Directives and Forms Catalog - USPS.com® - About
Directives and Forms Catalog - USPS.com® - About Directives and Forms Catalog - USPS.com® - About
Non-Postal Government Documents Form Number Edition Date Oldest Usable Date Title Stock Number Directives and Forms Catalog Where Used USPS Source ATF 5330.3C 3/00 3/00 Release and Receipt of Imported Firearms, Ammunition and Implements of War (4-part set) 7530-03-000-1140 PO GPO SE ATF 6-A 1/87 1/87 Application Permit for Import Firearms, Ammunition Compliance of War 7530-03-000-1141 PO GPO SH CA 1 4/99 4/99 Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/ Compensation 7530-03-000-9308 PS MDC N/A CA 2 1/97 1/97 Notice of Occupational Disease and Claim for Compensation 7530-03-000-9152 PS MDC SH CA 2-A 9/96 9/96 Notice of Recurrence 7530-03-000-9148 PS MDC SH CA 5 1/97 1/97 Claim for Compensation by Widow, Widower, and/or Children 7530-01-000-9200 PS MDC SH CA 5-B 1/97 1/97 Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren 7530-01-000-9248 PS MDC EA CA 6 1/97 1/97 Official Superior’s Report of Employee’s Death 7530-04-000-5307 PS MDC SH CA 7 11/98 11/98 Claim for Compensation 7530-03-000-9195 PS MDC SH CA 7/CA 20 11/99 11/99 Claim for Compensation on Account of Traumatic Injury or Occupational Disease 7530-03-000-9195 PS MDC N/A CA 7A 6/96 6/96 Time Analysis Form 7530-03-000-8658 PS MDC EA CA 7B 6/96 6/96 Leave Buy Back (LBB) Worksheet/ Certification and Election 7530-03-000-8659 PS MDC EA CA 10 8/87 8/87 What a Federal Employee Should Do When Injured at Work (card) 7530-03-000-9355 PS MDC EA CA 11 4/99 4/99 When Injured at Work 7530-02-000-9976 ERM MDC EA CA 13 7/87 7/87 Work Injury Benefits for Federal Employees (card) 7530-03-000-9035 PS MDC EA CA 16 2/05 2/05 Authorization for Examination and/or Treatment 7530-03-000-9302 PS MDC PK CA 17 1/97 1/97 Duty Status Report 7530-03-000-9116 PS MDC SH CA 20 1/99 1/99 Attending Physician’s Report CA 35-A 8/88 8/85 Evidence Required in Support of a Claim for Occupational Diseases 7530-01-000-9192 PS MDC SH CA 35-B 8/88 8/85 Evidence Required in Support of a Claim for Work-Related Hearing Loss 7530-01-000-9193 PS MDC SH CA 35-C 10/87 10/87 Evidence Required in Support of a Claim for Asbestos-Related Illness 7530-01-000-9194 PS MDC SH CA 35-D 8/88 8/88 Evidence Required in Support of a Claim for Work-Related Coronary/Vascular Condition 7530-01-000-9195 PS MDC EA CA 35-E 8/88 8/88 Evidence Required in Support of a Claim for Work-Related Skin Disease 7530-02-000-9892 PS MDC SH CA 35-F 8/88 8/88 Evidence Required in Support of a Claim for Work-Related Pulmonary Illness (not Asbestosis) 7530-01-000-9197 PS MDC SH CA 35-G 8/88 8/88 Evidence Required in Support of a Claim for Work-Related Psychiatric Illness 7530-01-000-9198 PS MDC SH CA 35-H 10/87 10/87 Evidence Required in Support of a Claim for Work-Related Carpal Tunnel Syndrome 7530-02-000-7001 PS MDC SH CA 915 2/99 2/99 Claimant Medical Reimbursement Form 7530-04-000-5308 PS MDC EA DD 285 8/76 8/76 Appointment of Unit Mail Clerk or Mail Orderly (card) 7530-03-000-1148 PO HQO EA Unit of Issue 134 Publication 223, May 2013
Form Edition Oldest Usable Where USPS Unit of Number Date Date Title Stock Number Used Source Issue EN 1122 5/09 5/09 Short Form Statement of Recovery (Department of Labor) N/A PS DOL N/A FD 258 12/82 12/82 Fingerprint Chart— Applicant (card) 7530-01-000-9306 PS MDC EA FE 6 1/99 1/99 Claim for Death Benefits (Federal Employees’ Group Life Insurance) (3 pages) 7530-01-000-9307 PS MDC SH FE 6-DEP 6/99 6/99 Statement of Claim — Option C, Family Life Insurance 7530-01-000-9308 PS MDC N/A GSA 2957 3/88 3/88 Reimbursable Work Authorization (9part set) 7530-03-000-1149 PO GSA SE GSA 2972 4/93 4/93 Agency Request for Adjustment to FBF SLUC Billings 7530-03-000-1150 AR GSA SH GSA 3305 5/89 5/89 Appraisal of Fair Annual Rental Rate 7530-03-000-1151 PS GSA SH GSA 3357 8/80 8/80 Appraisal of Fair Annual Parking Rate 7530-03-000-1152 PS GSA SH HCFA 1500 4/92 4/92 Health Insurance Claim Form (4 pages) 7530-01-000-9309 PS MDC SH IRS 3435 2/79 2/79 Payer’s Request for Identifying Number 7530-03-000-1153 CE HQO SH IRS 4782 1989 1989 Employee Moving Expense Information 7530-03-000-1154 SC HQO SH OF 7 9/88 9/88 Property Pass 7540-00-000-4264 PS MDC SH OF 11 7/87 7/87 Reference Request — Federal Records Center 7530-03-000-1155 PS GSA HD OF 15 12/60 12/60 Government Property Sales Announcement and Poster Combined 7540-00-473-5482 PS MDC HD OF 16 12/60 12/60 Sales Slip — Sale of Government Personal Property (4-part set) 7540-00-753-4941 PS MDC HD OF 27 1/94 1/94 U.S. Government Two-Way Memo (3part set) 7540-00-082-2447 PS MDC HD OF 346 11/85 11/85 U.S. Government Motor Vehicle Operator’s Identification (card) 7530-00-634-3999 PS MDC HD OF 363 7/94 7/94 Memorandum of Call 7540-00-634-4018 PS MDC PG OFI 36 2/92 2/92 Additional Data for Single Scope Background Investigations and Other Background Investigations 7530-03-000-1156 IC OPM SH OFI 79 8/94 8/91 Notice of Personnel Investigation 7530-03-000-1157 IC MDC EA OMB I-9 11/91 11/91 Employment Eligibility Verification 7530-02-000-9900 PS MDC SH OMB 1218- 4/86 4/86 Recordkeeping Guidelines for 7610-04-000-6181 ERM MDC N/A 0176 Occupational Injuries and Illnesses OPM 71 9/09 Previous editions usable Request for Leave or Approved Absence PS N/A SF 15 12/04 2/90 Application for 10-Point Veteran Preference 7540-00-634-3972 PS MDC SH SF 52 7/91 7/91 Request for Personnel Action 7540-01-333-6239 PS GSA HD SF 59 1/79 1/79 Request for Approval of Noncompetitive Action PS OPM SF 61 8/02 8/02 Appointment Affadavits PS OPM SF 62 10/79 10/79 Agency Request to Pass Over a Preference Eligible or Object to an Eligible PS OPM SF 75 10/91 1/89 Request for Preliminary Employment Data (4 pages) 7540-00-682-6750 PS GSA HD SF 81 2/89 2/89 Request for Space 7540-00-634-4030 PS GSA HD SF 85 9/95 9/95 Questionnaire for Non-Sensitive Positions PS OPM SF 85P 9/95 9/95 Questionnaire for Public Trust Positions PS OPM SF 85P-S 9/95 9/95 Supplemental Questionnaire for Selected Positions PS OPM SF 86 7/02 9/95 Questionnaire for National Security Positions 7540-00-634-4036 PS OPM HD Publication 223, May 2013 135
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Form<br />
Edition<br />
Oldest<br />
Usable<br />
Where <strong>USPS</strong> Unit of<br />
Number Date Date Title Stock Number Used Source Issue<br />
EN 1122 5/09 5/09 Short Form Statement of Recovery<br />
(Department of Labor)<br />
N/A PS DOL N/A<br />
FD 258 12/82 12/82 Fingerprint Chart— Applicant (card) 7530-01-000-9306 PS MDC EA<br />
FE 6 1/99 1/99 Claim for Death Benefits (Federal<br />
Employees’ Group Life Insurance) (3<br />
pages)<br />
7530-01-000-9307 PS MDC SH<br />
FE 6-DEP 6/99 6/99 Statement of Claim — Option C, Family<br />
Life Insurance<br />
7530-01-000-9308 PS MDC N/A<br />
GSA 2957 3/88 3/88 Reimbursable Work Authorization (9part<br />
set)<br />
7530-03-000-1149 PO GSA SE<br />
GSA 2972 4/93 4/93 Agency Request for Adjustment to FBF<br />
SLUC Billings<br />
7530-03-000-1150 AR GSA SH<br />
GSA 3305 5/89 5/89 Appraisal of Fair Annual Rental Rate 7530-03-000-1151 PS GSA SH<br />
GSA 3357 8/80 8/80 Appraisal of Fair Annual Parking Rate 7530-03-000-1152 PS GSA SH<br />
HCFA 1500 4/92 4/92 Health Insurance Claim Form (4 pages) 7530-01-000-9309 PS MDC SH<br />
IRS 3435 2/79 2/79 Payer’s Request for Identifying Number 7530-03-000-1153 CE HQO SH<br />
IRS 4782 1989 1989 Employee Moving Expense Information 7530-03-000-1154 SC HQO SH<br />
OF 7 9/88 9/88 Property Pass 7540-00-000-4264 PS MDC SH<br />
OF 11 7/87 7/87 Reference Request — Federal Records<br />
Center<br />
7530-03-000-1155 PS GSA HD<br />
OF 15 12/60 12/60 Government Property Sales<br />
Announcement <strong>and</strong> Poster Combined<br />
7540-00-473-5482 PS MDC HD<br />
OF 16 12/60 12/60 Sales Slip — Sale of Government<br />
Personal Property (4-part set)<br />
7540-00-753-4941 PS MDC HD<br />
OF 27 1/94 1/94 U.S. Government Two-Way Memo (3part<br />
set)<br />
7540-00-082-2447 PS MDC HD<br />
OF 346 11/85 11/85 U.S. Government Motor Vehicle<br />
Operator’s Identification (card)<br />
7530-00-634-3999 PS MDC HD<br />
OF 363 7/94 7/94 Memor<strong>and</strong>um of Call 7540-00-634-4018 PS MDC PG<br />
OFI 36 2/92 2/92 Additional Data for Single Scope<br />
Background Investigations <strong>and</strong> Other<br />
Background Investigations<br />
7530-03-000-1156 IC OPM SH<br />
OFI 79 8/94 8/91 Notice of Personnel Investigation 7530-03-000-1157 IC MDC EA<br />
OMB I-9 11/91 11/91 Employment Eligibility Verification 7530-02-000-9900 PS MDC SH<br />
OMB 1218- 4/86 4/86 Recordkeeping Guidelines for<br />
7610-04-000-6181 ERM MDC N/A<br />
0176<br />
Occupational Injuries <strong>and</strong> Illnesses<br />
OPM 71 9/09 Previous<br />
editions<br />
usable<br />
Request for Leave or Approved Absence PS N/A<br />
SF 15 12/04 2/90 Application for 10-Point Veteran<br />
Preference<br />
7540-00-634-3972 PS MDC SH<br />
SF 52 7/91 7/91 Request for Personnel Action 7540-01-333-6239 PS GSA HD<br />
SF 59 1/79 1/79 Request for Approval of Noncompetitive<br />
Action<br />
PS OPM<br />
SF 61 8/02 8/02 Appointment Affadavits PS OPM<br />
SF 62 10/79 10/79 Agency Request to Pass Over a<br />
Preference Eligible or Object to an<br />
Eligible<br />
PS OPM<br />
SF 75 10/91 1/89 Request for Preliminary Employment<br />
Data (4 pages)<br />
7540-00-682-6750 PS GSA HD<br />
SF 81 2/89 2/89 Request for Space 7540-00-634-4030 PS GSA HD<br />
SF 85 9/95 9/95 Questionnaire for Non-Sensitive<br />
Positions<br />
PS OPM<br />
SF 85P 9/95 9/95 Questionnaire for Public Trust Positions PS OPM<br />
SF 85P-S 9/95 9/95 Supplemental Questionnaire for<br />
Selected Positions<br />
PS OPM<br />
SF 86 7/02 9/95 Questionnaire for National Security<br />
Positions<br />
7540-00-634-4036 PS OPM HD<br />
Publication 223, May 2013 135
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