DOE O 1322.4B, Directory of Standard, Optional and Other Agency Forms

i .. .J lr e U.S. Department of Energy Washington, D.C. ORDER DOE 1322.48 12-12-89 SUBJECT: DIRECTORY OF STANDARD, OPTIONAL, AND OTHER AGENCY FORMS 1. PURPOSE. To transmit the Directory of Standard, Optional, and Other Agency Forms (Attachment 2). Also included is a list of Departmental Reports and Forms Program Managers (Attachment 1), which were named in accordance with DOE 1322.28, FORMS MANAGEMENT, of 5-27-87. 2. CANCELLATION. DOE 1322.4A, DIRECTORY OF STANDARD, OPTIONAL, AND OTHER AGENCY FORMS, of 10-15-87. 3. SCOPE. The provisions of this Order apply to all Departmental Elements and contractors performing work for the Department as provided by law and/or contract and as implemented by the appropriate contracting officer. 4. REFERENCE. DOE 1322.28, FORMS MANAGEMENT, of 5-27-87, which establishes a forms management program that prescribes policy and provides general guidance and direction in preparing, obtaining, and approving forms in the Department of Energy. 5. DEFINITION. Controlled Form - A form for which distribution or issue is limited. A controlled form may be a Standard, Optional, or Other Agency Form. 6. PROCEDURES. a. Headquarters elements, when obtaining 100 copies or less, shall obtain forms from the self-service supply stores (SSSS) (GA-176, Forrestal and R-006, Germantown), when source of supply is SSSS. When ordering over 100 copies, a DOE F 4250.2, "Requisition for Supplies, Equipment, or Services," must be submitted to Chief of Logistics Operations, Forrestal (MA-203.62), or Chief of Logistics Operations, Germantown (MA-203.63), as appropriate. All other forms are requested directly from the listed source of supply. b. Field Elements should obtain standard and optional forms from local General Services Administration (GSA) sources. Those forms not available from GSA sources as well as Office of Personnel Management (OPM) forms, must be ordered by the Reports and Forms Program Managers, by submitting a properly signed DOE F 4250.2: U. S. Department of Energy 1000 Independence Avenue, SW. Forrestal Building, MA-203.62 Washington, DC 20585 DISTRIBUTION: INITIATED BY: All Departmental Elements Office of Organization and Management Systems I I I f ~ f f f ~ l I r I I I l f i I f J t ~ I I \ 2 DOE 1322.48 12-12-89 DOE F 4250.2's will be accepted from the designated Reports and Forms Program Managers ~· c. When Headquarters Reports and Forms Program Managers respond to HQ F 1322.3, "Minimum Stock Level Notice", submit a DOE F 4250.2 to Chief of Logistics Operations, Forrestal, MA-203.62. The DOE F 4250.2 should con­ tain the form number, title, and quantity required. Quantity required should be in "EACH" units of issue -- that is, sheets, pages, carbon sets, pads, etc. J d. Departmental organizations should request Standard, Optional, and Other • Agency Forms not listed in this directory by submitting DOE F 4250.2, to the Information Management Branch, MA-433.2 thru the appropriate Reports and Forms Program Manager. The requisition should contain the form number, title, estimated yearly usage, why the form is needed, and office of primary interest for each form ordered. e. Orders for controlled forms (properly completed DOE F 4250.2) will be submitted to MA-203.62. As these orders must be countersigned by the Reports and Forms Program Managers with program responsibility for the form, ordering units should allow extra time for receipt. BY ORDER OF THE SECRETARY OF ENERGY:

DONNA R. FITZPATRICK Assistant Secretary Management and Administration .. 'til ~ c - c (" ...... 0 NO I rr1 ...... N.,_. I W 00 N 1.0 N . DEPARTMENTAL REPORTS AND FORMS PROGRA~ MANAGERS +=-c:o ROUTING SYMBOL ORGANIZATION NAME LOCATION TELEPHONE NUMBER MA-211 ASSISTANT SECRETARY, MANAGEMENT PETER A. RICHARDS 4B-172 FORRESTAL (202) 586-2351 AND ADMINISTRATION ACTING FTS 896-2351 PE-3 OFFICE OF POLICY, PLANNING EDITH R. HORNE 7E-090 FORRESTAL (202) 586-1059 e AND ANALYSIS FTS 896-1059 RW-132 OFFICE OF CIVILIAN RADIOACTIVE RICHARD MINNING GB-270 FORRESTAL (202) 586-4349 WASTE MANAGEMENT FTS 896-4349 GC-50 OFFICE OF GENERAL COUNSEL CLAUDE F. BARNES 6E-050 FORRESTAL (202) 586-2942 FTS 896-2942 CP-10 ASSISTANT SECRETARY FOR T.J. HOPKINS 7B-118 FORRESTAL (202) 586-1351 CONGRESSIONAL AND FTS 896-1351 INTERGOVERNMENTAL AFFAIRS IE-3 ASSISTANT SECRETARY FOR JOYCE FELDT 7C-034 FORRESTAL (202) 586-5856 INTERNATIONAL AFFAIRS AND FTS 896-5856 ENERGY EMERGENCIES NE-13 ASSISTANT SECRETARY FOR DAETTA H. WILES D-411 GERMANTOWN (301) 353-4996 NUCLEAR ENERGY FTS 233-4996 FE-30 ASSISTANT SECRETARY FOR CAROLYN KLYH D -115 GERMANTOWN (301) 353-2430 8 FOSSIL ENERGY FTS 233-2430 CE-40 ASSISTANT SECRETARY, FRANCES H. RHOADES 6B-052 FORRESTAL (202) 586-8757 CONSERVATION AND FTS 896-8757 RENEWABLE ENERGY DP-542.2 ASSISTANT SECRETARY FOR PATRICIA A. RHODERICK D-304 GERMANTOWN (301) 353-5408 DEFENSE PROGRAMS FTS 233-5408 )::> c-t- c-t- Q.l (") ::r -o 3 Q.l m <.0 ::I m c-t- ...... ...... !!I'"~''""F1"1't":'1!~.'"""'"""'.,..;""""'~"-m>"<~ . ..,.,.,. . .....,_,.,..,.,~,.,'1't~""'~~~·""l!'.~"'ll'~"'~~·~~~lii'·"Ti"'~-.~<:<o~~~~~~"!""·"'>i"'~~'"'l~~~<~)i"'"~~~l;'l'!f"'>'lffl'l'~!l\\'l'~"'I;'~~~~.~·-,"*)')1!1:1.~~1';~..,.._,"'1~~~.,-~!II~'IW'~"~<'tll"', ,. ,~4¥~$¥.\~..r'<< ROUTING SYMBOL ORGANIZATION NAME RG-12 ECONOMIC REGULATORY CYNTHIA A. FORD ADMINISTRATION El-23 ENERGY INFORMATION JOHN H. WEINER ADMINISTRATION EH-10 ASSISTANT SECRETARY FOR GEOFFREY J. JUDGE ENVIRONMENT, SAFETY AND HEALTH HG-12 OFFICE OF HEARINGS AND APPEALS OTTO S. REID ER-622 OFFICE OF ENERGY RESEARCH SHIRLEY J. FERGUSON HI -1.1 OFFICE OF MINORITY ECONOMIC LINDA CHAN-RUDNICK IMPACT IG-14 OFFICE OF INSPECTOR GENERAL WILMATINE SLAUGHTER OPD ALBUQUERQUE OPERATIONS OFFICE MARGARITA Y. SEXSON CHICAGO OPERATIONS OFFICE JOSEPH FREEMAN '--' ,. 4( .... '--' LOCATION TELEPHONE NUMBER 5B-137 FORRESTAL (202) 5B6-4222 FTS 896-4222 2F-063 FORRESTAL (202) 586-6537 FTS 896-6537 7A-113 FORRESTAL (202) 586-4704 FTS 896-4704 6G-041 FORRESTAL (202) 586-6622 FTS 896-6622 H-201 GERMANTOWN (301) 353-5275 FTS 233-5275 5B-110 FORRESTAL (202) 586-1593 FTS 896-1593 5D-031 FORRESTAL (202) 586-1924 FTS 896-1924 U.S. DOE FTS 846-4826 ALBUQUERQUE OPERATIONS OFFICE P.O. BOX 5400 ALBUQUERQUE, NM 87115 U.S. DOE FTS 972-2217 CHICAGO OPERATIONS OFFICE 9800 S CASS AVENUE ARGONNE, ILL 60439 -o QJ lO ro N ..... 0 No •rn ..... N ......... •w OON \.ON l, ~ co ;:I::> r-t ri" QJ (") ::::; 3 ro :::l ri" ......... n (; ~ "' .. (' . .. c (' ...... 0 NO •m ...... N ,_. I W CON 1.0 N ROUTING . SYMBOL ORGANIZATION NAME LOCATION TELEPHONE NUMBER ~ co IDAHO OPERATIONS OFFICE DELPHA RUSHIN WCBEI FTS 583-1507 EG&G IDAHO P.O. BOX 1625 IDAHO FALLS, ID 83402 NEVADA OPERATIONS OFFICE FRED KOOPMAN U.S. DOE FTS 575-3121 e NEVADA OPERATIONS OFFICE P.O. BOX 98518 LAS VEGAS, NV 89193-8518 OAK RIDGE OPERATIONS OFFICE MARY BOOKER U.S. DOE FTS 626-0944 OAK RIDGE OPERATIONS OFFICE P.O. BOX E OAK RIDGE, TN 37831

RICHLAND OPERATIONS OFFICE GAIL ROKKAN U.S. DOE FTS 444-8274 RICHLAND OPERATIONS OFFICE MS A7-27 FEDERAL BUILDING P.O. BOX 550 RICHLAND, WA 99352 SAN FRANCISCO OPERATIONS OFFICE KAREN PAYNE U.S. DOE FTS 536-6372 SAN FRANCISCO OPERATIONS OFFICE -AIS DIVISION 4TH FLOOR 1333 BROADWAY OAKLAND, CA 94612 SAVANNAH RIVER OPERATIONS T.C. WALKER U.S. DOE FTS 239-3045 OFFICE SAVANNAH RIVER OPERATIONS OFFICE P.O. BOX A ):::> AIKEN, SC 29802 c-t- c-t- OJ () ::::,- -o 3 OJ ro <.0 :::::5 ro c-t- w ,_. \'iliii~""'~'I'W~>·)'I";~...,~·~~~"':~""'~~,,,,,ii"N"'''"'''-""""'~on~-~.~~~W~-!IMii,Q¥1\ \i!IRi<~ .,'hh· iflf?:IP\OIU,, .. r"'!!!~~~~~li4li\., !i l!li.$.,i01ti! ,lll't.'ll/ll'~~\1\~~~~~~ .41it_.t(W~I'!L' .. , ""'0 )::> OJ rl- <.0 rl-ro OJ (") .+:> :::::,- 3 ro ROUTING ::::s SYMBOL ORGANIZATION NAME LOCATION TELEPHONE NUMBER rl- ....... PR653 STRATEGIC PETROLEUM RESERVE DEE SPILLMAN U.S DOE FTS 686-4260 PROJECT MANAGEMENT OFFICE STRATEGIC PETROLEUM RESERVE PROJECT MANAGEMENT MS PR-653 900 COMMERCE RD EAST NEW ORLEANS, LA 70123 OSTI/ OFFICE OF SCIENTIFIC AND JUDY C. SPRAKER U.S. DOE FTS 626-9362 0 MA-201 TECHNICAL INFORMATION OSTI P.O. BOX 62 OAK RIDGE, TN 37831 BPA-SSTD BONNEVILLE POWER SONDRA STEVENSON U.S. DOE FTS 429-5769 ADMINISTRATION BONNEVILLE POWER ADMINISTRATION BPA-SSTD P.O. BOX 3621 PORTLAND, OR 97208-3621 WESTERN AREA POWER JERRY SPATH U.S. DOE FTS 327-1664 ADMINISTRATION WESTERN AREA POWER ADMINISTRATION P.O. BOX 3402 GOLDEN, CO 80401 ALASKA POWER ADMINISTRATION JOSEPH M. MALINOVSKY U.S. DOE FTS 586-7405 ALASKA POWER ADMINISTRATION (, P.O. BOX 020050 JUNEAU, AK 99802 SOUTHEASTERN POWER PATSY R. GRIFFITH U.S. DOE 8 (404) 283-99ll ADMINISTRATION SOUTHEASTERN POWER X 213 ADMINISTRATION SAMUEL ELBERT BLDG ELBERTON, GA 30635 ...... 0 No •rn ........ N....,. •w CON I.ON . .+:> c:o ~ ~ , ~ .. . .. ~ C' ROUTING SYMBOL II> -. ORGANIZATION SOUTHWESTERN POWER ADMINISTRATION MORGANTOWN ENERGY TECHNOLOGY CENTER PITTSBURGH ENERGY TECHNOLOGY CENTER PITTSBURGH NAVAL REACTORS OFFICE SCHENECTADY NAVAL REACTORS (!' NAME MARSHA DIETRICH DONNA CALE KAREN L. AUER TIM GLOCK PAUL DMYTERKO " LOCATION TELEPHONE NUMBER U.S. DOE SOUTHWESTERN POWER ADMINISTRATION P.O. BOX 1619 TULSA,, OK 74101 FTS 745-7454 U.S DOE FTS 923-40B1 MORGANTOWN ENERGY TECHNOLOGY CENTER P.O. BOX 880 3610 COLLINS FERRY ROAD MORGANTOWN, WV 26505 U.S DOE FTS 723-5914 PITTSBURGH TECHNOLOGY CENTER P.O. BOX 10940 PITTSBURGH, PA 15236 U.S. DOE FTS 721-7230 PITTSBURGH NAVAL REACTORS OFFICE P.O. BOX 109 WEST MIFFLIN, PA 15142-0109 U.S. DOE FTS 563-6391 SCHENECTADY NAVAL REACTORS OFFICE P.O. BOX 1069 SCHENECTADY, NY 12301-1072 c ...... o NO I ITI ....... N.,_. I W OON ~N ..j::o c:o -o OJ <.0 ro U1 OJ ;:, 0. 0"\ e e )::> M- c-t- OJ n :::r 3 ro ;:, M- ....... ~""""""':-.""11"'~,.,..,,.,.,..........,,.~~F1"""'.'1;'"'""""'~~~'M.\I'"~J';~~·~-w~"'~~i·''''"!l.'~l'lf")'1!'"'!!~~'''1-~~~~il">~~~~tl"\~~,.~"'~~~~~~,_.~~,.. J " J c FORM NUMBER **STANDARD SF- I SF- 7 SF- 7A SF- 78 SF- 7D SF- 8 SF- IS SF- 18 r- --- TITLE PRINTING AND BINDING REQUISITION SERVICE RECORD SERVICE RECORD-CONTINUATION EMPLOYEE RECORD POSITION IDENTIFICATION STRIP NOTiCE TO FEDERAL EMPLOYEE ABOUT UNEMPLOYMENT INSURANCE APPLICATION FOR 10-POINT VETERAN PREFERENCE REQUEST FOR QUOTATIONS () ' ' LATEST EDITION INITIATING DATE AGENCY 07-79 GPO 12-80 OPM 05-80 OPM 12-80 OPM 09-64 OPM 06-87 DOL 07-83 OPM 10-83 GSA OFFICE OF PRIMARY INTEREST

MA-203.2 MA-41.2 MA-41.2 HA-41. 2 MA-41. 2 MA-41. 2 MA-41.2 MA-40.3 SOURCE OF SUPPLY MA-203.52 ssss ssss ssss ssss ssss ssss ssss . . COMMENTS DISPOSE OF EXISTING STOCK UPON RECEIPT OF NEW EDITION ~ ' -a NO I rr1 -N- I w OON \ON . """' o::J e e -c)> S::Ur-1" c.o r-1" ros:u n -=r 3 (1) ::s r-1" N FORK NUMBER SF- 24 SF- 25 SF- 25A SF- 258 SF- 26 SF- 28 SF- 30 SF- 33 SF- 34 ~ TITLE BID BOND PERFORMANCE BOND PAYMENT BOND CONTINUATION SHEET (For Standard Forms 24, 25, & 25A) AWARD/CONTRACT AFFIDAVIT DF INDIVIDUAL SURETY AMENDMENT OF SOLICITATION/ MODIFICATION OF CONTRACT SOLICITATION, OFFER AND AWARD ANNUAL BID BOND - -· LATEST EDITION DATE 04-85 10-83 10-83 10-83 04-85 10-83 10-83 04-B5 10-83 INITIATING AGENCY GSA GSA GSA GSA GSA GSA GSA GSA GSA L OFFICE OF PRIMARY INTEREST --- MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 SOURCE OF SUPPLY ssss ssss ssss ssss MA-405.2 ssss ssss MA-405.2 ssss COMMENTS ~ "):> tlJ c-t" tO c-t" CtltJJ n N=r 3 Ctl :::::s c-t" N 0 (; 1-'c:::J No lrrl ....... N._. •w CON I.ON ~ OJ .,._ .. c . . c c ...... o NO I fT'1 ...... N,.... I w CON 0..0 N . ~ OJ LATEST OFFICE OF EDITION INITIATING PRIMARY SOURCE OF FORN NUNBER TITLE DATE AGENCY INTEREST SUPPLY CONNENTS SF- 35 ANNUAL PERFORMANCE BOND 10-B3 GSA HA-40.3 ssss SF- 39 REQUEST FOR REFERRAL OF 11-BB OPM MA-41. 2 ssss PREVIOUS EDITIONS USABLE; DE- e ELIGIBLES PLETE STOCKS BEFORE ISSUING SF- 39A REQUEST AND JUSTIFICATION FOR 10-74 OPM MA-41. 2 ssss SELECTIVE FACTORS AND QUALITY RANKING FACTORS SF- 44 PURCHASE ORDER-INVOICE-VOUCHER I0-83 GSA MA-40.3 ssss SF- 44A PURCHASE ORDER-INVOICE-VOUCHER 10-83 GSA MA-40.3 HA-203.62 (Seller's Invoice) SF- 44B PURCHASE ORDER-INVOICE-VOUCHER 10-83 GSA MA-40.3 MA-203.62 (Seller's Copy of Order) SF- 44C PURCHASE ORDER-INVOICE-VOUCHER 10-83 GSA MA-40.3 MA-203.62 8 (Receive Report-Accounting Copy) SF- 44D PURCHASE ORDER-INVOICE-VOUCHER 10-83 GSA MA-40.3 MA-203.62 (Memorandum Copy) SF- 50 NOTIFICATION OF PERSONNEL 08-88 OPM MA-41. 2 MA-203.62 0487 EDITIONS MUST BE USED ACTION (Controlled) BEGINNING 10-l-88; PREVIOUS EDITIONS USABLE; DEPLETE ~)> EXISTING STOCKS BEFORE ISSUiNG A> ...... (.Q ...... CDAJ SF- SOA NOTICE OF SHORT-TERM 06-88 OPM MA-4I. 2 MA-203.62 DISPOSE OF EXISTING STOCK ON (") EMPLOYMENT (Controlled) RECEIPT OF REVISION w ::r 3 CD ::3 ...... N ""'0 :t> PJ .-+ (,Q .-+ (t)PJ () ~ ;;:r 3 ro ::::l .-+ LATEST OFFICE OF N EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COMMENTS --- --- SF- 508 NOTIFICATION OF PERSONNEL 08-88 OPM MA-41. 2 MA-203.62 0487 EDITIONS MUST BE USED ACTION (Marginally Punched BEGINNING 10-l-88; PREVIOUS Continous)(Controlled) EDITIONS USABLE; DEPLETE EXISTING STOCKS BEFORE ISSUING 0 SF· 52 REQUEST FOR PERSONNEL ACTION 08-88 OPM MA-41.2 ssss 0487 EDITIONS MUST BE USED . BEGINNING 10-l-BB; PREVIOUS EDITIONS USABLE; DEPLETE EXISTING STOCKS BEFORE ISSUING SF- 59 REQUEST FOR APPROVAL OF 01-79 OPM MA-41.2 ssss NONCOMPETITIVE ACTION SF- 61 APPOINTMENT AFFIDAVITS 06=86 OPM MA-41. Z ssss SF- 618 DECLARATION OF APPOINTE£ 10-88 OPM MA-4!.2 ssss PREViOUS EDITIONS USABLE; DIS- POSt OF 10/81 EDITION AFTER 12/) i ,90 OR WHEN STOCK IS DE- PLETEb. WHICHEVER IS SOONER SF- 62 AGENCY REQUEST TO PASS OVER A 10-79 OPM MA-41 ;; ssss PREFERENCE ELIGIBLE OR OBJECI TO AN ELIGIBLE

SF- 63 MEMORANDUM OF CALL 08-81 GSA MA-203.2 ssss ~ () SF- 65A U. S. GOVERNMENT MESSENGER 12-72 GSA MA-203.2 ssss ENVELOP£--4 1/8 X 9 1/2 SF- 65B U. S. GOVERNMENT MESSENGER 12-71 GSA MA-203.2 ssss ENVELOP£--9 3/4 X 12 ,_. 0 NO I fT1 ,_. SF- 65C U. S. GOVERNMENT MESSENGER 12-71 GSA MA-203.2 ssss N ,_. I w ENVELOP£--12 X 16 00 N 1.0 N -"" o::1 '-.., L, L ,.... .. 1-. ~ c FORM NUMBER TITLE SF- 66 OFFICIAL PERSONNEL FOLDER (Controlled) SF- 66B LABEL - CAUTION PERSONNEL RECORDS RESTRICTED USAGE SF- 66D EMPLOYEE MEDICAL FOLDtR (EMF) SF- 71 APPLICATION FOR LEAVE SF- 75 REQUEST FOR PRELIMINARY EMPLOYMENT DATA SF- 83 REQUEST FOR OMB REVIEW SF- 83A INSTRUCTIONS FOR SF-83 SF- 85 QUESTIONNAIRE FOR NON-SENSJ- liVE POSITIONS SF- 85A NATIONAL AGENCY CHECK - DATA FOR NONSENSITIVE OR NONCRITI- CAL-SENSITIVE POSITION SF- 86 QUESTIONNAIRE FOR SENSITIVE POSITIONS #"'\. ~. l LATEST EDITION INITIATING DATE AGENCY 0!-89 OPM 03-78 OPM 04-85 OPM 03-79 OPM 01-89 OPM 09-83 OMB 09-83 OMB 12-87 OPM 02-77 OPM 10-87 OPM • OFFICE OF PRIMARY SOURCE OF INTEREST SUPPLY --- MA-41.2 MA-203.62 MA-41.2 ssss MA-41. 2 ssss MA-41. 2 ssss MA-41. 2 ssss MA-433.2 MA-433.2 MA-433.2 MA-433.2 MA-41.2 ssss MA-41.2 ssss DP-542.2 ssss COMMENTS "' ~-·· ;' PREVIOUS EDITIONS USABLE; DE- PLETE EXISTING STOCKS BEFORE ISSUING PREVIOUS EDITIONS OBSOLETE; DISPOSE OF EXISTING STOCK BE- FORE ISSUING PREVIOUS EDITIONS OBSOLETE; DISPOSE OF EXISTING STOCK UPON RECEIPT REPLACES DP-1. PT I & II. PREVIOUS EDITiONS MAY NOT BE ...... 0 NO I I"T1 ...... N ,_. I W CON 1.0 N ~ OJ e - "'0 )> ~ ('"t- 1.0 ('"t- ('[)~ n (.TI ::::r 3 ('[) :::! ('"t- N ")> llJ r+ c..o r+ ('[)ll.J () (J) ::r 3 ('[) :::1 r+ N LATEST OFFICE OF EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COMMENTS --- USED. REPLACES DOE F 5631.24. SF- 86A CONTINUATION SHEET FOR 10-87 OPM DP-542.2 ssss REPLACES DP-1, PT I & II. n QUESTIONNAIRE FOR SENSITIVE PREVIOUS EDITIONS CANNOT BE POSITIONS USED SF- 87 FINGERPRINT CHART 04-84 OPM DP-542.2 ssss PREVIOUS EDITIONS CANNOT BE USED SF- 88 REPORT OF MEDICAL EXAMINATION 03-89 GSA/ICMR MA-41. 2 ssss PREVIOUS EDITIONS USABLE; DE- PLETE EXISTING STOCKS BEFORE ISSUING SF- 91 OPERATOR'S REPORT OF MOTOR 11-76 GSA MA-203.2 ssss VEHICLE ACCIDENT SF- 91A INVESTIGATION REPORT OF MOTOR 06-78 GSA MA-203.2 MA-203.62 VEHICLE ACCIDENT SF- 95 CLAIM FOR DAMAGE, INJURY OR 07-85 DOJ MA-3.2 MA-203.62 DEATH 0 SF- 98 NOTICE OF INTENTION TO MAKE A 02-73 DOL MA-40.3 ssss SERVICE CONTRACT AND RESPONSE TO NOTICE SF- 98A NOTICE OF INTENTION TO MAKE A 02-73 DOL MA-40.3 ssss SERVICE CONTRACT AND RESPONSE TO NOTICE (Attachment A) ...... 0 SF- 99 NOTICE OF AWARD OF CONTRACT 05-65 DOL MA-40.3 ssss No •rn ...... N..- •w CION \.ON . ~ c:o L L L J JO c ~ 'lr - . c ~ "~ ...... t:::l NO I rr1 ...... N- I w CON 1.0 N . ~ co LATEST OFFICE OF EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COMMENTS SF- 105 CERTIFICATE OF MEMBERSHIP IN 12-79 OPM MA-41. 2 ssss THE UNITED STATES CIVIL 0 SERVICE RETIREMENT SYSTEM SF- 113A MONTHLY REPORT OF FEDERAL 06-88 OPM MA-433.2 MA-431. 2 PREVIOUS EDITIONS USABLE CIVIL EMPLOYMENT SF- 113G MONTHLY REPORT OF FULL-TIME 06-88 OPM MA-433.2 MA-431. 2 PREVIOUS EDiTIONS USABLE EQUIVALENT/WORK-YEAR CIVILIAN EMPLOYMENT SF- 115 REQUEST FOR RECORDS 08-83 NARA MA-433.2 MA-433.2 DISPOSITION AUTHORITY SF- I !SA REQUEST FOR RECORDS 12-83 NARA MA-433.2 MA-433.2 DISPOSITION AUTHORITY-- CONTINUATION SHEET

SF- 119 STATEMENT OF CONTINGENT OR 10-83 GSA MA-40.3 ssss OTHER FEES -SF- 120 REPORT OF EXCESS PERSONAL 04-57 GSA MA-203.2 MA-203.62 PROPERTY SF- 120A CONTINUATION SHEET (Report of 04-57 GSA MA-203.2 MA-203.62 Excess Personal Property) -c)> SF- 121 ANNUAL REPORT OF UTILIZATION 08-85 GSA MA-203.2 MA-203.62 llJ c-1" (Q c-1" AND DISPOSAL OF EXCESS AND COCJ SURPLUS PERSONAL PROPERTY n ........ ~ 3 SF- 122 TRANSFER ORDER--EXCESS 06-74 GSA MA-203.2 MA-203.62 co ::I PERSONAL PROPERTY c-1" N ")> ll1 <"+ tO <"+ ctlll> n co ::r 3 ctl :::::! <"+ LATEST OFFICE OF N EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COMMENTS SF- 126 REPORT OF PERSONAL PROPERTY 07-78 GSA HA-40.3 MA-203.62 FOR SALE HA-203. 2 SF- 126A REPORT OF PERSONAL PROPERTY 02-65 GSA HA-40.3 MA-203.62 0 FOR SALE (Continuation Sheet) HA-203. 2 SF- 127 REQUEST FOR OFFICIAL PERSONNEL 07-86 NARA MA-41. 2 ssss FOLDER (Separated Employee) SF- 129 SOLICITATION MAILING LIST 10-83 GSA MA-40.3 ssss APPLICATION SF- 135 RECORDS TRANSMITTAL AND 07-85 NARA MA-203.2 MA-203.43 RECEIPT SF- 135A RECORDS TRANSMITTAL AND 07-85 NARA MA-203.2 MA-203.43 RECEIPT (Continuation Sheet) SF- 144 STATEMENT OF PRIOR FEDERAL 09-83 OPM MA-41. 2 ssss (; SERVICE SF- 152 REQUEST FOR CLEARANCE OR 01-87 GSA MA-433.2 MA-433.2 DISPOSE OF EXISTING STOCK CANCELLATION OF A STANDARD OR UPON RECEIPT OF NEW EDITION OPTIONAL FORM OR EXCEPTION SF- 153 COMSEC MATERIAL REPORT (CARBON 09-88 DOD MA-205.11 ssss PREVIOUS EDITIONS OBSOLETE; >--'0 INTERLEAVED MARGINALLY DEPLETE EXISTING STOCK BEFORE NO PUNCHED) ISSUING I fT1 ..... N- I W SF- 162 INTERLIBRARY LOAN REQUEST 06-88 LC MA-203.2 MA-232.2 DEPLETE EXISTING STOCK BEFORE CON ISSUING \.0 N . ~ OJ L l, c ~ c FORM NUMBER SF- 171 SF- 171A SF- 172 SF- 177 SF- 180 SF- 181 SF- 203 SF- 210 SF- 215 .. __ ~ TITLE APPLICATION FOR FEDERAL EMPLOYMENT CONTINUATION SHEET FOR STANDARD FORM 171 AMENDMENT TO APPLICATION FOR FEDERAL EMPLOYMENT - SF-171 STATEMENT OF PHYSICAL ABILITY FOR LIGHT DUTY WORK REQUEST PERTAINING TO MILITARY RECORDS RACE AND NATIONAL ORIGIN IDENTIFICATION ANNUAL AUDIOVISUAL REPORT SIGNATURE CARD FOR CERTIFYING OFFICER DEPOSIT TICKET LATEST EDITION DATE 06-88 06-88 06-88 09-84 07-86 05-82 05-78 07-81 05-78 C' INITIATING AGENCY OPM OPM OPM OPM NARA OPM NARA TO TO OFFICE OF PRIMARY INTEREST ---- MA-41. 2 MA-41. 2 MA-41 .2 MA-41. 2 MA-41. 2 MA-41. 2 CP-10 MA-3.2 MA-3.2 SOURCE OF SUPPLY ssss ssss ssss ssss ssss ssss PA-l MA-343.2 MA-343.2 c COMMENTS PREVIOUS EDITIONS USA6LE UNTIL 12/31/90 DEPLETE EXISTING STOCK BEFORE ISSUING DEPLETE EXISTING STOCK BEFORE ISSUING 1-'0 NO I rT'1 ...... N,_. I w OON 1..0 N ~ OJ e e -c)> 1),) .-t- t.O .-t- (t)l),) n 1..0 :::r 3 ro ::s .-t- N ._.....~~~~~~~....,~"'l·~~~~~""~~ftl~\'0~~ '!"P''?"~''''''!'I"•'.?!'I,O!T".,fi\i\,4& F.l."'·~$1'1'~~~~~· ")> cu cT 1.0 cT rocu n ...... ::r 03 ct> ::I cT LATEST OFFICE OF N FORM NUMBER EDITION INITIATING PRIMARY SOURCE OF TITLE DATE AGENCY INTEREST SUPPLY COMMENTS SF- 224 STATEMENT OF TRANSACTIONS 05-82 TD MA-3.2 MA-341 (Classified According to Approp.Fund & Receipt Acctg. and Related Control Totals) 0 SF- 252 ARCHITECT-ENGINEER FIXED-PRICE 10-83 GSA MA-40.3 ssss "' CONTRACT SF- 254 ARCHITECT-ENGINEER AND RELATED 12-88 GSA MA-40.3 ssss PREVIOUS EDITIONS OBSOLETE; SERVICES QUESTIONNAIRE MA-223.2 MA-223.2 DISPOSE OF EXISTING STOCK UPOh RECEIPT OF NEW

SF- 255 ARCHITECT-ENGINEER AND RELATED 12-88 GSA MA-40.3 ssss PREVIOUS EDITIONS OBSOLETE; SERVICES QUESTIONNAIRE FOR MA-223.2 MA-223.2 DISPOSE OF EXISTING STOCK UPON SPECIFIC PROJECT RECEIPT OF NEW SF- 256 SELF-IDENTIFICATION OF 08-87 OPM MA-41.2 ssss DISPOSE OF EXISTING STOCK UPON REPORTABLE HANDICAP RECEIPT OF REVISION SF- 258 REQUEST TO TRANSFER, APPROVAL, 10-78 NARA MA-433.2 MA-433.2 AND RECEIPT OF RECORDS TO THE NATIONAL ARCHIVES Of THE U.S. SF- 269 FINANCIAL STATUS REPORT (LONG 04-88 OMB MA-3.2 ssss DISPOSE OF EXISTING STOCK ON (; FORM) RECEIPT OF REVISION SF- 270 REQUEST FOR ADVANCE OF 07-76 OMB MA-3.2 ssss REIMBURSEMENT SF- 271 OUTLAY REPORT AND REQUEST FOR 07-76 OMB MA-40.3 HA-402.2 REIMBURSEMENT FOR CONSTRUCTION PROGRAMS ....... o NO I IT1 ....... SF- 272 FEDERAL CASH TRANSACTIONS 07-76 OMB MA-3.2 HA-343.2 N...._. REPORT I w OON 1.0 N ~ co L, L L ,..~ ... • ""' "'" : • FORM NUMBER SF- 272A SF- 273 SF- 274 SF- 275 SF- 278 SF- 279 SF- 281 SF- 294 SF- 295 SF- 308 ~ TITLE FEDERAL CASH TRANSACTIONS REPORT (Continuation) REINSURANCE AGREEMENT FOR A MILLER ACT PERFORMANCE BOND REINSURANCE AGREEMENT FOR A MILLER ACT PAYMENT BOND REINSURANCE AGREEMENT IN FAVOR OF THE UNITED STATES EXECUTIVE PERSONNEL FINANCIAL DISCLOSURE REPORT FPDS - INDIVIDUAL CONTRACT ACTION REPORT FPDS - SUMMARY CONTRACT ACTION REPORT ($25,000 OR LESS) SUBCONTRACTING REPORT FOR IN- DIVIDUAL CONTRACTS SUMMARY SUBCONTRACTING REPORT REQUEST FOR DETERMINATION AND RESPONSE TO REQUEST c LATEST EDITION DATE 09-76 10-83 10-83 10-83 OJ-87 10-89 10-88 10-83 04-81 05-85 INITIATING AGENCY OMB GSA GSA GSA OPM GSA GSA GSA GSA DOL OFFICE OF PRIMARY INTEREST MA-3.2 MA-40.3 MA-40.3 MA-40.3 GC-50 MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 • SOURCE OF SUPPLY MA-343.2 ssss ssss ssss ssss MA-405.21 ssss ssss MA-203.62 ssss c COIIMENTS PREVIOUS EDITIONS OBSOLETE; DISPOSE OF EXISTING STOCK ON RECEIPT OF REVISION EFFECTIVE 9/15/88 - NO OTHER EDITIONS ARE USABLE ,_. 0 NO I rr1 ,_. N ,_. I W 00 N 1.0 N ~ co 0 8 ,)::o C1J M" tO M" (t)C1J (') ,_. ~ 1-'3 (t) ::I M" N FORM NUMBER TITLE SF- 312 CLASSIFIED INFORMATION NON- DISCLOSURE AGREEMENT (CON- TROLLED) SF- 360 REQUEST TO APPROVE AN INTER- AGENCY REPORTING REQUIREMENT SF- 424 APPLICATION FOR FEDERAL ASSISTANCE SF- 700 SECURITY CONTAINER INFORMATION SF- 701 ACTIVITY SECURITY CHECKLIST SF- 702 SECURITY CONTAINER CHECKLIST SF- 703 TOP SECRET COVERSHEET SF- 704 SECRET COVERSHEET SF- 705 CONFIDENTIAL COVERSHEET L ~ .. LATEST EDITION DATE 09-88 12-88 04-88 08-85 08-85 08-85 08-85 08-85 08-85 INITIATING AGENCY GSA/ISOO GSA OMB GSA/ISOO GSA/ISOO GSAfj:;OO GSA/ISOO GSA/ISOO GSA/ISOO L OFFICE OF PRIMARY INTERE'i! DP-542.2 MA-433.2 MA-40.3 DP-542.2 DP-542.2 DP-542.2 DP-542.2 DP-542.2 DP-542.2 SOURCE OF SUPPLY MA-203.62 MA-433.2 ssss ssss ssss ssss ssss ssss ssss • COMMENTS --- REPLACES SF-189 AND SF-189A PREVIOUS EDITIONS OBSOLETE; DISPOSE OF EXISTING STOCK UPON RECEIPT OF NEW; CAN BE REPRO- OUCED LOCALLY DISPOSE OF EX!STING STOCK ON RECEIPT OF RtVISION - CAN BE PRODUCED LOCALLY REPLACES DOE ~ o632.3 RErLACES DOE F 5632.2, DOE F 563(.4, AND DOE F 5632.7 REPLACES DOE F. 5535.6 REPLACES DOE F 5635.6 REPLACES DOE F 5635.6 L -u )> llJ rl" 1.0 rl" CDilJ () ...... :::r N3 CD ::s rl" N () t () ...... Cl NO 'I"T'l ...... N._. •w CON I.ON . ~ c:c • .. c . LATEST EDITION

FORM NUMBER TITLE DATE SF- 706 TOP SECRET (DISKETTE LABEL) 01-87 SF- 707 SECRET (DISKETTE LABEL) 01-87 SF- 708 CONFIDENTIAL (DISKETTE LABEL) 01-87 SF- 709 CLASSIFIED (DISKETTE LABEL) 01-87 SF- 710 UNCLASSIFIED (DISKETTE LABEL) 01-87 SF- 711 DATA DESCRIPTOR (DISKETTE 01-87 LABEL) SF- 712 CLASSIFIED SCI (DISKETTE 10-87 LABEL) SF- 1012 TRAVEL VOUCHER 10-77 c ' OFFICE OF INITIATING PRIMARY AGENCY INTEREST GSA/ISOO DP-542.2 GSA/ISOO DP-542.2 GSA/ISOO DP-542.2 GSA/ISOO DP-542.2 GSA/ISOO DP-542.2 GSA/ISOO DP-542.2 GSA/ISOO DP-542.2 GSA HA-3.2 • . SOURCE OF SUPPLY COMMENTS ssss ssss ssss ssss ssss ssss ssss ssss ('J ....... o NO I I"T1 ....... N.,.._. I w 00 N 1.0 N . ~ o::J e - ")> JlJ .-+ 1.0 .-+ (I)JlJ n ....... ~ W3 (I) ::s .-+ N ~'l'i'·~~~'I"JJ!~!""'·~~~~~~!ImiJ!IIe'lm'!lq~ *"''"' ;;w.:,~.;~ii~"''*"' ,¥ i¥ """ i1 '·~""-'""'·.·""''· a!!l ,tj; ~.·~:+!J~O!(Op ,.Jill! 11, §$,'l<~.lni.,J.s "·'"'~~~~~~~"'~ FORM NUMBER SF- 1012A SF- 1034 SF- 1034A SF- 1038 SF- lOBO SF- 1081 SF- 1093 SF- 1094 SF- 1103 L TITLE TRAVEL VOUCHER (Memorandum) PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL PUBLIC VOUCHER FOR PURCHASES AND SERVICES OTHER THAN PERSONAL (Memorandum) ADVANCE OF FUNDS APPLICATION AND ACCOUNT VOUCHER FOR TRANSFERS BETWEEN APPROPRIATIONS AND/OR FUNDS VOUCHER AND SCHEDULE OF WITHDRAWALS AND CREDITS SCHEDULE OF WITHHOLDINGS UNDER THE DAVIS-BACON ACT (40 U.S.C. 276a) AND/OR THE CONTRACT WORK HOURS AND SAFETY STANDARDS ACT U.S. TAX EXEMPTION CERTIFICATE (Controlled) U.S. GOVERNMENT BILL OF LADING ORIGINAL (CONTROLLED) • "' LATEST EDITION DATE 10-77 10-87 10-87 10-77 04-82 09-82 10-71 10-83 04-85 INITIATING AGENCY GSA TO TO GSA TO TO GAO GSA GSA L OFFICE OF PRIMARY INTEREST MA-3. 2 MA-3.2 MA-3.2 HA-3.2 MA-3.2 MA-3.2 MA-40.3 MA-40. 3 MA-203.2 SOURCE OF SUPPLY ssss ssss ssss ssss ssss ssss ssss MA-203.62 MA-203.62 • COitltENTS PREVIOUS EDITIONS MAY BE USED REPLACES SF-1169 PREVIOUS EDITIONS MAY BE USED PREVIOUS EDITIONS OBSOLETE L ""0 )> llJ rl­ I.Q rl­ Cl>llJ n ...... ::::,- ~3 Cl) ::I c-+ N 0 u ....... 0 NO I IT\ ....... N ..... I W CON \ON . ~ co • . " c • . c c .... o NO I I"T'' .... I'\) ..... I w 00 N 1.0 N . ~ LATEST OFFICE OF o::J EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COMMENTS SF- 1145 VOUCHER FOR PAYMENT UNDER 09-73 TO GC-50 GC-45 FEDERAL TORT CLAIMS ACT SF- 1150 RECORD OF LEAVE DATA 12-77 OPM MA-3.2 MA-331.1 e SF- 1151 NONEXPENDJTURE TRANSFER 12-79 TO MA-3.2 MA-331 AUTHORIZATION SF- 1152 DESIGNATION OF BENEFICIARY 09-67 GAO MA-41.2 ssss UNPAID COMPENSATION OF DECEASED CIVILIAN EMPLOYEE SF- 1153 CLAIM FOR UNPAID COMPENSATION 04-82 GAO MA-41. 2 ssss OF DECEASED CIVILIAN EMPLOYEE SF- 1156 PUBLIC VOUCHER FOR FEES AND 09-73 TO GC-50 GC-50 MILEAGE OF WITNESSES SF- 1157 CLAIMS FOR WITNESSES ATTfN- 04-80 TO GC-50 GC-50 e DANCE FEES, TRAVEL, AND MIS- CELLANEOUS EXPENSE SF- 1164 CLAIM FOR REIMBURSEMENT FOR 11-77 GSA MA-3.2 ssss EXPENDITURES ON OFFICIAL BUSINESS ""0 ::t> g., M- 1.0 M- Ctlg., n ....... ::r- <..n3 Ctl ~ M- N '"C)> Po> r-1" 1.0 r-1" Cl)Q,> ("") 1-'':r 0'13 C1) :::s r-1" LATEST OFFICE OF EDITION INITIATING PRIMARY SOURCE OF N FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COMMENTS --- SF- 1166 OCR VOUCHER AND SCHEDULE OF 05-84 TO MA-3.2 MA-203.62 PAYMENTS (Controlled) n SF- 1167 OCR VOUCHER AND SCHEDULE OF 05-84 TO MA-3.2 MA-203.62

PAYMENTS (CONTINUATION SHEET) (CONTROLLED) SF- 1170 REDEMPTION OF UNUSED TICKETS 02-89 GSA MA-3.2 ssss PREVIOUS EDITIONS USABLE; DE- PLETE EXISTING STOCKS BEFORE ISSUING SF- 1183 SUBSCRIBER LIST FOR ISSUANCE TO MA-3.2 MA-331.1 OF UNITED STATES SAVINGS BONDS SF- 1184 UNAVAILABLE CHECK CANCELLATION 06-84 TO MA-3.2 MA-343. 2 SF- Jl87 REQUEST FOR PAYROLL DEDUCTIONS 06-89 OPM MA-41. 2 ssss PREVIOUS EDITIONS OBSOLETE; FOR LABOR ORGANIZATIONS DUES DISPOSE OF EXISTING STOCK UPON RECEIPT OF REVISION; STOCKED ONLY BY SUPER OF DOCUMENTS SF- Jl92 AUTHORIZATION FOR PURCHASE AND 03-79 TO MA-3.2 ssss (J REQUEST FOR CHANGE: u. s. SERIES EE SAVINGS BOND SF- Jl93 LETTER OF CREDIT (FEDERAL RE- 05-73 TO MA-3.2 MA-203.62 SERVE BANK) (CONTROLLED) SF- Jl93A LETTER OF CREDIT (Treasury 10-76 TO MA-3.2 MA-343.2 Disbursing Center or Regional Office) 1-'0 NO I fT1 ...... N~-' I W CON 1.0 N . ~ c:c L - L L • .. • ~ .. • . ~ • c c "' ' ...... a NO I f"T'1 ...... N.,_. I w (X) I'\) \0 I'\) . ~ lATEST OFFICE OF co EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COIIIENTS SF- 1194 AUTHORIZED SIGNATURE CARD FOR TO HA-40.3 HA-405.2 PAYMENT VOUCHERS ON lETTERS OF HA-3. 2 MA-34.42 CREDIT SF- 1199A DIRECT DEPOSIT SIGN-UP FORM 06-87 TO HA-3. 2 ssss DEPLETE EXISTING STOCK 0 SF- 1200 GOVERNMENT SILL OF LADING 08-82 GSA MA-203.2 MA-203.62 CORRECTION NOTICE (Controlled) SF- 1402 CERTIFICATE OF APPOINTMENT 10-83 GSA MA-40.3 ssss SF- 1403 PREAWARD SURVEY OF PROSPECTIVE 09-88 GSA HA-40.3 ssss PREVIOUS EDITIONS USABLE; DE-CONTRACTOR (GENERAL) PLETE EXISTING STOCKS BEFORE ISSUING SF- 1404 PREAWARD SURVEY OF PROSPECTIVE 09-88 GSA MA-40.3 HA-405.2 PREVIOUS EDITIONS USABLE; DE-CONTRACTOR - TECHNICAL PLETE EXISTING STOCKS BEFORE ISSUING SF- 1405 PREAWARD SURVEY OF PROSPECTIVE 09-88 GSA MA-40.3 MA-203.62 PREVIOUS EDITIONS USABLE, pE- e CONTRACTOR - PRODUCTION PLETE EXISTING STOCKS BErQRE ISSUING SF- 1406 PREAWARD SURVEY OF PROSPECTIVE 09-es GSA MA-40.3 ssss PREVIOUS EDITIONS USA~L~; DE-CONTRACTOR - QUALITY ASSURANCE PLETE EXISTING STOCKS 6~FORE ISSUING SF- 1407 PREAWARD SURVEY OF PROSPECTIVE 09-88 GSA MA-40.3 ssss PREVIOUS EDITIONS USABLE; DE-CONTRACTOR - FINANCIAL PLETE EXISTING STOCKS BEFORE -c)> CAPABILITY ISSUING llJ rl" 10 rl" COllJ n -=r ....... 3 C1) ::s rl" N FORM NUMBER TITLE SF- 1408 PREAWARD SURVEY OF PROSPECTIVE CONTRACTOR - ACCOUNTING SYSTEM SF- 1409 ABSTRACT OF OFFERS SF- 1411 CONTRACT PRICING PROPOSAL COVER SHEET SF- 1412 CLAIM FOR EXEMPTION FROM SUB- MISSION OF CERTIFIED COST OR PRICING DATA SF- 1413 STATEMENT AND ACKNOWLEDGEMENT SF- 1414 CONSENT OF SURETY SF- 1415 CONSENT OF SURETY AND INCREASE OF PENALTY SF- 1416 PAYMENT BONO FOR OTHER THAN CONSTRUCTION CONTRACTS SF- 1417 PRE-SOLICITATION NOTICE (Construction Contract) L ,.-.. .. • LATEST EDITION DATE 09-88 09-88 07-87 10-83 06-89 10-83 11-87 10-83 12-88 INITIATING AGENCY GSA GSA GSA GSA GSA GSA GSA GSA GSA L OFFICE OF PRIMARY INTEREST MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40.3 MA-40. 3 SOURCE OF SUPPLY ssss ssss ssss ssss ssss ssss ssss ssss ssss • . COIIMENTS PREVIOUS EDITIONS USABLE; DE- PLETE EXISTING STOCKS BEFORE ISSUING PREVIOUS EDITIONS USABLE; DE- PLETE EXISTING STOCKS BEFORE ISSUING DISPOSE OF EXISTING STOCK ON RECEIPT OF NEW EDITION PREVIOUS EDITIONS USABLE; DE- PLETE EXISTING STOCKS BEFORE ISSUING PREVIOUS EDITIONS MAY NOT BE USED

PREVIOUS EDITIONS OBSOLETE; DISPOSE OF EXISTING ~lOCK BE- FORE ISSUING L, "'0 )::o ~ ...... I.C ...... ro~ n -~ CP3 ro ::s ...... I') n (I - Cl NO I fT1 -Nl-' I w CP N \0 N ~ OJ -~--~-" ___ , ___ ,, ,,,_,, __ ~,.·--·-' c ~.!!_IUI_~m SF- 1420 SF- 1421 SF- 1423 SF- 1424 SF- 1426 SF- 1427 SF- 1428 SF- 1429 "'-· TITLE PERFORMANCE EVALUATION CONSTRUCTION CONTRACTS PERFORMANCE EVALUATION (ARCHITECT-ENGINEER) INVENTORY VERIFICATION REPORT INVENTORY DISPOSAL REPORT INVENTORY SCitEDULE A (Meta 1 s in Hill Product Form) INVENTORY SCHEDULE A, CONTINUATION SHEET (Metals in Hill Product Form) INVENTORY SCHEDULE B INV£NTORY SCHEDULE B, CONTINUATION c LATEST EDITION INITIATING DATE ~~_r,.cr 10-83 GSA 10-83 GSA 12-88 GSA 07-89 GSA 07-89 GSA 07-89 GSA 07-89 GSA 07-89 GSA • ~ OFFICE OF PRIIIARY SOURCE OF !~~I!~I SUPPLY HA-40. 3 ssss HA-40.3 ssss MA-40.3 ssss HA-40.3 ssss MA-40.3 ssss MA-40.3 ssss HA-40.3 ssss HA-40.3 ssss () . COtiiENTS PREVIOUS EDITIONS OBSOLETE; DISPOSE OF EXISTING STOCK ON RECEIPT OF REVISION PREVIOUS EDITIONS USABLE; FORM IS TO BE REPRODUCED LOCALLY; CAN NO LONGFH GET SUPPLY FROM GSA AFTER 10-31-89 PREVIOUS EDITIONS USABLE; FORM IS TO BE REPRODUCED LOCALLY; CAN NO LONGER GET SUPPLY FROM GSA AFTER 10-31-89 PREVIOUS EDITIONS USABLE; FORM IS TO BE REPRODUCED LOCALLY; CAN NO LONGER GET SUPPLY FROM GSA AFTER 10-31-89 PREVIOUS EDITIONS USABLE; FORM IS TO BE REPRODUCED LOCALLY; CAN NO LONGER GET SUPPLY FROM GSA AFTER 10-31-89 PREVIOUS EDITIONS USABLE; FORM IS TO BE REPRODUCED LOCALLY; f.AN NO LONGER GET SUPPLY FROM ~SA AFTER 10-31-89 ...... 0 NO I ...., ...... N ~--' I w OON 1.0 N . ""' 0::1 - -o )> "'~ c.c ~ (l).:U n ...... ::T 1.03 (1) ::s ~ N e ~~f~r:~'r~~~-~~~~~iii!l\&\l\lhM\i\'i,iAA041'!l\'~~<iliN!II$ilil!ij ~lll-~1\llliiii~WiAIIP, 1:1 ('I' ; M 4,\ ) '!"'f"ff<f 1'1!" *!14!1F,.¥il, f, ;!"• ;~.!.,,~, ~,Mil'lG'.~~t, .. JlM ¥1. ,)i$ ,)i&_% t,.!,i,,J-1, .5\.+J W,"},@N,&~X,,I&1!ffl!.li.,mn#.i'Wf'ill'i'!l!tillll'li!'~I'!!'II''IJQ-,-,,.(i;ii¥1 'li:SIQ AA#JQ lj k.l" ""0 )> llJ c+ tO c+ ct>llJ (') N:::::T" 03 m ::::::1 c+ LATEST OFFICE OF FORM NUMBER EDITION INITIATING PRIMARY N TITLE DATE AGENCY SOURCE OF !I!.TEREST SUPPLY COMMENTS SF- 1430 INVENTORY SCHEDULE C 07-89 GSA MA-40.3 ssss PllfVIOUS EDITIONS USABLE; FORM (Work In, Process) IS 10 ~E REPRODUCED LOCALLY; CAN NtJ lONGER GET SUPPLY FROM 1431 INVENTORY SCHEDULE C, GSA ArrER 10-31-89 (' SF- 07-89 GSA MA-40.3 ssss PREVIOU~ EDITIONS USABLE; FORM ' ' CONTINATION SHEET (Work I~ 1 S TCl ilE REPRODUCED LOCALLY; Process) CAN No LONGER GET SUPPLY FROM GSA AFTER 10-31-89 SF- 1432 INVENTORY SCHEDULE D 07-89 GSA MA-40.3 ssss PREVIOU" ~DITIONS USABLE; FORM (Special Tooling and Sper.1a1 IS TO Uf REPRODUCED LOCALLY; Test Equipment) CAN NO LONGER GET SUPPLY FROM GSA AFTER 10-31-89 SF- 1433 INVENTORY SCHEDULE D 07-89 GSA MA-40.3 ssss PREVIOUS EDITIONS USABLE; FORM CONTINUATION SHEET (Special IS TO BE REPRODUCED LOCALLY; Tooling and Special Test CAN NO LONGER GET SUPPLY FROM Equipment) GSA AFTER 10-31-89 SF- 1434 TERMINATION INVENTORY SCHEDULE 07-89 GSA MA-40.3 ssss PREVIOUS EDITIONS USABLE; FORM E (Short Form for Use With SF IS TO BE REPRODUCED LOCALLY; 1438 only) CAN NO LONGER GET SUPPLY FROM GSA AFTER 10-3!-89 SF- 1435 SETTLEMENT PROPOSAL (Inventory 07-89 GSA MA-40.3 ssss PREVIOUS EDITIONS USABLE; FORM Basis) IS TO BE REPRODUCED LOCALLY; CAN NO LONGER GET SUPPLY FROM GSA AFTER 10-31-89

0 SF- 1436 SETTLEMENT PROPOSAL (Total 07-89 GSA MA-40.3 ssss PREVIOUS EDITIONS USABLE; FORM Cost Basis) IS TO BE REPRODUCED LOCALLY; CAN NO LONGER GET SUPPLY FROM GSA AFTER 10-31-89 SF- 1437 SETTLEMENT PROPOSAL FOR COST- 07-89 GSA MA-40.3 ssss PREVIOUS EDITIONS USABLE; FORM REIMBURSEMENT TYPE CONTRACTS IS TO BE REPRODUCED LOCALLY; CAN NO LONGER GET SUPPLY FROM GSA AfTER 10-3!-89 SF- 1438 SETTLEMENT PROPOSAL (Short 07-89 GSA MA-40.3 ssss PREVIOUS EDITIONS USABLE; FORM ..... CJ Form) IS TO BE REPRODUCED LOCALLY; No CAN NO LONGER GET SUPPLY FROM lrn GSA AfiER 10-31·8~ ..... N._. lw OON \ON ..,. o:J Lr . Lr L ' . r . ., • (') • . (') c I' 1-'0 NO I rr1 ....... N......, I w 00 I'.) 1.0 I'.) -1'>- LATEST OFFICE OF c::o EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COMMENTS SF- 1439 SCHEDULE OF ACCOUNTING 07-89 GSA MA-40.3 ssss PREVIOUS EDITIONS USABLE; FORM INFORMATION IS TO BE REPRODUCED LOCALLY; CAN NO LONGER GET SUPPLY FROM GSA AFTER 10-31-89 0 SF- 1440 APPLICATION FOR PARTIAL 07-89 GSA MA-40.3 ssss PREVIOUS EDITIONS USABLE; FORM PAYMENT IS TO BE REPRODUCED LOCALLY; CAN NO LONGER GET SUPPLY FROM GSA AFTER 10-31-89 SF- 1442 SOLICITATION, OFFER, AND AWARD 04-85 GSA MA-40.3 ssss (Construction, Alteration, Repair) SF- 1443 CONTRACTOR'S REQUEST FOR 10-82 GSA MA-40.3 ssss PROGRESS PAYMENT SF- 2800 APPLICATION FOR DEATH BENEFITS 04-86 OPM MA-41. 2 ssss - CIVIL SERVICE RETIREMENT SYSTEM SF- 2801 APPLICATION FOR IMMEDIATE 01-82 OPM MA-41.2 ssss RETIREMENT - CIVIL SERVICE RETIREMENT SYSTEM SF- 2801-1 CERTIFIED SUMMARY OF FEDERAL 01-82 OPM MA-41. 2 ssss -SERVICE - Civil Service Retirement System SF- 2801-2 SPOUSE'S NOTIFICATION OF SUR- 01-82 OPM MA-411 MA-411.3 VIVOR ELECTION (CSRS) ")::oo PJ r+ t.O r+ Cl>PJ () N::::r- ...... 3 ([) ::::::1 r+ N ~~~:n'l"~~~,~··"''''1''<::""1""'1"\'l••'l<m'~'hl.~\l'!llllllr~4"'U ::; ~":••UHJ.~_. .~- ~~!"~% . .R Y«iA .4 J<! • "'J'.,.",~1'!\I' M, .t< .• f'\: .• \ ii!i. 4 1M. ¥ ·ttri."'!!~~~~~.,__Mf!!<m'~-•)J:;I%4 Wft,q:;:. ftl\lH.N 41!!9'\lm" 1 i'!'li~,.._~i$itw~;.~.~Jt%. 1'1~ ~IJHL . h ;q: .~ FORM IIIIIBER TITLE SF- 2802 APPLICATION FOR REFUND OF RETIREMENT DEDUCTIONS - Civil Service Retirement System SF- 2802B CURRENT/FORMER SPOUSE'S NOT!- FICATION OF APPLICATION FOR REFUND OF RETIREMENT DE- DUCTIONS UNDER THE CSRS SF- 2803 APPLICATION TO MAKE DEPOSIT OR REDEPOSIT - Civil Service Retirement System SF- 2804 APPLICATION TO MAKE VOLUNTARY CONTRIBUTIONS - Civil Service Retirement System SF- 2805 REQUEST FOR RECOVERY OF DEBT DUE THE UNITED STATES SF- 2806 INDIVIDUAL RETIREMENT RECORD {Civil Service Retirement System) SF- 2807 REGISTER OF SEPARATIONS AND TRANSFERS-CIVIL SERVICE RETIREMENT SYSTEM SF- 2808 DESIGNATION OF BENEFICIARY CIVIL SERVICE RETIREMENT SYSTEM SF- 2809 HEALTH BENEFITS REGISTRATION FORM - FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM '--' ... • LATEST EDITION DATE 11-87 11-87 03-87 05-80 10-88 02-80 07-80 07-84 06-88 INITIATING AGENCY OPM OPM OPM OPM OPM OPM OPM OPM OPM L OFFICE OF PRIMARY INTEREST MA-41.2 MA-41. 2 MA-41. 2 MA-41. 2 MA-3.2 MA-3.2 MA-41. 2 MA-41. 2 MA-41. 2 SOURCE OF SUPPLY ssss MA-414 .I ssss ssss ssss ssss ssss ssss ssss COIIIENTS 1187 EDITION IS NOT TO BE USED USE OPM FORM 1425 UNTIL FUR- THER NOTICE PREVIOUS EDITIONS MAY NOT BE USED PREVIOUS EDITIONS OBSOLETE; DISPOSE OF EXISTING STOCK ON RECEIPT OF REVISION 07/84 & 09/85 ARE USABLE. {GSA NSN 7540-01-231-6227) L

~)> g.,~ c.c ~ C1)g., (') N~ N3 C1) :::s ~ N (1 ' (; t-'0 NO I rn ..... N,_. I w OON 10 N .p. c;:J () c LATEST EDITION INITIATING FORN NUNBER TITLE DATE AGENCY SF- 2809A FEDERAL EMPLOYEES HEALTH BENE- 07-87 OPM FITS PROGRAM INFORMATION FOR FEDERAL CIVILIAN EMPLOYEES AND U. S. POSTAL EMPLOYEES SF- 2810 FEDERAL EMPLOYEES HEALTH BENE- 01-87 OPM FITS PROGRAM NOTICE OF CHANGE IN HEALTH BENEFITS ENROLLMENT SF- 2811 TRANSMITTAL AND SUMMARY REPORT 06-84 OPM TO CARRIER - FEDERAL EMPLOYEES Health Benefits Program SF- 2812 REPORT OF WITHHOLDINGS AND CONTRIBUTIONS FOR HEALTH 08-88 OPM BENEFITS, LIFE INSURANCE, AND RETIREMENT SF- 2812A REPORT OF WITHHOLDINGS AND 08-88 OPM CONTRIBUTIONS FOR HEALTH BENE- FITS BY ENROLLMENT CODE SF- 2817 LIFE INSURANCE ELECTION 02-88 OPM Federal Employees Group Life Insurance Program SF- 2817A FEDERAL EMPLOYEES' GROUP LIFE 09-87 OPM INSURANCE - A Description and Certification of Enrollment in the FEGLI Program . . OFFICE OF PRINARY SOURCE OF !!HEREST SUPPLY MA-41. 2 ssss MA-41. 2 ssss MA-3.2 ssss MA-3.2 MA-331.1 MA-3.2 MA-331.1 MA-41. 2 ssss MA-41. 2 ssss (' ' CONNENTS PREVIOUS EDITIONS OBSOLETE (GSA NSN 7540-01-232-1234) (GSA NSN 7540-01-23!-4279) REPRODUCE LOCALLY REPRODUCE LOCALLY PREVIOUS EDITIONS MAY NOT BE USED PREVIOUS EDITIONS MAY NOT BE USED 1-'0 NO I I"T1 ...... Nl-' I w 00 N \.0 N ~ OJ 0 - -o )> Ill .-t- 1.0 .-t­ CO!ll n N::::r W3 co ::I .-t- N ""C)> QJ c-+ (,Q c-+ Cl)QJ (") N::::T *"'3 Cl) ::s c-+ LATEST OFFICE OF N EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COMMENTS --- SF- 2818 CONTINUATION OF LIFE INSURANCE 09-85 OPM MA-41. 2 ssss COVERAGE AS A RETIREE OR COMPENSATION - Federal Employ- ees' Group Life Insurance Prog SF- 2819 NOTICE OF CONVERSION PRIVILEGE 05-87 OPM MA-41. 2 ssss ONLY 0587 AND !085 EDITIONS C" - Federal Employees' Group ARE USABLE Life Insurance Program SF- 2821 AGENCY CERTIFICATION OF 07-87 OPM MA-41. 2 ssss 5-86 EDITIONS USABLE INSURANCE STATUS - Federal (GSA NSN 7540-01-231-5587) Employees' Group Life Insurance SF- 2822 REQUEST FOR INSURANCE 02-88 OPM MA-41. 2 ssss PREVIOUS EDITIONS ARE OBSOLETE Federal Employees' Group Life (GSA NSN 7540-01-231-5588) Insurance Program SF- 2823 DESIGNATION OF BENEFICIARY 09-85 OPM MA-41. 2 MA-414.1 (GSA NSN 7540-01-231-6228) Federal Employees' Group Life Insurance Program SF- 2824 DOCUMENTATION IN SUPPORT OF 07-84 OPM MA-41. 2 ssss DISABILITY RETIREMENT - Civil Service Retirement System SF- 2824A APPLICANT'S STATEMENT OF 07-84 OPM MA-41. 2 ssss c DISABILITY IN CONNECTION WITH DISABILITY RETIREMENT UNDER THE CIVIL SERVICE RETIREMENT SF- 2824B SUPERVISOR'S STATEMENT IN CON- 07-84 OPM MA-41.2 NECTION WITH DISABILITY RE- TIREMENT UNDER THE CIVIL SER- VICE RETIREMENT SF- 2824C PHYSICIAN'S SIATEMENT IN CON- 07-84 OPM MA-41.2 NECTION WITH OISABILITY RE- t--'c:J TIREMENT UNDER THE CIVIL SER- No VICE RETIREMENT SYSTEM •rn ....... N,__. •w OON \.ON *"' co l, L L j.- • (" ~ ~ . ~ 1-'0 NO I 1""1 ...... I'\),_. I w OON 1.0 N ...,.. OJ LATEST OFFICE OF EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE DATE AGENCY INTEREST SUPPLY COIIIIENTS SF- 28240 AGENCY CERTIFICATION OF RE- 07-84 OPM MA-41. 2 ASSIGNMENT AND ACCOMMODATION EFFORTS IN CONNECTION WITH DISABILITY RETIREMENT 0 SF- 2824E DISABILITY RETIREMENT APPLICA- 07-84 OPM MA-41. 2 liON CHECKLIST IN CONNECTION WITH DISABILITY RETIREMENT UN- DER THE CS RETIREMENT SYSTEM

SF- 3105 DOCUMENTATION IN SUPPORT Of 08-87 OPM MA-41.2 DISABILITY RETIREMENT APPLICA- TION (FERS) SF- 3105C PHYSICIAN'S STATEMENT IN CON- 08-87 OPM MA-41. 2 MA-414.1 NECTION WITH DISABILITY RE- TIREMENT UNDERS FERS SF- 3106 APPLICATION FOR REFUND OF RE- 09-88 OPM MA-41.2 PREVIOUS EDITIONS OBSOLETE; T1REMENT DEDUCTIONS - FERS DISPOSE UPON RECEIPT SF- 3107 FERS APPLICATION FOR IMMEDIATE 03-88 OPM MA-41.2 HA-414.1 RETIREMENT SF- 3107-1 CERTIFIED SUMMARY OF FEDERAL 03-88 OPH MA-41.2 e SERVICE - FERS SF- 3107-2 SPOUSE'S CONSENT TO SURVIVOR 03-88 OPH HA-41. 2 ELECTION - (FERS) SF- 5805 REQUEST FOR FUNDS 03-88 TO HA-3.2 MA-343.2 (3 PART FORH)-DEPLETE EXISTING STOCK BEFORE ISSUING \J)> ~c-+ 10 c-+ (I)~ n N=r U13 (I) :::3 c-+ N FORM NUMBER **OPTIONAL OF- 5 OF- 7 OF- II OF- 13 OF- 13A OF- 136 OF- 13C OF- 17 L, TITLE INQUIRY AS TO AVAILABILITY PROPERTY PASS (Controlled) REFERENCE REQUEST--FEDERAL RECORDS CENTERS FORM DESIGN GUIDE SHEET (8 1/2 X II) FORM DESIGN GUIDE SHEET (II X 17) FORM DESIGN GUIDE SHEET FOR 33 1/2 REDUCTION ADP FORM DESIGN SPACING GUIDE SEALED BID LABEL ~ ' LATEST EDITION DATE 03-82 09-88 07-87 08-81 08-81 10-81 03-77 10-83 INITIATING AGENCY OPM GSA NARA GSA GSA GSA OPM GSA L OFFICE OF PRIMARY INTEREST MA-41. 2 MA-203.2 MA-203.2 MA-433.2 MA-433.2 MA-433.2 MA-433.2 MA-40.3 SOURCE OF SUPPLY ssss MA-203.62 MA-203.43 ssss MA-203.52 MA-203.52 MA-203.52 ssss , COMMENTS PREVIOUS EDITIONS OBSOLETE; DISPOSE OF EXISTING STOCKS BE- FORE ISSUING USE EXISTING STOCK BEFORE AWARDING NEW EDITION L ""0 )::> llJ..-t- 1.0 ...... C'Ds:u () N=s- 0\3 I'D ::I ...... N (' (; ....... 0 No 'ITl ....... N ._. 'w CX>N <..ON *"' co (' FORM NUMBER OF- 27 OF- 41 OF- 67 OF- 68 OF- 69 OF- 86 OF· 95 OF- 101 OF- 116 OF- 120 1- TITLE U.S. GOVERNMENT - 2-WAY MEMO ROUTING AND TRANSMITTAL SLIP ACTIVITY SCHEDULE RECORD OF TRAVEL EXPENSES ASSIGNMENT AGREEMENT TITLE IV OF THE INTERGOVERNMENTAL PER- SONNEL ACT OF 1970 PERSONAL DATA (WARNING) (Adhesive Backed Labe 1 s) ( 5x3) OPEN - LOCKED (SiGN) (3" wide Drawer Tab) SUMMARY WORKSHEET FOR ESTIMATING REPORTING COSTS RECORD OF TOP SECRET MATERIAL DIPLOMATIC POUCH MAIL REGIS- TRATION LATEST EDITION DATE 07-81 07-76 1991 08-76 02-89 05-76 07-75 02-74 11-78 01-75 (' INITIATING AGENCY GSA GSA GSA GSA OPM OPM GSA/ISOO GSA DOS DOS OFFICE OF PRIMARY INTEREST --- MA-203.2 MA-203.2 MA-203.2 MA-3.2 MA-41.2 MA-203.2 DP-542.2 MA-433.2 DP-542.2 DP-542.2 SOURCE OF SUPPLY ssss ssss ssss MA-343.2 ssss MA-203.41 ssss MA-433.2 DP-3 DP-40 c COMMENTS PREVIOUS EDITIONS OBSOLETE - IN DECEMBER 1990 DISPOSE OF ALL STOCK OF THE 1990 EDITION PREVIOUS EDITIONS USABLE; DE- PLETE EXISTING STOCKS BEFORE ISSUING STOCKING LOCATION CHANGED FROM GSA/FEDERAL SUPPLY SERVICE TO GSA/INFORMATION RESOURCES MANAGEMENT/KMAS ....... Cl NO I f'T'1 ....... !'\,) ....... I W CX> N \.0 N ~ co e e -c)> llJ ....,. c.o ....,. Cl)QJ () N::::r -....j3 Cl) ::3 ....,. N FORM NUMBER OF- 185 OF- 185A OF- 283 OF- 299 OF- 300 OF- 336 OF- 346 OF- 1114 OF- 1419 OF- 1419A Lt TITLE OUTGOING TELEGRAM (OCR) OUTGOING TELEGRAM (OCR) (Continuation Sheet) U.S. MERIT SYSTEMS PROTECTION BOARD APPEAL REQUEST BY EMPLOYEE FOR ACTION ON ALLOTMENT OF PAY QUALIFICATIONS ANALYSIS AND APPRAISAL OF CANDIDATES FOR SUPERVISORY POSITIONS CONTINUATION SHEET U. S. GOVERNMENT MOTOR VEHICLE OPERATOR'S IDENTIFICATION CARD

BILL OF COLLECTION ABSTRACT OF OFFERS - CONSTRUCT ION ABSTRACT OF OFFERS - CONSTRUCT ION (CONTINUATION SHEET) • LATEST EDITION INITIATING DATE AGENCY 08-85 DOS 08-85 DOS 05-85 MSPB Ol-B2 OPM 06-82 OPM 04-86 OPM 11-85 OPM 12-79 GAO 11-88 GSA 11-88 GSA Lt ""0)> $lJ c-+ t.C c-+ ('[)jlJ (') N :::r 003 ('[) :::s c-+ OFFICE·OF PRIMARY SOURCE OF N INTEREST SUPPLY COMMENTS IE-3 ssss IE-3 ssss c MA-41.2 ssss MA-3.2 MA-331.1 MA-41.2 ssss MA-40.3 MA-40.3 FORMERLY SF-36 MA-203.2 MA-203.62 FORMERLY SF-46 (J MA-3.2 MA-203.62 MA-40.3 ssss FORMERLY SF-1419 ,_. 0 NO I rr1 MA-40.3 ssss FORMERLY SF-1419 ,_. N._. I W CON 1.0 N ~ co L C' FORM NUMBER **DEPARTMENT OF ARMY DD- 250 DD- I I42 " TITL~ MATERIAL INSPECTION AND RECEIVING INTERAGENCY DOCUMENT REQUEST **DEPARTMt~T OF JUSTICE FD- 25B FINGERPRINT CARDS (FBI) I- 9 EMPLOYMENT ELIGIBILITY VERIFICATION **DEPARTMENT OF LABOR CA- I FEDERAL EMPLOYEE'S NOTICE OF TRAUMATIC INJURY AND CLAIM FOR CONTINUATION OF PAY/ COMPENSATION (Controlled) CA- 2 FEDERAL EMPLOYEE'S NOTICE OF OCCUPATIONAL DISEASE AND CLAIM FOR COMPENSATION (Controlled) CA- 2A NOTICE OF RECURRENCE OF DISABILITY AND CLAIM FOR PAY/COMPENSATION CA- 3 REPORT OF TERMINATION OF DISABILITY AND/OR PAYMENT LATEST EDITION DATE 03-87 03-86 03-86 12-87 12-74 (' INITIATING AGENCY OFF ICE OF PRIMARY INTEREST MA-40.3 DP-542.2 DP-542.2 MA-41. 2 MA-41.2 MA-41. 2 MA-41.2 MA-41.2 SOURCE OF SUPPLY MA-40.3 DP-40 ssss MA-414.2 MA-203.62 MA-203.62 MA-414.1 MA-414.1 • c . .. COMMENTS All other editions obsolete All other editions obsolete ...... 0 NO I f'T1 ....... N ,_. I W co "" \.0 N .f::o co 0 e ""C)> SlJc-+ tO c-+ C'DSlJ n N~ \.03 C'D ::s c-+ N -c)> PJ~ I.C ~ ct>PJ () w=r 03 ro ::3 LATEST OFF ICE OF ~ EDITION INITIATING PRIMARY SOURCE OF N FORM NUMBER TITLE DATE ---- AGENCY INTEREST SUPPLY COMMENTS CA- 58 CLAIM FOR COMPENSATION BY 09-75 MA-41. 2 MA-414.1 PARENTS, BROTHERS, SISTERS, GRANDPARENTS, GRANDCHILDREN CA- 6 OFFICIAL SUPERIOR'S REPORT OF 07-76 MA-41.2 ssss (' EMPLOYEE'S DEATH CA- 7/20 CLAIM FOR COMPENSATION ON 10-88 MA-41.2 MA-414.1 REPLACES CA-4, CA-7, AND CA-20 ACCOUNT OF TRAUMATIC INJURY OR OCCUPATIONAL DISEASE WITH CA-20 ATTENDING PHYSICIAN'S CA- 8 CLAIM FOR CONTINUING 08-87 MA-41.2 MA-414.1 COMPENSATION ON ACCOUNT OF DISABILITY CA- 16 REQUEST FOR EXAMINATION AND/OR 08-86 MA-41.2 MA-414.1 TREATMENT CA- 17 DUTY STATUS REPORT 08-85 MA-41. 2 MA-414.1 OSHA- 100F LOG OF FEDERAL OCCUPATIONAL EH-10 EH-341 (; INJURIES AND ILLNESSES OSHA- 200 BUREAU OF LABOR STATISTICS LOG EH-10 EH-341 AND SUMMARY OF OCCUPATIONAL INJURIES AND ILLNESSES OWCP- 1500A HEALTH INSURANCE CLAIM FORM 03/85 MA-41. 2 MA-414.1 1-'C) No •rn ....... N._. •w (X)N \ON . ~ OJ ~ L L ~ - (' FORM NUMBER **DEPARTMENT OF STATE DSP- II DSP- 82 • TITLE APPLICATION FOR PASSPORT APPLICATION FOR PASSPORT BY MAIL **GOVERNMENT PRINTING OFFICE GPO- 2511 **GSA GSA F 1128 MEMORANDUM, ORDER AND SUPPLEMENTARY SPECIFICATIONS DANGER (SIGN) **OFFICE OF PERSONNEL MANAGEMENT 1510 FE- 6 CERTIFICATION OF AGENCY OFFER OF POSITION AND REQUIRED DOCUMENTATION CLAIM FOR DEATH BENEFITS (' LATEST EDITION DATE 10-81 12-86 09-71 10-82 INITIATING _AGENCY DOS GPO GSA OFFICE OF PRIMARY INTEREST MA-203.2 MA-203.2 MA-203.2 MA-203.2 MA-41. 2 MA-41.2 SOURCE OF SUPPLY MA-203.62 MA-203.62 MA-203.52 MA-203.3 MA-414.1 MA-414.1 .. C' COMMENTS REPRODUCE LOCALLY ...... 0 NO •m ...... N._. I W

OON 1..0 N ~ OJ e - ")> Ill c-+- 1.0 c-+­ ctlDJ n w ::r -3 (0 ::;, c-+- N """'"''""''"_, . .,.,..,_...,,"'....,..""~,..lll'r\'r,<j'>'l"'l'I'/I'Jjl1l'l'!\1'~'~~~~·~~'"!ii'>~~~~~~""'"W"~~'~'f:t•'~'l'l''''~'m>'R'!'I'Illllff;(~"'''<<~~~<~~<:_.~~n~·'.l!'l~"'~~~~~"'~.,""""""""~-~~. -.~. s~~~"'i"!."ii, 1!11-f!X'!t .. ~ ¢<.a~~ FORM NUMBER TITLE FE- 6-DEP STATEMENT OF CLAIM, OPTION C FAMILY LIFE INSURANCE FE- 7 CLAIM FOR ACCIDENTJAL DISMEMBERMENT BENEFITS OPI'I- 813 REQUEST FOR VERIFICATION OF MILITARY RETIREE'S SERVICE OPM- 1019 INFORMATION ON SCHEDULE C POSITION AND INCUMBENT **THRIFT INVESTMENT BOARD TSP- I FEDERAL RETIREMENT THRIFT SAVINGS PLAN - ELECTION FORM TSP- 2 ELECTION FORM (FERS) TSP- 2L CERTIFICATION OF TRANSFER OF FUNDS AND JOURNAL VOUCHER FOR LOAN PAYMENTS "-' t - . LATEST EDITION DATE 04-81 02-89 05-87 06-87 INITIATING AGENCY TIB NFC c OFFICE OF PRIMARY INTEREST --- MA-41-2 MA-41-2 MA-4L 2 MA-41-2 MA-41-2 MA-41-2 MA-41-2 SOURCE OF SUPPLY ssss MA-411 MA-411 MA-411 COMMENTS REQUEST FROM OPM REPRODUCE LOCALLY REPRODUCE LOCALLY "-' ""0 )> llJ ri" tO ri" I'DS:U n w::::s­ N3 I'D :::::1 ri" N (' 0 ' 1--'0 NO I f'T1 ........ N ,_. I w CON 1.0 N . ~ co (' " . • c • \. (' "' I-' 0 NO I rT1 I-' N.,._. I w CX> N lD N . ~ LATEST OFFICE OF c:o EDITION INITIATING PRIMARY SOURCE OF FORM NUMBER TITLE I)ATE AGENCY INTEREST SUPPLY COMMENTS TSP- 3 FEDERAL RETIREMENT THRIFT MA-4~.2 MA-411 SAVINGS PLAN - DESIGNATION OF BENEFICIARY FORM TSP- 4 ELECTRONIC FUNDS TRANSFER MESS NFC MA-41. 2 MA-411 0 AGE FORM TSP- 5 EMPLOYEE DATA/PAYMENT/ADJUST- NFC MA-41. 2 MA-411 MENT RECORD INPUT FORM TSP- 5L LOAN PAYMENT NFC MA-41. 2 MA-411 TSP- 6 STATEMENT REGARDING SPOUSE(S) TIB MA-41. 2 MA-411 TSP- ELECTION OF BENEFITS TIB MA-41.2 MA-411 TSP- 8 PARTICIPANT STATEMENT NFC MA-41. 2 MA-411 - TSP- 9 CHANGE OF ADDRESS TIB MA-41. 2 MA-411 TSP- 10 REQUEST FOR POSITIVE ADJUST- NFC MA-41.2 MA-411 MENT "'0)::> llJ ri" (.Q ri" C"Oll.J MA-41. 2 MA-411 () TSP- II TSP ANNUITY BENEFITS TIB W::J W3 ro :::l ri" N "'*"""""'~_."'¥"'~'l\'"'~~ ... ~~'*'ili1Atit J.iWJXi.\iiih'M·JkQitl_lilii+f-'1'1'!~~~~-~,o;•W!M<Il<!l!~lliPTI l~,11"iffll'll"!!,_.,.~~--~~" Q ,!};,,.., __ ,.. ~-·'1"".~'1"' ,i"~''~'"'·'~ .. ~~-" + lll'l'l""''!'i-~~~~""""'""4"""''~"'~·"'11!1'"'1'1l.~i ¢f i·i·Fi!¥4,NQ}#,il! biMM~~ FORM NUMBER TITLE TSP- 12 APPLICATION FOR SUBSTANTIALLY EQUAL PAYMENTS TSP- 13 DESIGNATION OF AN ELIGIBLE RE- TIREMENT PLAN TSP- 14 JOINT WAIVER OF SPOUSE'S ANNUITY TSP- 15 CHANGE IN NAME OR MARITAL STATUS TSP- 16 REQUEST FOR A WAIVER OF NOTICE TO SPOUSE OR WAIVER OF SPOUSE'S CONSENT TSP- 17 APPLICATION FOR ACCOUNT BALANCE OF DECEASED PARTICI- PANT TSP- 18" VALIDATION OF RETIREMENT IN- FORMATION TSP- 20 TSP LOAN APPLICATION TSP- 21 TSP LOAN AGREEMENT/PROMISSORY NOTE TSP- 21E TSP EDUCATIONAL LOAN DOCUMEN- TAT ION ~ ~ . ~ LATEST EDITION DATE 04-89 INITIATING AGENCY TIB TIB TIB TIB TIB TIB TIB TIB NFC NFC L OFFICE OF PRIMARY INTEREST MA-41.2 MA-41.2 MA-41.2 MA-41. 2 MA-41. 2 MA-41.2 MA-41. 2 MA-41.2 MA-41. 2 MA-41.2 SOURCE OF SUPPLY MA-411 MA-411 MA-411 MA-411 MA-411 MA-411 MA-411 MA-411 MA-411 MA·411 COMMENTS L "'0)> PJ r-t­ \0 r-t­ COPJ n w ::r -""3 co ::s r-t- ~ (' (.; ~-"o No !.rn N,__. •w CX>~ 1.0~ . """' co -~,----·--··-~~'"~··-~--~-·-- ·----·-··-·--~,. i ~· \.. ' .. ·,. " FORM NUMBER TSP- 21H TSP- 21M TSP- 21R TSP- 22 TSP- 23 TSP- BKOI TSP- BK02 TSP- BK04

TSP- BKOS TITLE TSP FINANCIAL HARDSHIP LOAN DOCUMENATION TSP MEDICAL LOAN DOCUMENTATION TSP RESIDENTIAL LOAN DOCUMEN­ TATION TSP LOAN PAYMENT ALLOTMENT FOR M LOAN PAY SCHEDULE TSP WITHDRAWAL INFORMATION WITHDRAWING YOUR TSP ACCOUNT BALANCE (PACKAGE CONTAINS TSP FORMS 6, 7, 9. IJ-18) LOAN BOOKLET THRIFT SAVINGS PLAN ANNUITIES c LATEST EDITION DATE 03-88 INITIATING AGENCY NFC NFC NFC NFC NFC NFC liB liB TIB OFFICE OF PRIMARY INTEREST MA-41. 2 MA-41. 2 MA-41. 2 MA-41.2 MA-41.2 MA-41.2 MA-41. 2 MA-41.2 MA-41. 2 • \. SOURCE OF SUPPLY MA-41J MA-4ll MA-411 MA-411 MA-411 MA-411 MA-411 MA-411 MA-411 (' COMMENTS ...... 0 NO I IT1 ...... N,_. I W (X) N 1.0 N +::> c:c e 0 -c )::> Olri- \0 rl- ct>OI n w :::r U13 ct> ::I rl- N "''!<""""'"""'""'<r"l...,...~;-..~~'~l"'Jo<~~"W~~~~~!?I -~~~·~ll!lfl'l.IIQI""Il<iii~.,'!Jlll J$,J!lW~IIIJ!II'\4~1111'-~I!;,'III!!n>~~~ •• q;p ;;•~·~N """'''*""~""'~.-~ ..... ? l4f ~l;""\"'I~!JI ,i'<Siil¥("!1!4~ FORM NUMBER TITLE **TREASURY FMS- 2108 STATEMENT OF UNEXPENDED BALANCES FORM 1099MISC MISCELLANEOUS INCOME TFS- I664R REQUEST TO REMAIL UNDELIVERABLE CHECK AND/OR BOND **OTHER D- 4 D.C. WITHHOLDING MW- 507 MARYLAND WITHHOLDING VA- 4 VIRGINIA WITHHOLDING W- 4 FEDERAL WITHHOLDING L, ,. • I , LATEST EDlTION DATE I987 04/80 INITIATING AGENCY TO IRS TO ~ OFFICE OF PRIMARY INTEREST MA-3.2 MA-3.2 MA-3.2 MA-3.2 MA-3.2 MA-3.2 MA-3.2 SOURCE OF SUPPLY MA-331 MA-343.2 MA-343.2 ssss ssss ssss ssss . ........ ....._~ ,..,.... ,. COIIIENTS ~ "'U )::o Ill~ 1.0 ~ m tu (') w :::r 0"13 m ::::s ~ N (' (J ...... o NO I ITI ...... N._. I w 00 N 1.0 N ~ OJ