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STANDARD FORMS

PDF Fill and Print Forms List
Form No. Product Code Form Title Rev. Date
std004.pdf  860002  Contract/Contractors Evaluation   5/2002  
std005.pdf  860001  Intra-Office Requisition (Local Request)   6/88  
std007.pdf  860013  Message Transmittal   5/96  
std008.pdf  860014  Special Handling Request   3/2007  
std009.pdf  860003  Space Action Request   3/2002  
std012.pdf  860004  Fresh Produce Weekly Order   Order Low Use Form via Sam Carbone (916) 445-5360. 4/2005  
std013a.pdf  860005  Intergovernmental Service Agreement and Invoice   6/88  
std016.pdf    Contract Award Report   11/92  
std017a.pdf  860007  Nondiscrimination Clause (OCP-1)   9/2000  
std018.pdf  860008  Standard California Nondiscrimination Construction Contract Specifications   Form is an instructional document. Fillable parts not available. 1/95  
std019.pdf  860009  Nondiscrimination Compliance Statement   3/95  
std020.pdf  860155  Telecommunications Service Request http://www.dts.ca.gov/stnd/resources/forms.asp?key=2113  9/2003  
std021.pdf  860010  Drug-Free Workplace Certification   12/93  
std025.pdf  860131  Transfer of Budget Allotment   9/94  
std026.pdf  860016  Budget Revision   7/2000  
std027.pdf  860011  Application for Discharge from Accountability   8/97  
std027a.pdf  860012  Claim For Reimbursement   4/2009  
std029.pdf  860034  Real Estate Service Request   10/2001  
std031.pdf  860051  Standard Budget Schedule   4/95  
std033.pdf  860062  Supplementary Schedule of Salaries and Wages   4/95  
std040a.pdf  860077  Sub-Purchase Order   6/2001c  
std059.pdf  860036  Operators Booklet http://www.ofa.dgs.ca.gov/StateFleetHandbook/default.htm  7/2000  
std061.pdf    Glove Box Directory of Approved Auto Repair Facilities http://www.ofaapps.dgs.ca.gov/Approved_Auto_Rpr_Fac/  3/2002  
std065.pdf  860017  Purchasing Authority Purchase Order   7/2003  
std065a.pdf  860019  Purchasing Authority Purchase Order Continuation   7/2003  
std066.pdf  860120  Purchase Estimate   10/2006  
std066a.pdf  860121  Purchase Estimate Continuation   6/94  
std067.pdf  860122  Publishing Order   2/2003  
std070.pdf  860020  Records Inventory Worksheet   5/92  
std071.pdf  860022  Records Transfer List   3/96  
std073.pdf  860025  Records Retention Schedule   6/2002  
std076.pdf  860100  State Records Center Reference Request   11/2006  
std096.pdf  860026  Purchase Order/Estimate Change Request   4/94  
std099.pdf  860027  Report of Crime on State Property http://www.chp.ca.gov/pdf/std_99.pdf  11/2006  
std100.pdf  860103  Office Memo   4/95  
std100b.pdf  860105  Mini Memo   9/70c  
std106.pdf  860028  Stock Received Report   5/82c  
std107.pdf  860079  Notice of Correction of Invoice   8/2005  
std108.pdf  860023  Returned Stock Report   5/94  
std115.pdf  860127  Storeroom Supplies Order   7/88  
std115a.pdf  860029  Requisition-Direct Deliveries Receipt   4/94  
std116.pdf  860030  Supply Order   6/99  
std119.pdf  860134  Stock Control Record/Stock Price Quotation   8/97  
std152.pdf  860031  Property Survey Report   9/2000c  
std157.pdf  860032  Property Inventory Listing   6/94  
std158.pdf  860033  Property Transfer Report   7/2000  
std204.pdf  860035  Payee Data Record   6/2003  
std208.pdf  860156  Penalty Calculation   1/2000  
std209.pdf  860135  Invoice Dispute Notification   7/2006  
std210.pdf  860037  Short Form Contract (For agreements up to $9,999.99) http://www.ols.dgs.ca.gov/contracting+info/formsandinstruction.htm  6/2001  
std213.pdf  860190  Standard Agreement http://www.ols.dgs.ca.gov/Contracting+Info/formsandinstruction.htm  9/2001  
std213a.pdf  860191  Standard Agreement Amendment http://www.ols.dgs.ca.gov/Contracting+Info/formsandinstruction.htm  4/2001  
std215.pdf  860192  Agreement / Summary http://www.ols.dgs.ca.gov/Contracting+Info/formsandinstruction.htm  4/2001  
std218cont.pdf  860038  Claim Schedule (CALSTARS)   3/91  
std218dd.pdf  860039  Claim Schedule – EFT Transactions   6/94  
std218et.pdf  860040  Claim Schedule Electronic Tape   6/94  
std219tt.pdf  860195  Replenishment Claim Schedule   4/2005  
std236.pdf  860041  Hotel/Motel Transient Occupancy Tax Waiver (Exemption Certificate for State Agencies)   9/91  
std242.pdf  860043  U.S. Savings Bonds Purchase/Payroll Deduction Authorization   Fill & Print eForm STD242 (REV. 12/2005) is due to be published April 16,2006 12/2005  
std243.pdf  860044  Designation of Persons Authorized to Receive Warrants (Government Code Section 12479)   12/2004  
std250.pdf  860045  Employee Asbestos Notification   3/2002  
std254.pdf  860137  Straight Bill of Lading   6/2005  
std255.pdf  860046  Moving Service Authorization (Employee Household Goods)   7/2006  
std255a.pdf  860138  Moving Service Authorization (Bid Proposal – Mobile Home)   7/2006  
std255c.pdf  860047  Excess Lodging Rate Request/Approval   12/2005  
std256.pdf  860048  Moving/Relocation Expense Approval Request   2/96  
std257.pdf  860049  Out-of-State Travel Approval Request   5/94  
std257c.pdf  860050  Out-of-State Travel Request   5/94  
std260.pdf  860052  Blanket Approval for Out-of-State Travel   5/94  
std261.pdf  860053  Authorization to Use Privately Owned Vehicles on State Business   3/95  
std262.pdf  860054  Travel Expense Claim   9/2007  
std262a.pdf  860139  Travel Expense Claim (CALSTARS)   9/2007  
std265.pdf  860055  Insurance Verification and Authorization to Operate Privately Owned/Rented Leased Aircraft on State Business   2/91  
std268.pdf  860056  Accident Report (Other than Motor Vehicle)   11/2007  
std269.pdf  860140  Accident Identification   6/2008  
std270.pdf  860141  Vehicle Accident Report http://www.orim.dgs.ca.gov/Publications/270.htm  2/2002  
std273.pdf  860058  Official Monthly Travel Log   9/2006  
std274.pdf  860144  Review of State Driver Accident (Supervisor's)   1/2003  
std275.pdf  860057  Claims Against the State of California   3/93  
std276.pdf  860059  Vehicle Usage Justification   10/96  
std276a.pdf  860060  Passenger Vehicle Usage Report   1/2007  
std278.pdf  860063  Superior Accomplishment Gift or Cash Award Recommendation   8/98  
std340.pdf  860145  Audit Report   2/75  
std377.pdf  860064  Vehicle Home Storage Request/Permit   9/2008  
std399.pdf  860065  Fiscal Impact Statement (Regulations and Orders)   12/2008  
std400.pdf  860067  Notice Publication/Regulations Submission   4/99  
std404c.pdf  860147  Remittance Advice (Continuous) (carbonless)   4/95  
std407.pdf  860068  Payroll Header Change   4/97  
std422.pdf  860149  Salary Advances Paid/Offset Report   8/2005  
std432.pdf  860150  Stop Payment Request   The Std. 432 is temporarily unavailable because of a technical difficulty. We are sorry for the inconvenience and are currently working to correct this problem. 6/9/05 4/2006c  
std435.pdf  860069  Request for Duplicate Controller's Warrant/Stop   9/2000c  
std436.pdf  860061  Duplicate Wage and Tax Statement Request   9/2006c  
std438.pdf  860151  Revolving Fund Disbursement Voucher   10/2006  
std439.pdf  860152  Disbursement Voucher   3/2002  
std440.pdf  860143  Transfer Receipt   1/2006  
std442.pdf    Report of Deposit (Bank of America)   eForm Print Only Sample. Must order Paper Form. (Emergency Supply Only) 5/2001  
std442p.pdf    Report of Deposit (Bank of America Presort Account)   eForm Print Only Sample. Must order Paper Form. (Emergency Supply Only) 2/97  
std442m.pdf    Report of Deposit (Bank of America Misc-Sort Account)   eForm Print Only Sample. Must order Paper Form. (Emergency Supply Only) 3/2002  
std445.pdf  860070  Report of Bank/Savings and Loan Association Account-Outside the Treasury System   6/98  
std447.pdf    Report of Deposit (Union Bank of California)   eForm Print Only Sample. Must order Paper Form. (Emergency Supply Only) 2/97  
std449.pdf    Report of Deposit (West America Bank)   eForm Print Only Sample. Must order Paper Form. (Emergency Supply Only) 2/97  
std457.pdf  860071  CSU Student Payroll Action Request   10/2008  
std458.pdf  860072  Voluntary Child Support Deduction/Authorization   6/2001  
std459.pdf  860073  Voluntary Spousal Support Deduction/Authorization   4/90  
std500.pdf    The Work Number – Employee http://www.sco.ca.gov/Files-PPSD/empinfo_howto_std500.pdf  12/2005  
std501.pdf    The Work Number – Verifier http://www.sco.ca.gov/Files-PPSD/empinfo_howto_verify.pdf  10/98  
std567.pdf  860157  Depositor's Disbursement Voucher   4/97  
std603.pdf  860075  Absences Without Pay Report   10/92  
std607.pdf  860076  Change in Established Position   10/2008  
std607a.pdf  860158  Change in Established Position   12/93  
std608.pdf  860159  Established Position Record (Permanent)   4/2002  
std608a.pdf  860160  Established Position Record (Temporary)   9/2008  
std610.pdf  860074  Health Questionnaire (With Physician’s Report)   12/2002  
std612.pdf  860078  Employee Transfer Data   6/2001  
std618.pdf  860162  Benefit Option Selection   4/93  
std618s.pdf  860080  Industrial Disability Leave With Supplementation Benefits Information and Options Selection   6/94  
std619.pdf  860081  Industrial Disability Benefits Information   7/93  
std625.pdf  860082  Classification and/or Certification Action Request   8/88  
std628.pdf  860083  Employment Inquiry   6/2009  
std630.pdf  860085  Employee Contract Grievance   10/95  
std631.pdf  860086  Excluded Employee Grievance   8/2002  
std634.pdf  860088  Absence and Additional Time Worked Report   8/2002  
std636.pdf  860089  Report of Performance for Probationary Employee   8/2002  
std636a.pdf  860087  Report of Performance for Probationary Employee (For Performance Based Budget Agencies)   6/96  
std637.pdf  860161  Performance Appraisal Summary/Individual Development Plan   7/94c  
std639.pdf  860091  Salary Garnishment   5/2009  
std639cfs.pdf  860091  Salary Garnishment – Child Support / Family Support   5/2009  
std640.pdf  860092  Employee Attendance Summary   9/2008c  
std642.pdf  860163  Monthly Employee Leave Record   4/93  
std644.pdf  860093  Annual Leave Credits Statement   9/94  
std645.pdf  860094  Employee Suggestion   7/2007  
std645a.pdf  860095  Suggestion Evaluation Report   4/95  
std650.pdf  860096  Miscellaneous Deduction Change Report   8/2005  
std653.pdf  860097  Long-Term Assignment (LTA) Information and Certification of Subsistence Rate   6/94  
std654.pdf  860164  Long-Term Assignment Cost Analysis   8/89  
std666.pdf  860098  Payroll Exceptions Report   3/97  
std671.pdf  860166  Miscellaneous Payroll/Leave Actions   12/99  
std674.pdf  860167  Payroll Adjustment Notice   10/2000  
std674ar.pdf  860168  Payroll Adjustment Notice – Accounts Receivable (A/R)   2/3/06 STD. 674AR (REV. 12/2005) is under construction. It is anticipated to be completed April 14, 2006 12/2005  
std674d.pdf  860169  Industrial/Non-Industrial Disability Pay Request   STD. 674D is under development. Expected completion date is Feb. 15, 2008. 7/2006  
std675.pdf  860099  Supplemental Wage Deduction   9/97  
std676p.pdf  860102  Non-USPS Adjustment Request – Payments   10/2008  
std676v.pdf  860154  Non-USPS Adjustment Request – Values   10/2008  
std677.pdf  860170  Nondisclosure of Employee Home Address Request   2/99  
std678.pdf  860171  Examination and/or Employment Application http://www.spb.ca.gov/jobs/stateapp_adobe.htm  12/2006c  
std680a.pdf  860172  Personnel Action Request   8/2003  
std681.pdf  860173  Monthly Attendance Report   1/2000  
std682.pdf  860174  Authorization for Extra Hours   2/2007  
std683.pdf  860175  Pay Adjustment Request (New)   6/2000  
std686.pdf  860176  Employee Action Request   7/2007c  
std687.pdf  860177  Separation/Disposition of CalPERS Contributions   Fill and Print eForm STD. 687 (REV. 11/2006) is being deveoped and is not available. 11/2006  
std688.pdf  860104  Oath of Office   11/99  
std689.pdf  860106  Oath of Allegiance and Declaration of Permission to Work for Persons Employed by the State of California   5/2002  
std692.pdf  860178  Dental Plan Enrollment Authorization   6/26/08 Fill & Print Form STD. 629 (REV. 2/2008) is under review by the author agency. Expected to be approved and added to website by July 17, 2008. 2/2008  
std696.pdf  860179  Dental Plan Direct Payment Authorization   5/2008  
std697.pdf  860107  Training Request   10/2004  
std698.pdf  860180  Life Insurance Enrollment Authorization   3/97  
std699.pdf  860181  Direct Deposit Enrollment Authorization   1/2006  
std700.pdf  860108  Vision Plan Enrollment Authorization   6/2/08 WEB PDF REV. 2/2008 is expected to be completed within the next two weeks. 2/2008  
std701c.pdf  860109  Cash Option Enrollment Authorization – FlexElect Program   9/2005  
std701r.pdf  860110  Reimbursement Account Enrollment Authorization – FlexElect Program   5/2002  
std702.pdf  860182  Consolidate Benefits (CoBen) Cash Enrollment Election   4/2000  
std703.pdf  860123  Vision Plan Direct Payment Authorization   12/2008  
std750.pdf  860111  Managerial Performance Appraisal Summary   6/94  
std802.pdf  860112  Federal Excise Tax Exemption Certificate   9/93  
std805a.pdf  860113  State Agency Trust Check Replacement Application (Executed WITHIN the State of California)   9/2001  
std805b.pdf  860114  State Agency Trust Check Replacement Application (Executed OUTSIDE the State of California)   4/94  
std807.pdf  860115  Payment Bond to Accompany Construction Contract   9/87  
std810.pdf  860116  Contracting Activity Report http://www.documents.dgs.ca.gov/pd/smallbus/reportspage/Std810test.xls  11/2003  
std811.pdf  860117  Small Business Preference and Certification Request   12/2007  
std812.pdf  860184  Disabled Veterans Business Enterprise Certification Application http://www.pd.dgs.ca.gov/smbus/paperapp.htm  1/2002  
std815.pdf  860118  Advertising in the Contracts Register   6/2002  
std821.pdf  860119  Contract Advertising Exemption Request   10/2006  
std830.pdf  860186  Target Area Contract Preference Act Preference Request For Goods and Services   1/2005  
std831.pdf  860187  Enterprise Zone Act (EZA) Preference Request   1/2005  
std832.pdf  860188  Local Agency Military Base Recovery Area (LAMBRA) Preference Request   1/2005  
std840.pdf  860124  Disabled Veteran Business Enterprise Participation Summary   The Std. 840 is temporarily unavailable. It will be returned as soon as the Prescribing Document, which you will need to properly prepare the newly revised form, becomes available. For the interim, please continue to use the existing procedures, available summary form, etc. These documents are located on the DGS-PD Small Business and DVBE services website at: www.pd.dgs.ca.gov/smbus 3/2007  
std840a.pdf  860125  Additional Disabled Veteran Business Enterprise Contacts   The Std. 840A is temporarily unavailable. It will be returned as soon as the Prescribing Document, which you will need to properly prepare the newly revised form, becomes available. For the interim, please continue to use the existing procedures, available summary form, etc. These documents are located on the DGS-PD Small Business and DVBE services website at: www.pd.dgs.ca.gov/smbus 3/2007  
std843.pdf    Disabled Veterans Business Enterprise Equipment Owner or Broker Declaration http://www.pd.dgs.ca.gov/smbus/default.htm  5/2006  
std850.pdf  860128  Fire Safety Inspection Request   4/2000  
std897.pdf  860129  Bilingual Pay Authorization   4/95  
std910.pdf  860084  Essential Functions Health Questionnaire   Established January 2002 to replace STD. 610 HQ. 1/2002  
std912.pdf  860126  Military Service Declaration   7-94  
std995a.pdf  860132  Non-USPS-Agency Collection Accounts Receivable   7/94  
std995r.pdf  860133  Non-USPS Refund of Overcollections   7/94  
Updated : 8/14/2007