Forms Clearance and Approval

• Legal Form Number: BP-A0640
• Date: 2010-06
• Year: 2010
• Section: Federal Bureau of Prisons

BP-A0640 Forms Clearance and Approval CDFRM

Sept

11

U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS

From (Program Manager) Division/Branch Submission Date

To (BOP Forms Manager) Information Management Office, PIM Branch

Type o f Request: Form Number: Translation:

Form Do you want form to be available on the public site BOP.GOV?

Title o f Form:

Purpose o f Form:

Program Statement Prescribing the Proposed Form:

Justification for this change or issuance:

Signature of Program Manager Responsible for this Form Date

NOTE: Attach a sample of the proposed form to this form. The sample should be in Microsoft Word using

Courier New with all margins ½ inch. Final design will be done in the forms management office. All

BOP forms must be referred to in a directive. If there is no current directive for a form, it must

be prescribed in a future directive by title and number.

CLEA RANCE AND

APPRO VAL

This form has been reviewed and designed b y IMO and is now ready for approval.

Signature of Forms Manager Date

This form has been r eviewed by me and i s ready for production, distribution, and use. A

prescribing Program Statement will be prepared in the future if there is not one now.

Signature of Branch Chief Responsible for Form Date

FINAL

APPROVAL

Signature of Chief, Information Management Office Date

For Forms M anag ement use only

Form Number Assigned

Prescribed PS Number

Type o f Form

Notes

PDF Pre scr ibed by P1222 Rep lac es B P-06 40 dtd JUL 0 8

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