NASA Form 892 at a glance
What it is: The Employee Property Pass/Loan Agreement and Removal Permit is a form of the National Aeronautics and Space Administration.
Who signs: Employee signs and dates.
A filled-in NASA Form 892 example: an employee borrows a laptop for telework
How to fill out NASA Form 892, box by box
Employee name, organization, custodial account number and phone number
Enter the employee name (Last, First M.I.).
Enter the name of the organization to which the employee belongs.
Enter the custodial account number to which the equipment belongs.
Enter the employee's work phone number.
Period of the loan, removal date, return date and contract number
This form applies to NASA equipment in the custody of NASA employees or (on site) contractor employees performing official duties off-site (telework or travel). This agreement consistent with the conditions set forth herein authorizes the employee/contractor to remove the equipment described to the location cited for the official purpose or project stated and for a temporary period not to exceed 180 days. Subject equipment will be returned at the conclusion of subject loan period or project, or immediately at the discretion of NASA upon notice to the employee.
Select the required period of the loan.
Enter the actual removal date.
Enter the actual or approximate return date.
Enter the contract number if contractor employee.
Justification and location
Employee making the request enters a justification for the loan, and includes the location where the equipment will be utilized.
Equipment description
Enter the item number, in sequence, for each item requested.
Enter the Equipment Control Number (ECN).
Enter the Item description.
Enter the Model number of the item.
Enter the Serial number of the item.
Enter "Last Item" on the row immediately following the last entry in block 10.
Use the NF 892A Continuation Sheet, if necessary.
Employee acceptance
The employee requests, accepts, and assumes complete responsibility for the equipment listed and certifies that it will be used to conduct official NASA business.
The employee also certifies that this pass/loan is requested for the minimum time required to complete the specified purpose or project.
The employee assumes full responsibility for the accountability, care, safeguard, and use of the NASA equipment and shall not permit its use for other than the purpose of this loan.
The employee may be subject to disciplinary action and/or pecuniary liability for any loss, damage, or destruction of the NASA equipment resulting from the employee's negligence, misuse, dishonesty, or wanton and willful misconduct.
Property custodian, division chief or contracting officer and SEMO
The Property Custodian signs and dates this block acknowledging that the property will be removed from NASA, and ensures that the status of the equipment is properly updated in NASA Property (N-PROP).
The Division Chief or Contracting Officer if contractor employee, signs and dates this block certifying the validity of the loan.
The Center SEMO approves the request for employee passes/loans exceeding 30 days and monitors compliance with specified return date.
The center Supply and Equipment Management Officer's (SEMO) approval is required for loans over 30 days.
Return of property
The Property Custodian signs and dates this block acknowledging the condition and return of the equipment, and ensures that the equipment status is properly updated in N-PROP.
Page number and total number of pages
Enter the page number and the total number of pages in the loan agreement at the top of the form.
Sources
[1] NASA Form 892, Employee Property Pass/Loan Agreement and Removal Permit, National Aeronautics and Space Administration (the Official source link on this page).