA3396

Who issues GSA Form 3396?

The footer prints General Services Administration and GSA 3396 (REV. 12/2019). GSA hosts it in its forms library, and GSA's page lists FSS P 4025.5 CHGE 4 as its authority or regulation.

Who signs GSA Form 3396?

The form has two signatures: the preparer in block 17 and the approver in block 18, each with a date.

What case statuses does the form list?

Block 6 has boxes for New, Active, Inactive and Closed by this action.

What goes with the report?

Block 14 says to attach copies of all pertinent correspondence and supporting documentation.

Does GSA Form 3396 come with instructions?

No. The PDF is one page of blocks with no instructions, filing address, privacy notice or OMB number.

GSA Form 3396: Report of Compliance Activity