Form
Number
|
Form Title
|
ELM Reference
|
|---|
CFC 100
|
CFC Pledge Card
|
617.42
|
DD 214
|
Certificate of Release or Discharge From Active Duty
|
512.232
|
CA–1
|
Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
|
541.3, 542.111, 542.112, 542.21, 544.11, 544.12, 544.211, 544.212, 545.721, 545.724, 545.731, 545.75, 545.77, 547.51, 547.54, 821.121
|
CA–2
|
Notice of Occupational Disease and Claim for Compensation
|
541.3, 542.121, 542.21, 544.11, 544.12, 544.211, 544.212, 547.52, 821.121, 821.133
|
CA–2a
|
Notice of Federal Employee’s Recurrence of Disability and Claim for Pay/Compensation
|
541.3, 542.131, 542.21, 544.22, 545.722
|
CA–3
|
Report of Termination of Disability and/or Payment
|
525.148
|
CA–5
|
Claim for Compensation by Widow, Widower, and/or Children
|
541.3, 542.141, 542.21, 544.23, 821.123
|
CA–5b
|
Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren
|
541.3, 542.141, 542.21, 544.23
|
CA–6
|
Official Superior’s Report of Employee’s Death
|
541.3, 544.23, 821.123
|
CA–7
|
Claim for Compensation
|
525.141, 545.81, 545.82
|
CA–16
|
Authorization for Examination and/or Treatment
|
543.3, 544.12, 545.2, 545.21, 545.23, 545.44, 545.45, 545.5
|
CA–17
|
Duty Status Report
|
544.12, 545.52
|
CA–20
|
Attending Physician’s Report
|
525.141, 545.5
|
ES 931
|
Request for Wage Separation Information
|
551.422, 552.32, 552.51, 552.52, 553.13, 553.21, 553.23
|
ES 934
|
Request for Information or Reconsideration of Federal Findings
|
551.422, 552.42, 552.52, 553.22
|
ES 936
|
Request for Verification of UCFE Wage and Separation Information Furnished on Form ES 931
|
551.422, 552.52, 553.23
|
FE–6
|
Claim for Death Benefits (Federal Employees’ Group Life Insurance Program)
|
538.312, 538.33, 538.341, 567.31
|
FE–6 DEP
|
Statement of Claim
|
538.341
|
FE–7
|
Claim for Accidental Dismemberment
|
538.342
|
FE–8
|
Election of Living Benefits
|
534.4, 536.4
|
IRS Form W–4P
|
Withholding Certificate for Pension or Annuity Payments
|
589.52
|
OPM 1431
|
Spouse’s Consent to Survivor Election
|
564.24
|
OPM 1482
|
Agency Certification of Status of Reemployed Annuitant
|
537.131, 537.132
|
OPM 1528
|
Notification of Earnings for Medicare Eligibility
|
574.251
|
OSHA 2
|
Citation and Notification of Penalty
|
825.51, 825.6
|
OSHA 300
|
Log of Work–Related Injuries and Illnesses
|
812.32, 813.2, 813.31, 821.11, 821.122, 821.141, 821.144, 821.4, 824.41, 825.441
|
OSHA 300A
|
Summary of Injuries and Illnesses
|
812.32, 813.2, 813.31, , 821.142, 821.144, 821.4, 825.441
|
OSHA 301
|
Injury and Illness Incident Report
|
821.11, 821.122, 821.144
|
PS 50
|
Notification of Personnel Action
|
349.3, 354.23, 354.253, 365.213, 418, 421.516, 421.526, 422.155, 422.531, 422.831, 435.31, 495.48, 514.52, 519.233, 546.23, 552.41, 553.11, 553.12, 553.132, 935.211, 935.212, 935.262
|
PS 202
|
Health Benefits Refund Payment Authorization
|
525.132
|
PS 337
|
Clearance Record for Separated Employee
|
936.42
|
PS 820
|
Ranking of Position Request
|
212.2, 231, 232
|
PS 991
|
Application for Promotion or Assignment
|
354.242, 354.253
|
PS 999
|
Application for Reinstatement List
|
354.252, 354.271, 354.272
|
PS 1017–A
|
Time Disallowance Record
|
432.711
|
PS 1188
|
Cancellation of Organization Dues from Payroll Withholdings
|
925.11, 925.122, 925.5,
|
PS 1192
|
U.S. Savings Bond Authorization for Purchase and Request for Change
|
616.31
|
PS 1216
|
Employee’s Current Mailing Address
|
593.33, 665.5
|
PS 1221
|
Advanced Sick Leave Authorization
|
513.522
|
PS 1223–A
|
Earnings Statement
|
422.531, 422.831, 512.532
|
PS 1223–B
|
Earnings Statement – Net to Bank
|
422.531, 422.831, 924.71
|
PS 1224
|
Court Duty Leave – Statement of Service
|
516.23
|
PS 1314
|
Regular Rural Carrier Time Certificate
|
516.23
|
PS 1555
|
Statement of Account for CAGs H–L
|
868.133
|
PS 1723
|
Assignment Order
|
422.142
|
PS 1727
|
Award Recommendation/Authorization
|
495.47, 495.48
|
PS 1767
|
Report of Hazard, Unsafe Condition, or Practice
|
813.32, 814.1, 824.41, 824.61, 824.62, 824.631, 824.632, 824.633, 824.634, 824.635
|
PS 1769
|
Accident Report
|
821.11, 821.121, 821.123, 821.13, 821.131 821.131, 821.132821.142, 821.144, 824.41, 825.441
|
PS 1772
|
Accident Log
|
824.41
|
PS 1773
|
Report of Hazard Log
|
824.634
|
PS 1783
|
On-the-job Safety Review/Analysis
|
821.22
|
PS 1902
|
Justification for Billing Accounts Receivable
|
744.43
|
PS 1961
|
Employee Uniform Allowance Statement
|
938.4
|
PS 2146
|
Employee’s Claim for Personal Property
|
641.52
|
PS 2240
|
Pay, Leave, or Other Hours Adjustment Request
|
594.5
|
PS 2246
|
Terminal Leave Worksheet
|
512.7
|
PS 2342
|
Request: Unemployment Compensation Data
|
551.422
|
PS 2417
|
Confidential Statement of Employment and Financial Interests (for Use by Postal Service Employees)
|
662.2
|
PS 2432
|
Individual Training Progress Report
|
438.222, 732.11
|
PS 2485
|
Medical Examination and Assessment
|
546.621
|
PS 2488
|
Authorization for Medical Report
|
541.3, 545.5
|
PS 2489
|
Identification of Physical/Mental Disability
|
546.621
|
PS 2491
|
Medical Report – First Aid Injuries
|
541.3
|
PS 2548
|
Individual Training Record
|
732.13, 817.9
|
PS 2556
|
Third Party Statement of Recovery
|
541.3, 547.57, 547.7, Exhibit 547.57c
|
PS 2557
|
Employee’s Third–Party Recovery Statement
|
541.3, 547.58, 547.73, 547.74, Exhibit 547.58c, Exhibit 547.73
|
PS 2559
|
Third Party Claim – Information Request
|
541.3, 547.59b, Exhibit 547.59b
|
PS 2560
|
Referral of Third Party Material
|
541.3, 547.59, Exhibit 547.59d
|
PS 2562
|
Injury Compensation Program – Notice of Potential Third Party Claim
|
541.3, 547.55, 547.57, 547.58, 547.59, Exhibit 547.55
|
PS 2573
|
Request – OWCP Claim Status
|
541.3
|
PS 2577
|
Assignment of Claim to the USPS
|
541.3, 547.59, 547.72,
Exhibit 547.59c
|
PS 3074
|
Request for Waiver of Claim for Erroneous Payment of Pay
|
437.32, 437.4, 437.5
|
PS 3111
|
Specific Notice to Employees Entering (or Already in) Nonpay Status – Change in Health Benefits Regulations
|
525.222
|
PS 3189
|
Request for Temporary Schedule Change for Personal Convenience
|
516.33, 517.621
|
PS 3239
|
Payroll Deduction Authorization to Liquidate Postal Service Indebtedness
|
453.22
|
PS 3241
|
Statement of Receipts and Disbursements (Employee Social and Recreational Funds)
|
615.62, Exhibit 615.62
|
PS 3544
|
Post Office Receipt for Money
|
547.73
|
PS 3971
|
Request for or Notification of Absence
|
511.23, 511.42, 512.411, 512.412, 512.42, 512.421, 512.422, 513.331, 513.332, 513.34, 513.341, 513.342, 513.35, 514.51, 515.51, 516.33, 517.31, 517.621, 519.6, 519.742, 547.83
|
PS 3972
|
Absence Analysis
|
511.42, 513.393
|
PS 4584
|
Observation of Driving Practices
|
831.331
|
PS 4588
|
Observation of Work Practices — Delivery Services
|
812.52
|
PS 4589
|
Observation of Work Practices — General
|
812.52
|
PS 4943
|
Locker Record
|
612.241
|
PS 5900
|
Hiring Worksheet
|
344.1, 363.2
|
PS 6803
|
Wage and Separation Information
|
551.422, 552.32, 552.51, 553.13, 553.21, 553.221, 553.23
|
PS 6886
|
Thrift Savings Plan – Request for Retroactive Contributions
|
594.42, 594.43, 594.451, 594.46
|
PS 7314
|
Medical Agreement
|
868.131
|
PS 7381
|
Requisition for Supplies, Services, or Equipment
|
753.12
|
PS 8006
|
Uniform Allowance Code Sheet (For Regular, Contract, or Work Clothes Program)
|
935.212, 935.262, 938.4
|
PS 8201
|
Pre–Tax Health Insurance Premium Waiver/Restoration Form for Career Employees
|
524.832
|
PS 8202
|
Pre–Tax Health Insurance Premium Election/Waiver Form for Noncareer Employees
|
524.833
|
PS 8214
|
Certificate of OSHA, Safety, and Environmental Records Transfer
|
811.42
|
RI 76–10
|
Assignment of Federal Employees’ Group Life Insurance
|
534.5, 536.5
|
SF 8
|
Notice to Federal Employees About Unemployment Insurance
|
552.41, 553.12, 553.21
|
SF 180
|
Requests Pertaining to Military Records
|
512.232
|
SF 278
|
Financial Disclosure Report for Executive Branch Personnel
|
662.2
|
SF 813
|
Verification of a Military Retiree’s Service in Nonwartime Campaigns or Expeditions
|
512.232
|
SF 1150
|
Record of Leave Data
|
512.811, 512.812
|
SF 1152
|
Designation of Beneficiary – Unpaid Compensation of Deceased Civilian Employee
|
432.821
|
SF 1153
|
Claim for Unpaid Compensation of Deceased Civilian Employee
|
567.31, 567.334
|
SF 1187
|
Request for Payroll Deductions for Labor Organization Dues
|
924.11, 924.12, 924.4, 924.5, 924.72, 925.121, 925.122, 925.21, 925.5
|
SF 2800
|
Application for Death Benefits
|
567.31, 567.32, 567.33
|
SF 2801
|
Application for Immediate Retirement
|
562.352, 564.31
|
SF 2802
|
Application for Refund of Retirement Deductions
|
565.462, 565.514, 565.523
|
SF 2803
|
Application to Make Deposit or Redeposit
|
565.23
|
SF 2804
|
Application to Make Voluntary Contributions
|
565.41
|
SF 2806
|
Individual Retirement Record
|
525.149
|
SF 2809
|
Employee Health Benefits Election Form
|
521.613, 521.723, 521.73, 523.1, 523.2, 523.33, 523.4, 523.61, 523.632, 524.12, 524.32, 524.531, 524.542, 524.62, 524.64, 524.71, 524.921, 524.922, 524.95, 525.222, 525.233, 525.322, 525.422, 525.423, 525.454, 525.7, 526.322, 526.512, Exhibit 525.142, Exhibit 525.422
|
SF 2810
|
Notice of Change in Health Benefits Enrollment
|
521.613, 521.73, 523.632, 524.534, 524.542, 524.722, 524.73, 524.772, 524.773, 524.962, 524.966, 525.144, 525.145, 525.146, 525.222, 525.322, 525.422, 525.423, 525.441, 525.512, Exhibit 525.142, Exhibit 525.422
|
SF 2811
|
Transmittal and Summary Report to Carrier
|
526.52
|
SF 2817
|
Life Insurance Election (FEGLI)
|
534.343, 534.6, 535.113, 535.122, 535.124, 535.21, 535.22, 535.23, 535.24, 535.3, 535.51, 535.52, 535.611, 535.612, 535.63, 535.81, 535.831, 535.832, 535.911, 535.921, 537.132, 537.144, 539.11
|
SF 2818
|
Continuation of Life Insurance Coverage as a Retiree or Compensationer
|
534.343, 536.112, 536.211
|
SF 2819
|
Notice of Conversion Privilege – Federal Employees’ Group Life Insurance Program
|
534.341, 535.63, 535.722, 535.73
|
SF 2821
|
Agency Certification of Insurance Status
|
534.341, 535.63, 535.722, 537.172, 538.312, 538.322, 538.33, 539.12
|
SF 2822
|
Request for Insurance (FEGLI)
|
535.82, 535.831, 539.14
|
SF 2823
|
Designation of Beneficiary
|
534.343, 537.321, 538.111, 538.121, 538.124, 538.131, 538.16, 538.18, 539.13
|
SF 3102
|
Designation of Beneficiary – Federal Employees’ Retirement System
|
587.32
|
SF 3104
|
Application for Death Benefits
|
587.61, 587.62
|
SF 3106
|
Application for Refund of Retirement Deductions
|
585.51
|
SF 3107
|
Application for Immediate Retirement
|
582.78
|
SF 3107–2
|
Spouse’s Consent to Survivor Election
|
584.28
|
SF 3108
|
Application to Make Service Credit Payment
|
585.35
|
TSP–1
|
Thrift Savings Plan Election Form
|
591.36, 594.465
|
TSP–3
|
Designation of Beneficiary
|
597.41
|
TSP–16
|
Exception to Spousal Requirements
|
597.241
|
TSP–17
|
Information Relating to Deceased Participant
|
597.512
|
TSP–19
|
Transfer of Information Between Agencies
|
591.35
|
TSP–20
|
Thrift Savings Plan Loan Application
|
596.31, 596.32
|
TSP–21–R
|
Residential Loan Documentation
|
596.32
|
TSP–30
|
Interfund Transfer Request
|
593.23
|
TSP–75
|
Age–Based In–Service Withdrawal Request
|
597.32
|
TSP–76
|
Financial Hardship In–Service Withdrawal Request
|
597.32
|
WH 380-E
|
FMLA Certification of Health Care Provider for Employee’s Serious Health Condition
|
512.412, 513.332, 515.52
|
WH 380-F
|
FMLA Certification of Health Care Provider for Family Member’s Serious Health Condition
|
512.412, 513.332, 515.532
|
WH 381
|
FMLA Notice of Eligibility and Rights and Responsibilities
|
512.412, 513.332
|
WH 384
|
FMLA Certification for Qualifying Exigency for Military Family Leave
|
512.412, 515.535
|
WH 385
|
FMLA Certification for Serious Injury or Illness of Covered Servicemember — for Military Family Leave
|
512.412, 515.532
|
