forms stocked at the beltsville service center · forms stocked at the beltsville service center...

43
FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER Sponsor Stk-No UIS Desc Edition AMS/GIPSA AD-1023 PK100 CONTAINER EXAMINATION WORKSHEET 11/1/1986 FLEXIBLE CONTAINER AD-748 PD100 CONTAINER EXAMNTN WORKSHT 5/1/1985 AD-749 PD 100 CUMULATIVE ORIGNL INSP OF CONDITION OF 11/1/1977 CONTAINER APHIS AD-1038 PK100 STATEMENT OF UNDERSTANDING 10/1/1987 AD-1039 PK100 TRAINING PLAN-AGREEMENT 12/1/1987 AD-741 PD100 CONTAINER EXAMNTN WORKSHT (TABLE V & 11/1/1986 TABLE VII) ARS AD-245-4 PKG100 REQUEST FOR PUBLICATION 8/1/1984 AD-941 PKG50 BIOLOGICAL SHIPMENT RECORD-FOREIGN 11/1/1995 OVERSEAS SOURCE AD-942 PKG100 BIOLOGICAL SHIPMENT RECORD QUARANTINE 5/1/1990 FACILITY AD-943 PK100 BIOLIGICAL SHIPMENT 4/1/1998 Friday, April 30, 2004 Page 1 of 41

Upload: others

Post on 22-Jan-2020

13 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER Sponsor Stk-No UIS Desc Edition AMS/GIPSA AD-1023 PK100 CONTAINER EXAMINATION WORKSHEET 11/1/1986 FLEXIBLE CONTAINER AD-748 PD100 CONTAINER EXAMNTN WORKSHT 5/1/1985 AD-749 PD 100 CUMULATIVE ORIGNL INSP OF CONDITION OF 11/1/1977 CONTAINER

APHIS AD-1038 PK100 STATEMENT OF UNDERSTANDING 10/1/1987 AD-1039 PK100 TRAINING PLAN-AGREEMENT 12/1/1987 AD-741 PD100 CONTAINER EXAMNTN WORKSHT (TABLE V & 11/1/1986 TABLE VII)

ARS AD-245-4 PKG100 REQUEST FOR PUBLICATION 8/1/1984 AD-941 PKG50 BIOLOGICAL SHIPMENT RECORD-FOREIGN 11/1/1995 OVERSEAS SOURCE AD-942 PKG100 BIOLOGICAL SHIPMENT RECORD QUARANTINE 5/1/1990 FACILITY AD-943 PK100 BIOLIGICAL SHIPMENT 4/1/1998

Friday, April 30, 2004 Page 1 of 41

Page 2: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-944 PKG25 RECORD OF SHIPMENT OF EXOTIC 10/1/1994 MICROORGANISMS FOR AD-944A PKG25 RECORD OF RELEASE OF EXOTIC 10/1/1994 MICROORGANISMS FOR

BSC SHIPPING LABELS RO SHIPPING LABELS (INTERNAL USE ONLY) 1/31/2003 CSRS AD-416 BX1000 RESEARCH WORK UNIT/PROJ DESCPTN-RES 4/1/1992 RESUME-INPUT AD-417 PK100 RES WORK UNIT/PROJECT DESCPTN/CLASSN OF 4/1/1992 RES-INPUT AD-427 PD 100 REQUEST FOR INFORMATION RETRIEVAL 4/1/1979 DA OO-RI 71-013 EA A FEE-FOR-SERVICE PLAN WITH PREFERRED 2004 PROVIDER ORGANIZATIONS

DA/OO AD-1146 EA CHILDREN SERVICES POSTER 2001 AD-1148 EA CHILDREN SERVICES BROCHURE 2001 FAS AD-1072 EA BUILDING ON THE FRAMEWORK FOR CHANGE 3/1/1991 WOMEN AD-121 PKG100 PASSPORT REQUEST 2/1/1990 AD-750 PD 50 INTERNATIONAL TRAVEL CLEARANCE 5/1/1991 FMD AD-222 PD100 SPACE EVALUATION CHECK SHEET 4/1/1986

Friday, April 30, 2004 Page 2 of 41

Page 3: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

GSA-2957 EA REIMBURSABLE WORK AUTHORIZATION 3/1/1988 SF-118 PK100 REPORT OF EXCESS REAL PROPERTY 5/1/1996 SF-81 PK100 REQUEST FOR SPACE 2/1/1989 FNS AD-475B EA ***FNS ONLY*** AND JUSTICE FOR ALL Dec-99 AD-475C EA **FNS USE ONLY** AND JUSTICE FOR ALL 12/1/1999 AD-1060(SP) EA AND JUSTICE FOR ALL SPANISH AD-475A EA AND JUSTICE FOR ALL (ALL) 3/1/1998 FS AD-777 BK INNOVATE DEVELOP ENCOURAGE ACTIVATE 7/1/1985 SUGGEST

MRMD 270H BX "MRMD COPIER PAPER, SALMON, 8-1/2 X 11""" 53-E-1828 HD "ENVELOPE, KRAFT, 9-1/2 X 12, BLANK" 53-E-2906-31A HD "NFC ENVELOPE, GREEN, METERED, 9-1/2 X 7/1/1984 53-E-2906-45A HD "NFC ENVELOPE, GREEN, METERED, 10 X 15" 7/1/1984 53-E-6010 HD "ENVELOPE, WHITE, METERED, 4-1/8 X 9-1/2" 1/1/1983 53-E-6015 HD "ENVELOPE, WHITE WINDOW, METERED, 4-1/8 1/1/1983 X 9-1/2" 53-E-6020 HD "ENVELOPE,WHITE, METERED, 6-1/16 X 10-1/2" 1/1/1983 53-E-6025 HD "ENVELOPE, KRAFT, METERED, 9-1/2 X 12" 1/1/1983 53-E-6030 HD "ENVELOPE, KRAFT, METERED, 10 X 15" 1/1/1983 53-E-8700 HD "ENVELOPE, BLUE, ""SPECIAL ATTENTION"" 3-7/8 X 8-7/8""" 53-E-8701 HD "ENVELOPE, BLUE, ""SPECIAL ATTENTION"", 11/1/1987 6982-5 BX "MRMD BULK PAPER SUPPLY, PEACH-TAN, 11 X 17""" 7530-00-181-7174 BX "MRMD COPIER PAPER, WHITE, 8-1/2 X 11""" 7530-00-181-7175 BX "MRMD COPIER PAPER, WHITE, 8-1/2 X 14"""

Page 4: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Friday, April 30, 2004 Page 3 of 41

Page 5: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

7530-01-033-8891 BX "MRMD COPIER PAPER, WHITE, 8-1/2 X 11"", 3-HOLE PCHD" 7530-01-146-3361 BX "MRMD COPIER PAPER, BLUE, 8-1/2 X 11""" 7530-01-147-6811 BX "MRMD COPIER PAPER, YELLOW, 8-1/2 X 11""" 7530-01-147-6812 BX "MRMD COPIER PAPER, GREEN, 8-1/2 X 11""" 7530-01-148-1766 BX "MRMD COPIER PAPER, BUFF, 8-1/2 X 11""" 7530-01-150-0334 BX "MRMD COPIER PAPER, PINK, 8-1/2 X 11""" 7530-01-181-7175 BX "MRMD COPIER PAPER, WHITE, 8-1/2 X 14" 7530-01-335-2623 BX "MRMD COPIER PAPER, RECYCLED, WHITE, 8-1/2 X 11""" AD-1024 PKG 25 "CHANGE OF ADDRESS NOTICE, METERED, 6/1/1986 WASHINGTON, DC" AD-12A PKG100 MAILING LABEL WITHOUT INDICIA 9/1/1982 AD-270 PKG100 REQUEST FOR COPYING & DUPLICATING SVCS 10/1/1987 AD-414A PKG100 "MAILING LABEL, METERED, SELF-ADHESIVE, 1/1/1983 PIN-FED" AD-699 PD100 COPIER COST INVENTORY 1/1/1981 AD-841 EA EXECUTIVE CORRESPONDENCE POUCH 7/1/1981 AD-843 HD EXECUTIVE CORRESPONDENCE ENVELOPE 7/1/1981 OF-65A BX200 "MESSENGER ENVELOPES, 4-1/8 X 9-1/2" 1/1/1994 OF-65B BX250 "MESSENGER ENVELOPES, 9-1/2 X 12" 1/1/1994 OF-65C BX250 "MESSENGER ENVELOPE, 12 X 16" 1/1/1994 NFC AD-1000 PKG50 CLAIM FOR RELOCATION INCOME TAX Oct-00 ALLOWANCE AD-105 PKG100 **OBSOLETE** CHECK OR BOND FORWARDING 8/1/1975 RECORD (3 FORMS TO SHEET) AD-1095 EA "ACCOUNTING/PAY PERIOD CALENDAR, 14 X 1/1/2002 8-1/2"", SEPT. 2002-2004"

Friday, April 30, 2004 Page 4 of 41

Page 6: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-1095A EA "ACCOUNTING/ PAY PERIOD CALENDAR, 29 X 1/1/2002 17"", SEPT. 2002-2004" AD-1101 EA USDA CONFIDENTIAL CONFLICT OF INTEREST 8/1/1995 AD-1102 EA SPECIAL PROCESSING TRANSMITTAL 9/1/1997 AD-1103 EA ACCOUNTING/PAY PERIOD CALENDARS FISCAL 2/1/1999 YR 98-2010 AD-1104 EA STATEMENT OF EARNING AND LEAVE 2/1/1997 AD-1122 EA THE WORK NUMBER FOR EVERYONE 10/1/1997 AD-1128 EA REQUEST FOR ELECTRONIC DOWNLOAD 11/1/1998 SOFTWARE FROM NFC AD-1129 PK50 EMPLOYEE PERSONAL PAGE 5/1/1998 AD-1133 EA REQUEST FOR TABLE MANAGEMENT SYSTEM 04/04 (TMGT) ACTION AD-1173 EA CD-ROM REQUEST 3/1/2003 AD-139 PD 50 FINAL SALARY PAYMENT REPORT 1/1/1994 AD-187 EA MOTOR VEHICLE OPERATION & UTILIZATION 10/1/1982 RECORD AD-202 PKG 50 TRAVEL AUTHORIZATION/ ADVANCE 11/1/1996 AD-202M PKG 50 ATTACHMENT FOR MULTIPLE TRAVELERS 11/1/1996 AD-202P BX 300 TRAVEL AUTHORIZATION/ ADVANCE 4/1/1988 AD-202R PKG 50 ATTACHMENT FOR RELOCATION TRAVEL 11/1/1996 AD-202RE PKG 50 ATTACHMENT FOR ELECTION OF SEPARATE 11/1/1996 RELOCATION AD-216 PKG 50 VOUCHER DIFFERENCE STATEMENT 5/1/1977 AD-304 PD100 **OBSOLETE** REQ&AUTH FOR ALLOTMNT 12/1/1990 OF COMP FOR STATE INCOME TAX AD-320 SET 5 "TIME, ATTENDANCE & PROGRESS REPORT (FOR SCS ONLY)" AD-321 PK100 TIME AND ATTENDANCE REPORT 4/1/1990 AD-321-3 PKG100 TIME & ATTENDANCE REPORT 7/1/1990

Friday, April 30, 2004 Page 5 of 41

Page 7: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-337 EA TRANSMITTAL-PERSONNEL & PAYROLL FORM 4/1/1984 AD-343 PKG100 PAYROLL ACTION REQUEST 11/1/1995 AD-354 PK 50 REQUEST FOR INFORMATION 9/1/1993 AD-358 PD 50 VERIFICATION OF IMPREST CASH 2/1/1992 AD-359 PD100 CASHIER ACCOUNT AUDIT 6/1/1990 AD-382 PKG50 EMPLOYEE CLAIM FOR LOSS OR DAMAGE TO 10/1/1965 PERSONAL PROP AD-424 PD 50 EMP APPL REIMBMNT OF 4/1/1988 EXPENSES-SALE/PURCHASE-RSDNCE AD-496-4 PKG250 BILL FOR COLLECTION 5/1/1976 AD-497 PKG50 REQUEST FOR TR ACTION 12/1/1975 AD-55 EA MEMORANDUM OF TRAVEL EXPENSES 10/1/1950 AD-567 PKG100 TELETICKET PAYMENT TRANSMITTAL 8/1/1988 AD-568 PD 25 TRANSMITTAL - CREDIT CARD - GASOLINE 3/1/1981 AD-569 PD 50 EXPENSE RECORD FOR TEMPORARY QUARTERS 3/1/1985 AD-616 PK50 TRAVEL VOUCHER (TEMPORARY DUTY Nov-96 AD-616R PKG50 TRAVEL VOUCHER - RELOCATION 11/1/1996 AD-617 PK50 TRAVEL VOUCHER - CONTINUATION 11/1/1996 AD-617R PKG50 TRAVEL VOUCHER CONTINUATION SHEET - 11/1/1996 RELOCATION AD-63 EA *OBSOLETE* ALLOCATION OF FUNDS 10/1/1948 AD-633 PKG100 MULTIUSE STANDARD REQUISITIONING/ISSUE 3/1/1977 SYSTEM DOC AD-643 PKG100 TRANSMITTAL - GSA MOTOR POOL 2/1/1974 AD-644 EA TRANSPORTATION SVCS DISTRIBUTION - GSA 2/1/1974 MOTOR POOL AD-659 PD 50 CLAIM FOR UNIFORM ALLOWANCE 9/1/1986 AD-661 PKG 50 **OBSOLETE** CASHIER SUB-VOUCHER 7/1/1975

Friday, April 30, 2004 Page 6 of 41

Page 8: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-663 PKG100 REQ FOR ISSUANCE OF 10/1/1984 SUBSTITUTE/REPLACEMENT CHECK AD-667 PKG25 *OBSOLETE ** ADMINISTRATIVE BUDGET 7/1/1975 CONTROL AD-672 PKG 50 REIMBMNT/ADVANCE OF FUNDS AGREEMENT 9/1/1986 AD-673 PD 50 REQUEST TO BILL 4/1/1993 AD-694 PKG100 TRANSMITTAL OF MERIT PAY POOL DATA 4/1/1981 AD-703 EA *OBSOLETE* OPERATING PLAN 9/1/1982 AD-704 PKG50 *OBSOLETE * ALLOTMENT ADVICE 7/1/1976 AD-705 PD 50 *OBSOLETE* DEFECT TALLY SHEET FOR 7/1/1976 FROZEN BROCCOLI AD-706 PD 25 *OBSOLETE * STATMT OF ESTMTD 7/1/1976 REIMBMNTS/RECEIPTS AD-717 PKG50 AUDIT FOR LEAVE YEAR 20-- 5/1/2001 AD-718 PD100 PERIOD END ESTIMATES 10/1/1976 AD-729A PK100 MANAGEMENT CODE MASTER FILE UPDATE 6/1/1978 AD-729B PKG100 *OBSOLETE* ACCOUNTING CODE INPUT FORM 1/1/1980 AD-729C PKG 50 *OBSOLETE* ALLOCATION OF FUNDS 4/1/1983 AD-729D PKG 50 *OBSOLETE* ACCOUNTING CODE INPUT FORM 4/1/1983 AD-739 PKG100 *OBSOLETE* ALLOCATION OF FUNDS 9/1/1979 AD-740 PKG 50 *OBSOLETE* DEFECT TALLY SHEET FOR 12/1/1982 FROZEN BROCCOLI AD-742 PKG100 TRANSFER AND ADJUSTMENT VOUCHER 10/1/1991 AD-757 PKG100 MISCELLANEOUS PAYMENT SYSTEM 2/1/1994 AD-758 PD 100 *OBSOLETE* ACCOUNTING CLASSIFICATION 4/1/1979 CODES AD-766 PKG100 *OBSOLETE* PMIS REAL PROPERTY RECORD 1/1/1980 AD-780 PD 50 DISCOUNT NOTICE 10/1/1982

Friday, April 30, 2004 Page 7 of 41

Page 9: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-798 EA *OBSOLETE* PARTIAL RECEIPT 1/1/1981 AD-799 EA ***OBSOLETE ** DATA FOR INCLUSION IN SF-113 1/1/1981 REPORTS AD-838-5PE BX300 PURCHASE ORDER 7/1/1990 AD-838-7 PKG100 PURCHASE ORDER 7/1/1990 AD-838-7P BX 300 PURCHASE ORDER (PIN-FEED CONTINUOUS) 7/1/1990 AD-838A EA *OBSOLETE* PARTIAL RECEIPT 11/1/1975 AD-838B PD 50 INVOICE-RECEIPT CERTIFICATION 2/1/1991 AD-838D PKG 50 BPA-INVOICE RECEIPT CERTIFICATION 11/1/1991 AD-84 PKG100 SCHEDULE OF COLLECTIONS 12/1/1961 AD-844 PKG 50 **OBSOLETE** BILLINGS AND COLLECTIONS 11/1/1981 ACCOUNT MAINTENANCE PKG50 AD-846 PKG 50 *OBSOLETE* FEE/CHARGE DOCUMENT 1/1/1982 AD-847 PKG 50 *OBSOLETE* FEES AND CHARGES LISTING 1/1/1982 AD-952 EA ORGANIZATIONAL STRUCTURE CODES TABLE 12/1/1993 AD-953 PK100 *OBSOLETE* OFFICE PRODUCTS 6/1/1986 CENTER-OBLIGATION DOCUMENT AD-954 EA ACCOUNT NOTIFICATION-GOVERNMENT 1/1/1996 TRANSPORTATION SYS AD-955 PD 50 GSA TELEPHONE TRANSMITTAL 2/1/1990 AD-956 PD 50 REQUEST FOR ORGINATING OFFICE NUMBER 4/1/1992 ACTION AD-961 EA REMOTE FORMS QUEUING SYSTEM (RFQS) 6/1/1995 ELECTION FORMS AD-962 EA PAYROLL/PERSONNEL DOCUMENT REPORTS 9/1/1994 ELECTION FORM AD-995 PKG25 DELEGATION OF AUTHORITY 6/1/1986 AD-996 PKG50 *OBSOLETE* REQUEST FOR AD-744 ACTION 3/1/1989 AD-997 PK100 UNIT CERTIFYING OFFICER SIGNATURE CARD 1/1/1994

Friday, April 30, 2004 Page 8 of 41

Page 10: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-999 PK100 *OBSOLETE* MTR.VEHICLE ACCOUNTABILITY 4/1/1985 & DATA REC.DOC.TYPE 1 OF-1014A EA GENERAL LEDGER 12/1/1979 OF-1016 EA DISTRIBUTION LEDGER 12/1/1979 OF-1017G EA JOURNAL VOUCHER 9/1/1979 OF-1114 EA BILL OF COLLECTION 12/1/1979 OF-1114B EA COLLECTION VOUCHER 5/1/1979 OF-1120 EA TRANSPORTATION REQUEST ACCOUNTABILITY 3/1/1980 RECORD OF-1121 EA BILL OF LADING ACCOUNTABILITY RECORD 12/1/1979 OF-1129 PKG100 REIMBURSEMENT VOUCHER 10/1/1986 OF-1129A PKG100 CASHIER REIMBURSEMENT VOUCHER-ACCT. 10/1/1986 MEMO OF-1137 PK50 LEAVE RECORD 12/1/1979 OF-203 PD PRIVACY ACT INFORMATION REQUEST 7/1/1975 OF-211 PKG10 REQ. FOR CHANGE OR ESTABLISHMENT OF 10/1/1986 IMPREST FUND SBD-2152 EA U.S. SAVINGS BOND SF-1034 PKG100 PUB VOUCHER FOR PURCHASES/SVCS OTHER 10/1/1987 THAN PERSONAL SF-1035 PKG100 PUBLIC VOUCHER-PUR & SVC OTHER THAN 9/1/1973 PERSONAL(CON) SF-1035A PK100 PUB VOUCHER-PURCHASES/SVCS NOT 9/1/1973 PERSONAL-MEMO(CON) SF-1047 PKG100 PUBLIC VOUCHER FOR REFUNDS (LETTER 9/1/1973 SF-1048 PKG100 PUBLIC VOUCHER FOR REFUNDS 9/1/1973 SF-1049 PKG100 PUBLIC VOUCHER FOR REFUNDS (TABULAR 9/1/1973 SF-1050 PKG100 PUBLIC VOUCHER FOR REFUNDS (MEMO 9/1/1973 SF-1055 PKG100 CLAIM AGNST US FOR AMTS DUE - DECEASED 9/1/1967 CREDITOR

Friday, April 30, 2004 Page 9 of 41

Page 11: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

SF-1069 PKG100 VOUCHER FOR ALLOWANCES AT FOREIGN 1/1/1978 POSTS OF DUTY SF-1080 PKG100 VOUCHER-TRANSFER BETWN APPROPRIATNS 4/1/1982 &/OR FUNDS SF-1081 PKG100 VOUCHER & SCHEDULE OF WITHDRAWALS & 9/1/1982 CREDITS SF-1096 PKG100 SCHEDULE OF VOUCHER DEDUCTIONS 9/1/1982 SF-1098 PKG100 SCHEDULE OF CANCELLED OR UNDELIVERED 7/1/1980 CHECKS SF-1103-9 EA US GOVT BILL OF LADING 4/1/1985 SF-1113 PK100 PUBLIC VOUCHER FOR TRANSPORTATION 11/1/1986 CHARGES SF-1113A PKG100 *OBSOLETE* PUBLIC VOUCHER FOR TRANS. 11/1/1986 CHARGES MEMO. SF-1128 PKG100 PAYROLL-PERSONAL SERVICES-PAYROLL CERT 9/1/1982 & SUMMARY SF-1147 PK100 REQ FOR ISSUE OF REPLACMNT CHECK-ERROR 5/1/1995 NAME/DESIG SF-1152 PKG100 DESIGNATION OF BENEFICIARY-UNPAID 11/1/1991 COMPENSATION OF SF-1153 PK100 CLAIM FOR UNPAID COMP -DECEASED CIVILIAN 4/1/1982 EMPLOYEE SF-1154 PKG100 PUB VOUCHER FOR UNPAID COMP-DECEASED 9/1/1967 CIVILIAN EMP SF-1164 PG100 CLAIM FOR 11/1/1977 REIMBURSMNT-EXPENDITRS-OFFICIAL BUSINESS SF-1165 BK50 "RECEIPT FOR CASH - SUBVOUCHER, 50 PER 6/1/1983 SF-1166 OCR PK100 VOUCHER AND SCHEDULE OF PAYMENTS 5/1/1984 SF-1167 PKG100 VOUCHER AND SCHEDULE OF PAYMENTS 5/1/1984 SF-1186 EA TRANSMTL-TRANSPTATN SCHED'LS & RELATD 5/1/1997 BASIC DOC SF-1189 PKG100 REQ BY EMPYE-PYMT-SALARIES/WAGES BY 1/1/1978 CRED ACCOUNT

Friday, April 30, 2004 Page 10 of 41

Page 12: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

SF-1199A PK100 DIRECT DEPOSIT FORM 6/1/1987 SF-1203 EA PRIVATELY OWNED PERSONAL PROPERTY U.S. 4/1/1985 GOV.BILL OF SF-210 PKG100 SIGNATURE/DESIGNATION CARD FOR 7/1/1981 CERTIFYING OFFICER SF-215 PKG 50 DEPOSIT TICKET 5/1/1990 SF-224 PKG100 STATEMENT OF TRANSACTIONS 5/1/1982 SF-225 PKG100 REPORT ON OBLIGATIONS 3/1/1991 SF-232 PKG100 POWR OF ATTNY INDIVAL-COLLECTN OF 2/1/1975 SPECIFIC CHECK SF-2802 EA APPLICATION FOR REFUND OF RETIREMENT 1/1/1991 DEDUCTIONS SF-2803 PKG100 APPLICATION TO MAKE DEPOSIT OR REDEPOSIT 6/1/1992 SF-2804 EA APPLICATION TO MAKE VOLUNTARY 1/1/1995 CONTRIBUTIONS (CSRS) SF-2805 EA REQUEST FOR RECOVERY OF DEBT DUE TO THE 10/1/1988 SF-2806 EA INDIVIDUAL RETIREMENT RECORD 2/1/1980 SF-2811 EA TRANS'L/SUMMARY RPT TO CARRIER-HEALTH 6/1/1984 BENEFIT PROG W-4 EA WITHHOLDING EXEMPTION CERTIFICATE 1/1/2003 W-5 EA EARNED INCOME CREDIT ADV. PAYMENT 1/1/2003 OBPA SF-1151 PK100 NONEXPENDITURE TRANSFER AUTHORIZATION 12/1/1979 SF-132 PKG100 APPOINTMENT & REAPPOINTMENT SCHEDULE 7/1/1976 SF-133 PKG100 REPORT OF BUDGET EXECUTION 7/1/1976 OC AD-1012 EA HANDOUT FOLDER 6/1/1996 AD-1135 EA THE USDA HANDBOOK ON WORKPLACE 12/1/1998 VIOLENCE PREVENTION

Friday, April 30, 2004 Page 11 of 41

Page 13: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-1135A EA VIOLENCE IN THE WORKPLACE POSTER 12/1/1999 AD-155 PKG100 ORDER FOR PRINTED PUBLICATION 10/1/1961 AD-156 PD50 ORDER FOR BULK DISTRIBUTION OF 2/1/1989 AD-156A PD50 "INTERNAL DISTRIBUTION - ROOM 0466, SOUTH 2/1/1989 BUILDING" AD-159 PKG50 MANUSCRIPT CLEARANCE 8/1/1967 AD-271 PK100 REQUEST FOR PHOTOGRAPHIC SERVICES 2/1/1986 AD-273 EA ORDER FOR ADDITIONS TO MAILING CODES 8/1/1972 AD-400.1 EA "AL-STATE MAP,CNTY OUTLINE 8 1/2X11""" 6/1/1985 AD-400.10 EA "ID-STATE MAP,CNTY 8-1/2X11""" 6/1/1985 AD-400.11 EA "IL-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.12 EA "IN-STATE MAP,CITY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.13 EA "IA-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.14 EA "KS-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.15 EA "KY-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.16 EA "LA-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.17 EA "ME-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.18 EA "MD-STATE MAP,CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.19 EA "MA-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.2 EA "AZ-STATE MAP CNTY OUTLOOK 8-1/2X11""" 6/1/1985 AD-400.20 EA "MI-STATE MAP, CITY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.21 EA "MN-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.22 EA "MS-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.23 EA "MO-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.24 EA "MT-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.25 EA "NE-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985

Friday, April 30, 2004 Page 12 of 41

Page 14: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-400.26 EA "NV-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.27 EA "NH-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.28 EA "NJ-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.29 EA "NM-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.3 EA "AR-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.30 EA "NY-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.31 EA "NC-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.32 EA "ND-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.33 EA "OH-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.34 EA "OK-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.35 EA "OR-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.36 EA "PA-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.37 EA "RI-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.38 EA "SC-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.39 EA "SD-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.4 EA "CA-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.40 EA "TN-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.41 EA "TX-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.42 EA "UT-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.43 EA "VT-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.44 EA "VA-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.45 EA "WA-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.46 EA "WV-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.47 EA "WI-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.48 EA "WY-STATE MAP, CNTY OUTLINES" 6/1/1985

Friday, April 30, 2004 Page 13 of 41

Page 15: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-400.49 EA "AK-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.5 EA "CO-STATE MAP CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.50 EA "HI-STATE MAP, CNTY OUTLINES 8 1/2 X 11" 6/1/1985 AD-400.6 EA "CT-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.7 EA "DE-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.8 EA "FL-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-400.9 EA "GA-STATE MAP,CNTY OUTLINES 8-1/2X11""" 6/1/1985 AD-401.1 EA "US MAP, STATE OUTLINES/8 1/2 X 11" 6/1/1985 AD-401.2 EA "US MAP, STATE OUTLINES/NAMES IN BLK 8 1/2 6/1/1985 X 11" AD-448 EA "USDA ORGANIZATIONAL CHART, SIZE 18 X 24" 9/1/1990 AD-59 PKG 50 REQUEST FOR MANUSCRIPT REVIEW 1/1/1986 AD-652 PD50 REQUEST FOR VISUAL SERVICES 9/1/1980 AD-653 PD 100 MANUSCRIPT GUIDE SHEET 9/1/1974 (NON-REPRODUCIBLE BLUE) AD-653A PKG100 MANUSCRIPT GUIDESHEET (BROWN) PKG-100 1/1/1983 AD-656 PD REQ FOR USDA PUBLICATIONS 5/1/1976 AD-731 EA FREEDOM OF INFORMATION REQUEST LOG 3/1/1977 AD-78 PK100 REQUEST FOR PRINTING & BINDING 12/1/1995 AD-797 PD AUDIO VISUAL PROPOSAL 12/1/1981 AD-816 PKG100 GRID FOR FORMAT I AND FORMAT VI (DOUBLE 3/1/1985 PAGE SPREA AD-818 PKG100 GRID FOR FORMAT II & FORMAT VII 3/1/1985 AD-825 PK100 GRID FOR STATIONERY FORMAL AND INFORMAL 3/1/1981 LETTER AD-827 PKG 50 "GRID FOR PRES. MAT. CHARTS, GRAPHS, COPY 3/1/1981 SLIDES"

Friday, April 30, 2004 Page 14 of 41

Page 16: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-830 PKG100 MEDIUM OVERSIZE GRID FOR FORMAT II 80% 3/1/1985 REDUCTION AD-836 EA "LITHOGRAPHIC PRINT OF THE PRESIDENT (20 X 2001 24"")" AD-836A EA "LITHOGRAPHIC PRINT OF THE PRESIDENT (11 X 2001 14"")" AD-840B EA LITHOGRAPH PRINT OF THE SEC. OF 1/1/1993 AD-845 PD 50 "REQUEST FOR VIDEO, FILM, AND 4/1/1985 TELECONFERENCE" GPO-3430 EA ORDER FORM 2/1/1985 MP-1063 EA AGRICULTURE FACT BOOK 1994 1/1/1994 OF-272 EA REPORT DOCUMENTATION PAGE 4/1/1977 SF-14 PD TELEGRAPHIC MESSAGE 11/1/1980 OCFO "DM-2300-1,A1-9" EA AGRICULTURE TRAVEL REGULATIONS 7/1/1981 (AMENDMENTS 1-9) AD-1018 PKG100 NOTICE OF CHANGE TO DINERS GOVERNMENT 1/1/1985 CHARGE CARD AD-1083 PK50 REQUEST FOR ACTION FOR 2/1/1999 AD-1083A EA CONTINUATION SHEET FOR ORDERING 2/1/1999 PROCEDURES AD-622 PD100 NOTICE OF PREAPPLICATION REVIEW ACTION 12/1/1972 OF-1114A EA OFFICIAL RECEIPT 12/1/1979 SF-1038 PD 100 ADVANCE OF FUNDS APPLICATION & ACCOUNT 10/1/1977 SF-1145 PK100 VOUCHER FOR PAYMENT UNDER FEDERAL 1/1/1992 TORT CLAIMS SF-1193A EA LTR OF CREDIT (TREAS DISB CTR OR REGIONAL 10/1/1976 OFFICE) SF-269 PKG100 FINANCIAL STATUS REPORT (LONG FORM) 8/1/1991 SF-269A PKG100 FINANCIAL STATUS REPORT (SHORT FORM) 2/1/1992

Friday, April 30, 2004 Page 15 of 41

Page 17: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

SF-270 PKG100 REQUEST FOR ADVANCE OR REIMBURSEMENT 7/1/1976 SF-271 PKG100 OUTLAY RPT & REQ FOR REIMBURSEMENT FOR 7/1/1976 CONST PROGS SF-272 PKG100 FEDERAL CASH TRANSACTIONS REPORT 7/1/1976 SF-272A PKG100 FEDERAL CASH TRANSACTIONS REPORT 9/1/1976 (CONTINUATION) SF-424 PK100 FEDERAL ASSISTANCE (SEE AD-621-625) 4/1/1988 SF-424.2 BK APPLICATION FOR FED.ASSIST. W/SF-424C & 4/1/1988 SF-424D) SF-424A PKG100 *OBSOLETE* BUDGET INFORMATION 4/1/1988 NON-CONSTRUCTION PROGRAMS SF-424B PKG100 ASSURANCES NON-CONSTRUCTION PROGRAMS 4/1/1988 SF-424C PKG BUDGET INFORMATION CONSTRUCTION 4/1/1988 PROGRAMS SF-424D PKG ASSURANCES - CONSTRUCTIOIN PROGRAMS 4/1/1988 OCIO "DM-3020-1,AMEND" EA AMENDMENT TO THE DEPARTMENTAL FORMS 4/1/1995 CATALOG AD-10 PK100 LONG DISTANCE CALL RECORD 3/1/1959 AD-1019 EA TELEPHONE DIRECTORY UPDATE 11/1/1991 AD-102 PD100 TELEPHONE TOLL CALL REGISTER AND 3/1/1958 CERTIFICATE AD-1136 EA AGRICULTURE PROPERTY MANAGEMENT 9/1/1997 REGULATIONS AD-116 PK 50 CLEARANCE & APPRVL FOR DEPTMNTAL 9/1/1982 ISSUANCES AD-172 PKG200 CORRESPONDENCE CONTROL 7/1/1966 AD-234 PKG100 "CHARGE OUT (CARD), SIZE 8-1/2 X 11" 11/1/1986 AD-27 PD 100 RUSH SLIP 5/1/1963 AD-287 PKG50 EMPLOYEE SUGGESTION 7/1/1997

Friday, April 30, 2004 Page 16 of 41

Page 18: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-311 PG100 SPEED MEMO 3/1/1981 AD-367 PKG50 REPORTS EVALUATION CHECK LIST 12/1/1970 AD-368 PD 25 REPORT ANALYSIS AND CLEARANCE SHEET 2/1/1982 AD-396 EA INITIAL & SIGNATURE INDICATOR 12/1/1966 AD-410A EA USDA MEMORANDUM 2/1/1970 AD-474 PD 50 TRANSMITTAL - TELEPHONE & UTILITIES 1/1/1982 AD-604 EA ANNUAL LEAVE SCHEDULE 3-Dec AD-637 PD 50 GENERAL PURPOSE CODING 9/1/1974 AD-638 PD 50 REPORT PLANNING 2/1/1975 AD-687 PKG100 FORMS ACTION REQUEST AND NOTICE 3/1/1991 AD-764 EA REQUEST FOR NETWORK 9/1/1981 TELECOMMUNICATION SERVICES AD-778 PKG 25 SECRETARY'S MEMORANDA-FORMAT 1/1/1981 AD-778A EA SECRETARY'S ANNOUNCEMENT SERIES 9/1/1987 AD-793 PKG 50 FORMAL & INFORMAL LETTERHEAD - OFFICIAL 6/1/1980 AD-811 PD 50 DEPARTMENTAL REGULATION 1/1/1981 AD-811A EA AMENDMENT TO DEPARTMENTAL REGULATION 1/1/1981 AD-812 EA DEPARTMENTAL MANUAL 1/1/1981 AD-812A PKG100 AMENDMENT TO DEPARTMENTAL MANUAL 1/1/1981 AD-813 PKG100 DEPARTMENTAL NOTICE 1/1/1981 AD-814 PKG 50 DIRECTIVE FORMAT GUIDE 1/1/1981 AD-834 PD 50 IRM TECHNICAL APPROVAL REQUEST 1/1/1991 CERTIFICATION AD-835 PD 50 IRM SYSTEM AND SERVICE SECURITY 8/1/1990 CERTIFICATION AD-868 PD 100 CORRESPONDENCE SLIP 10/1/1982 DM-3020-1 EA DEPARTMENTAL FORMS MANUAL 9/1/1991

Friday, April 30, 2004 Page 17 of 41

Page 19: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

DM-3200-1 EA APPLICATION SYSTEMS LIFE CYCLE 3/1/1988 MANAGEMENT MANUAL DM-3440-1 EA "CLASSIFICATION, DECLASSIFICATION, AND 8/1/1983 SAFEGUARDING" GSA-2068A EA QTRLY RPT ADP PROVIDED ANOTHER AGY OR 6/1/1975 OBTAND COM'L OF-11 PKG100 REFERENCE REQUEST-FEDERAL RECORDS 7/1/1987 CENTERS OF-21 PD **OBSOLETE** CROSS-REFERENCE (33 2/1/1962 OF-363 PD 100 MEMORANDUM OF CALL 1/1/1994 OF-67 EA 2002 ACTIVITY SCHEDULE 1/1/2000 SF-135 PKG100 RECORDS TRANSMITTAL & RECEIPT 7/1/1985 SF-135A PKG100 RECORDS TRANSMITTAL & RECEIPT (CON 7/1/1985 SF-145 PKG100 TELEPHONE SERVICE REQUEST (FIELD USE) 6/1/1982 OCRE AD-1034 EA COMPLAINT OF EMPLOYMENT DISCRIMINATION 3/1/1989 AD-1056 EA SEXUAL HARASSMENT - POSTER IT COULD COST 9/1/1992 YOU AD-1056A EA SEXUAL HARASSMENT IT COULD COST YOU 9/1/1992 YOUR JOB.... AD-1058 EA FRAMEWORK FOR CHANGE: WORK FORCE 5/1/1990 DIVERSITY AD-1085 EA SEXUAL HARASSMENT IS ILLEGAL 9/03 AD-1181 EA EQUAL EMPLOYMENT OPPORTUNITYIS THE LAW 9/03 SF-181 PK100 RACE AND NATIONAL ORIGIN INDENTIFICATION 5/1/1982 OGC 53-E-1987 HD "OGC ENVELOPE, WHITE FIELD USE ONLY 4-1/8 X 9-1/2" 53-L-1986-30 PKG500 LETTERHEAD - BOND (OGC) FIELD USE 53-L-1986-50 PK500 LETTERHEAD - MANIFOLD (OGC) 53-L-1986-60 PKG500 LETTERHEAD - OGC

Friday, April 30, 2004 Page 18 of 41

Page 20: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-747 PKG100 COURT-ORDERED CHILD CARE OR ALIMONY 12/1/1982 DEDUCTION SF-94 PK100 STATEMENT OF WITNESS 2/1/1983 SF-95 PKG100 "CLAIM FOR DAMAGE, INJURY, OR DEATH" 7/1/1985 OHRM 1873 EA RETIREMENT EMBLEM(ONE PIECE JOINT AND 1/1/1985 CATCH) 198 EA 10 YEAR EMBLEM (RODIUM PLATED) 7107 EA EMBLEM-50-YEAR W/3-POINT DIAMOND CHARM 7109 EA EMBLEM-40-YEAR GOLD W/RUBY CHARM 7111 EA *OBSOLETE* EMBLEM-30-YEAR GOLD CHARM 7115 EA *OBSOLETE* EMBLEM-40-YEAR GOLD W/RUBY TIE TACK 7116 EA EMBLEM-35-YEAR GOLD TIE TACK 7121 EA EMBLEM-40-YEAR GOLD W/RUBY LAPEL PIN 7987 EA 35 YEAR LAPEL PIN 8225 EA 20 YEAR EMBLEM (RODIUM PLATED) 1/1/1985 8226 EA 30 YEAR EMBLEM(10K GOLD-FILLED ANTIQUE 1/1/1985 GOLD) 8227 EA 40 YEAR EMBLEM(10 K GOLD-FILLED ANTIQUE 1/1/1985 FINISH) 8228 EA 50 YEAR(10K GOLD-FILLED ANTIQUE FINISH) 1/1/1985 AD-1010 EA OCCUPATIONAL SAFETY AND HEALTH 4/1/1984 PROTEC.FOR USDA EMP AD-1032 EA CERTIFICATE OF RECOGNITION (TAKE PRIDE IN 2/1/1987 AMERICA AD-1053 EA "USDA EEO POSTER - 9/1/1992 COUNSELING,MEDIATION,& COMPLAINT"

Friday, April 30, 2004 Page 19 of 41

Page 21: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-1054 PK50 REQUEST FOR PAYROLL DEDUCTIONS FOR 6/1/1989 ASSOCIATION AD-1057 EA MANAGER'S GUIDE FOR SELECTIVE PLACEMENT 8/1/1989 AD-1061 EA BUILDING ON THE FRAMEWORK FOR CHANGE: 12/1/1990 WORK FORCE AD-1062 EA USDA CAREERS -POCKET FOLDER - MAKING A 12/1/1990 WORLD OF AD-1063 EA USDA CAREERS POCKET FOLDER 8/1/1999 AD-1064 EA USDA CAREERS - ADMINISTRATION 8/1/1999 AD-1065 EA USDA CAREERS - BUSINESS AND INDUSTRY 8/1/1999 AD-1066 EA USDA CAREERS - SCIENCE AND TECHNOLOGY 8/1/1999 AD-1067 EA USDA CAREERS - DIRECTORY 8/1/1999 AD-1067A NATURAL RESOURCES & ENVIRONMENT 99/08 AD-1073 EA RECOMMENDATION AND APPROVAL OF/A 4/1/1991 RECRUITMENT/ AD-1074 EA SERIVCE AGREEMENT FOR RECEIPT OF 4/1/1991 PAYMENT FOR A AD-1075 PK25 SENIOR EXECUTIVE SERVICE RECERTIFICATION 7/1/1991 AD-1075A PKG25 SES RECERTIFICATION EXECUTIVE'S 7/1/1991 STATEMENT OF AD-1078 EA THE STANDARDS OF ETHICAL CONDUCT FOR 9/1/1999 EMPLOYEES OF AD-1084 EA USDA SUMMER INTERN PROGRAM 9/1/1992 AD-1085 EA SEXUAL HARASSMENT 8/1/2003 AD-1090 PKG 25 REQUEST AND APPROVAL FOR OUTSIDE 1/1/1994 EMPLOYMENT AD-1097 EA GUIDE FOR EMPLOYEE RECOGNITION 12/1/1994 AD-1111 PK25 EMPLOYEE SUGGESTION PROGRAM 1/1/1997 AD-1121 EA PURCHASE CARD MANAGEMENT SYSTEM (PCMS) 10/1/1997 REQUEST FOR

Friday, April 30, 2004 Page 20 of 41

Page 22: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-1131 PKG 50 EMPLOYEE EXPRESS 6/1/1998 AD-1145 EA BALANCING OPTIONS WORK & LIFE BROCHURE 5/1/2002 AD-1145A EA BALANCING OPTIONS POSTER 5/1/2002 AD-1145B EA BALANCING OPTIONS FOLDER 5/1/2002 AD-1147 PKG25 USDA PUBLIC TRANSPORTATIN BENEFIT 10/22/2002 PROGRAM APPLICATION AD-1163 PKG50 CONFIRMATION OF REQUEST FOR REASONABLE 4/1/2002 ACCOMMODATIONS AD-1164 PKG50 REASONABLE ACCOMMODATION IN FORMATION 4/1/2002 REPORTING FORM AD-1165 PKG50 DENIAL OF REASONABLE ACCOMMODATION 4/1/2002 REQUEST AD-1166 EA ELDER CARE SERVICES AND REFERRALS 8/1/2002 (PAMPHLET) AD-1167 EA. ELDER CARE SERVICES AND REFERRALS 8/1/2002 AD-1170 TRANSIT SUBSIDY CASH REIMBURSEMENT 3/21/2003 CERTIFICATION AD-1181 EA EQUAL OPPORTUNITY EMPLOYMENT IS THE 9/1/2003 AD-141A EA CERTIFICATION OF APPRECIATION 12/1/1987 AD-184 PD100 APPL FOR MOTOR VEHICLE OPERATOR'S ID 9/1/1981 AD-284A EA "CERTIFICATE OF TRAINING, SIZE 8-1/2 X 11" 5/1/1992 AD-287-1 EA POINTERS FOR SUCCESSFUL SUGGESTIONS 10/1/1981 AD-287-2 PKG100 RECOMMEDATION & APPROVAL OF AWARDS 7/1/1994 AD-287-3 PKG50 REFERRAL AND APPRAISAL OF EMPLOYEE Sep-60 SUGGESTION AD-287-3A PKG 50 REFERRAL AND APPRAISAL OF EMPLOYEE 9/1/1960 SUGGESTION AD-332 PD100 POSITION DESCRIPTION COVER SHEET 4/1/1986 AD-349 PD100 EMPLOYEE ADDRESS 12/1/1993 AD-350B PKG100 USDA PERSONNEL DATA 6/1/1983

Friday, April 30, 2004 Page 21 of 41

Page 23: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-356 PD 50 DUES CHANGE-BETWEEN LOCALS WITHIN 5/1/1985 NAT'L LABOR ORG AD-356A PD 50 CANCELN OF WITHHOLDG DUES TO LABOR 5/1/1985 ORGANIZATIONS AD-408 PD100 CHANGE IN OVERSEAS EMPLOYMENT REPORT 5/1/1971 AD-411 PD 100 VACANCY ANNOUNCEMENT 5/1/1983 AD-411A PD 100 AGENCY SUMMARY VACANCY ANNOUNCEMENT 6/1/1981 AD-435 PKG 50 USDA PERFORMANCE APPRAISAL 11/1/1986 AD-435A PKG 50 "USDA,PERFORMANCE PLAN,PROGRESS REVIEW 12/1/1986 & APPRAISAL" AD-435B PKG 50 "PERFORMANCE PLAN, PROGRESS REVIEW AND 12/1/1986 APPRAISAL" AD-435C PKG100 SES APPRAISAL RECORD 3/1/1993 AD-435P BX500 USDA PERFORMANCE APPRAISAL (PINFEED 3/1/1993 VERSION) AD-471 PK100 CLASSIFIED DOCUMENT ACCOUNTABILITY 1/1/1984 AD-489 PKG50 RECORD OF IMPORTANT PAPERS 8/1/1971 AD-490 PD 25 ASSIGNEE EVALUATION OF MOBILITY 10/1/1977 ASSIGNMENTS AD-491 PKG100 SECURITY DEBRIEFING SECRECY AGREEMENT 2/1/1977 AD-495 PKG100 HONOR AWARDS NOMINATION FORM Sep-00 AD-507 PKG100 PROBATIONARY OR TRIAL PERIOD REPORT 10/1/1980 AD-507-P BX 300 PROBATIONARY-TRIAL PERIOD REPORT (PIN-FED 10/1/1980 VERSION) AD-581 PK100 LUMP SUM LEAVE OR COMPENSATORY TIME 2/1/1983 PAYMENTS AD-582 PKG 50 AUTHORIZATION FOR RESTORED ANNUAL 5/1/1978 LEAVE (NCR) AD-658 PKG100 WITHIN-GRADE INCREASE RECORD 9/1/1981 AD-658-P BX300 WITHIN-GRADE INCREASE RECORD (PIN-FED) 12/1/1981

Friday, April 30, 2004 Page 22 of 41

Page 24: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-67 PKG100 REQUEST FOR PRIOR CLEARANCE OF 6/1/1985 PERSONNEL ACTION AD-68 EA LENGTH OF SERVICE CERTIFICATE (40 YEARS) 2/1/1993 AD-68A EA LENGTH OF SERVICE CERTIFICATE (30 YEARS) 2/1/1993 AD-68B EA LENGTH OF SERVICE CERTIFICATE (20 YEARS) 2/1/1993 AD-68C EA LENGTH OF SERVICE CERTIFICATE (10 YEARS) 2/1/1993 AD-68D EA LENGTH OF SERVICE CERTIFICATE 1-Apr AD-68E EA LENGTH OF SERVICE CERTIFICATE (50 YEARS) 2/1/1981 AD-69 EA CERTIFICATE OF MERIT 1/1/1972 AD-696 PKG 50 NOTICE TO APPLICANT 8/1/1981 AD-715 EA DETAIL OF PERSONNEL COMPENSATION 8/1/1976 AD-734 PD 50 REQUEST FOR CANDIDATES 5/1/1981 AD-735 PD 100 EVALUATION OF CANDIDATES 9/1/1980 AD-738 EA USDA SAFETY INSPECTION CHECKLIST 8/1/1977 AD-743 EA DRIVING RECORD 10/1/1977 AD-762A PKG 50 PERSONNEL MANAGEMENT QUESTIONNAIRE 10/1/1981 AD-769 PKG 50 REQUEST FOR SES PERSONNEL ACTION 8/1/1986 AD-773 EA SUPERVISORY OR MANAGERIAL PROBATIONARY 5/1/1980 PERIOD RPT. AD-773-P BX 300 SUPERVISORY/MANAGERIAL PROBATIONARY 5/1/1980 PERIOD REPORT AD-775 EA CLASSIFICATION REVIEW ACTIVITY REPORT 7/1/1980 AD-776 EA "USDA, UPWARD MOBILITY PROG - JOST 7/1/1979 TRAINING SCHED" AD-779 PD 100 BIOGRAPHICAL SKETCH (PERSONNEL IN 5/1/1980 WASH.D.C.AREA ON AD-794 EA EQUAL EMPLOYMENT OPPORTUNITY POSTER 9/1/1981 (CONSL PHOTO)

Friday, April 30, 2004 Page 23 of 41

Page 25: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-815 EA POST EMPLOYMENT RESTRICTIONS 1/1/1991 AD-872 PKG 25 PROPERTY DAMAGE INCIDENT 12/1/1983 AD-881 PKG25 INDIVIDUAL DEVELOPMENT PLAN 3/1/1983 AD-S1063 EA LAS CARRERAS PROFESIONALES DEL USDA 2001 DR 4130-2 EA REVISED CRITERIA FOR THE SECRETARY'S 4/1/1998 HONOR AWARDS FD-258 EA FINGERPRINT CARD (CONTRACTORS) 12/1/1982 FE 74-AL EA FEDERAL EMPLOYEES GROUP LIFE INSURANCE FE-6 EA CLAIM FOR DEATH BENEFITS 12/1/1993 FE-74-A EA FEDERAL EMPLOYEES GROUP LIFE INSURANCE FERS-1 PKG FERS PRERETIREMENT COUNSELING & 2/1/1990 SEMINAR GUIDE FERS-1A PKG INDEX TABS FOR FERS PRERETIREMENT COUNSELING & FERS-1B EA BINDERS FOR PRERETIREMENT COUNSELING & SEMINAR HCFA-1500 EA HEALTH INSURANCE CLAIM FORM 12/1/1990 HISP-YRBK1 EA HISPANIC YEARBOOK 2000 2/3/2000 MTLSM002 PK100 LONG TERM CARE 2002 OF-104 PKG100 NAME CARD 9/1/1974 OF-306 PKG100 DECLARATION FOR FEDERAL EMPLOYMENT 1/1/2001 OF-5 PKG100 INQUIRY AS TO AVAILABILITY 3/1/1982 OF-510 PKG100 APPLYING FOR A FEDERAL JOB 9/1/1994 OF-612 PK100 OPTIONAL APPLICATION FOR FEDERAL 9/1/1994 EMPLOYMENT OF-630A PKG 50 REQUEST TO DONATE ANNUAL LEAVE TO 6/1/1989 LEAVE RECIPIENT OF-69 EA ASSIGNMENT AGREEMENT-IPA MOBILITY 2/1/1989 PROGRAM

Friday, April 30, 2004 Page 24 of 41

Page 26: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

OF-8 PKG100 POSITION DESCRIPTION 1/1/1985 OF-86 PK25O PERSONAL DATA WARNING LABEL 5X3 RED 5/1/1976 OF-86A PKG500 "PERSNL DATA WARNG LBL,3-1/2X1-WH PPR 5/1/1976 W/RED INK" OPM-1390 PD EXECUTIVE PERSONNEL TRANSACTION 4/1/1979 OPM-1482 EA AGENCY CERTIFICATION OF STATUS OF 11/1/1983 REEMPLOYED OPM-71 PK100 REQUEST FOR LEAVE OR APPROVED ABSENCE 1-Jun OWCP-1500 PKG50 HEALTH INSURANCE CLAIM FORM 4/1/1992 SF-1014A PK100 GENERAL LEGDER Oct-67 SF-105 PKG100 CERT OF MEMBERSHP IN US CIVIL SVC 12/1/1979 RETIRMNT SYSTEM SF-1150 PK100 RECORD OF LEAVE DATA Dec-77 SF-1150P BX500 RECORD OF LEAVE DATA SF-1154A PK100 PUBLIC VOUCHER FOR UNPAID COMPENSATION 9/1/1967 DUE A DECEA SF-1177 PK100 U.S. SAVINGS BOND ISSUE FILE ACTION 12/1/1965 SF-1182 PK100 SUBSCRIBER LIST FOR US SAVINGS BOND SF-1187 PK100 REQUEST-PAYROLL DEDUCTION-LABOR 6/1/1989 ORGANIZATION DUES SF-1188 PK100 CANCELLATION OF PAYROLL DEDUCTIONS FOR 1/1/1979 LABOR ORZN SF-1198 PKG100 REQ BY EMPLYE-ALLTMT OF PAY-CDT SAVNG 3/1/1982 ACCT-FIN ORG SF-127 PKG100 REQUEST FOR OFFICIAL PERSONNEL FOLDER 7/1/1986 SF-1402 EA CERTIFICATE OF APPOINTMENT 10/1/1983 SF-144 PKG100 STATMNT OF PRIOR FED CIVILIAN & MILITARY 10/1/1995 SERVICE SF-15 PKG100 CLAIM FOR 10-POINT VETERAN PREFERENCE 2/1/1990

Friday, April 30, 2004 Page 25 of 41

Page 27: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

SF-182 PK100 "REQ, AUTH, AGREEMENT, & 12/1/1979 CERTIFICATE-TRAINING" SF-182P BX 600 "REQUEST,AUTHORIZATION,AGREEMENT AND 9/1/1986 CERTIFICATION" SF-184 PKG100 REQUEST FOR EMPLOYEE MEDICAL FOLDER 1/1/1988 SF-256 PK100 SELF IDENTIFICATION OF MEDICAL DISABILITY 8/1/1987 SF-268 PD100 COBOL CODING SHEETS Sep-76 SF-293 PKG100 NOTICE TO SEPARATED EMPLOYEE 7/1/1989 CONCERNING DISP. OPF SF-308 EA REQUEST FOR WAGE DETERMINATION May-85 SF-3102 EA DESIGNATION OF BENEFICIARY 6/1/2000 SF-3112 PKG25 DOC. IN SUPPORT OF DISABILITY RETIRE APP. 12/1/1995 CSRS/FER SF-3113 PK100 APPLYING FOR IMMEDIATE RETIREMENT 1/1/1997 UNDER THE FERS SF-3114 PK100 APPLYING FOR DEATH BENEFITS UNDER THE 1/1/1997 SF-312 PKG100 CLASSIFIED INFORMATION NONDISCLOSURE 1/1/1991 AGREEMENT SF-39 PKG100 REQUEST FOR REFERRAL OF ELIGIBLES 11/1/1988 SF-39A PKG REQ/JUST FOR SELECTVE FCTRS & QUALTY 10/1/1974 RANKG FCTRS SF-424-1 EA APPLICATION FOR FEDERAL ASSISTANCE Apr-88 SF-450 PKG 50 CONFIDENTIAL FINANCIAL DISCLOSURE REPORT 7/1/1992 SF-50B-P BX 800 NOTIFICATION OF PERSONNEL ACTION 7/1/1991 SF-52 PKG100 REQUEST FOR PERSONNEL ACTION 7/1/1991 SF-52B BX2000 REQUEST FOR PERSONNEL ACTION 8/1/1988 SF-59 PK100 REQUEST FOR APPROVAL OF NONCOMPETITIVE 1/1/1979 ACTION SF-61 PK100 APPOINTMENT AFFIDAVITS 6/1/1986 SF-61B PKG100 DECLARATION OF APPOINTEE 11/1/1991

Friday, April 30, 2004 Page 26 of 41

Page 28: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

SF-62 PK100 AGENCY REQT TO PASS OVER A PREFERENCE 10/1/1979 ELIGIBLE ETC SF-66 EA OFFICIAL PERSONNEL FOLDER 1/1/1989 SF-66B PKG100 *OBSOLETE * LABEL-CAUTION PERSONEL 1/1/1981 RECORDS RESTRICED USAGE SF-66C EA MERGED RECORDS PERSONNEL FOLDER (MRPF) 11/1/1983 SF-66D EA EMPLOYEE MEDICAL FOLDER 4/1/1985 SF-700 PKG100 SECURITY CONTAINER INFORMATION 8/1/1985 SF-701 PK100 ACTIVITY SECURITY CHECKLIST 8/1/1985 SF-702 PKG100 SECURITY CONTAINER CHECK SHEET 8/1/1985 SF-703 PK100 TOP SECURITY COVER SHEET 8/1/1985 SF-704 PK100 SECRET COVER SHEET 8/1/1985 SF-705 PK100 CONFIDENTIAL COVER SHEET 8/1/1985 SF-71 PK100 APPLICATION FOR LEAVE 12/1/1997 SF-75 PKG100 REQUEST FOR PRELIMINARY EMPLOYMENT 10/1/1991 SF-78 PK100 CERTIFICATE OF MEDICAL EXAMINATION 10/1/1969 SF-8 PKG100 NTC TO FED EMP ABOUT UNEMPLOYMENT 6/1/1987 INSURANCE SF-85 PK100 QUESTIONNAIRE FOR NON-SENSITIVE POSITIONS 9/1/1995 SF-85P PK100 QUESTIONNAIRE FOR PUBLIC TRUST POSITIONS 9/1/1995 SF-86 PK100 QUESTIONNAIRE FOR SENSITIVE POSITIONS 9/1/1995 (NAT'L SECUR SF-86A PK100 CONTINUATION SHEET FOR QUESTIONNAIRES 9/1/1995 SF-87 PK100 FINGERPRINT CHART 4/1/1984 SF-93 PK100 REPORT OF MEDICAL HISTORY 6/1/1996 SF-95A PK100 "CLAIM FOR DAMAGE,INJURY OR DEATH 7/1/1985 (SPANISH VERSION)" TIPS-2 EA USDA MERIT PROMOTION PLAN 9/1/1984

Friday, April 30, 2004 Page 27 of 41

Page 29: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

TSP-1102 EA "*OBSOLETE* TSP OPEN SEASON NOV. 15, 2001 2002 TO JAN. 15, 2002" TSP-5 EA *OBSOLETE* SOMETHING TO SMILE ABOUT! 5/1/2001 TSP-6 EA THRIFT SAVINGS PLAN: STATEMENT Apr-92 REGARDING SPOUSES

OIG AD-870 PKG "REPORTING,ALLEGED, OR SUSPECTED 7/1/1982 BRIBERY ATTEMPTS" AD-873 PK100 PROPERTY PASS 6/1/1983 OO "AGPMR-AMEND,D-18" EA "AGRICULTURE PROPERTY MANAGEMENT 4/1/1994 REGULATIONS D,18" AD-1091 PKG25 REQUEST FOR EXPRESS DELIVERY 3/1/1994 PA-1613 EA DOING BUSINESS WITH USDA Apr-98 OC

AD-824 EA GRID FOR FACT MAT 3/1/1985 AD-840 EA LITHOGRAPH PRINT OF THE SEC.OF 3/1/1995 AGRICULTURE (20X24) AD-840A EA LITHOGRAPHIC PRINT OF THE SEC.OF 3/1/1995 AGRICULTURE 11X14

OPCD CD-ROM EA CD-ROM INCLUDING ALL FEGLI 99 OPEN 4/1/1999 ENROLLMENT CE-57 EA REDUCTION IN FORCE BENEFITS GUIDE 8/1/1994 FE-74-C EA FEDERAL EMPLOYEES GROUP LIFE INSURANCE 4/1/1999 FEGLI-LG EA FEGLI POSTER 28 X 43 FEGLI-MD EA FEGLI POSTER 11 X 17 4/1/1999 FEGLI-SM EA FEGLI 99 OPEN ENROLLMENT PERIOD - POSTER 4/1/1999 8-1/2X11

Friday, April 30, 2004 Page 28 of 41

Page 30: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

LTCNH2003 EA NEW HIRE MATERIAL FOR LONG TERM CARE 2003 OO-RI 20-59 EA INFORMATION FOR ANNUITANTS 5/1/1997 OO-RI 25-26 EA INFORMATION FOR SURVIVOR ANNUITANTS 1/1/1993 OO-RI 25-27 EA SURVIVOR BENEFITS FOR CHILDREN 11/1/1995 OO-RI 30-13 EA INFORMATION FOR DISABILITY ANNUITANTS 5/1/1993 OO-RI 38-126 EA LIFE EVENTS & YOUR RETIREMENT & 8/1/1995 INSURANCE BENEFITS OO-RI 70-1 EA FEHB GUIDE TO FEDERAL EMPLOYEES BENEFIT 11/1/2002 PLANS FOR CIVILIAN EMPLOY OO-RI 70-10 EA ENROLLMENT INFO. GUIDE COMPARISON CHART 1/1/2000 OO-RI 70-13 EA CUSTOMER SATISFACTION SURVEY OO-RI 70-5 EA GUIDE TO FEDERAL EMPLOYEES HEALTH 11/1/2002 BENEFITS PLANS OO-RI 70-7 EA 1994 ENROLLMENT INFO. GUIDE & COMPARISON 11/1/1995 CHART OO-RI 70-8 EA FEHB 2003 GUIDE TO FED EMPLOYEES HEALTH 2-Nov BENEFITS FOR CERTAIN TEMPS OO-RI 71-003 EA ALLIANCE HEALTH BENEFIT PLAN 2003 OO-RI 71-004 EA APWU HEALTH PLAN 2003 OO-RI 71-005 EA BLUE CROSS BLUE SHIELD SERVICE BENEFIT 3-Jan PLAN 2003 OO-RI 71-006 EA "GOVERNMENT EMPLOYEES HOSPITAL 2004 ASSOCIATION, INC BENEFIT PLAN" OO-RI 71-007 EA MAIL HANDLERS BENEFIT PLAN 2004 3-Jan OO-RI 71-009 EA NATIONAL ASSOCIATION OF LETTER CARRIERS 4-Jan HEALTH BENEFIT PLAN 2004 OO-RI 71-13 EA POSTMASTERS HEALTH BENEFIT PLAN 1/1/2001 OO-RI 71-3 EA *OBSOLETE* AMERICAN POSTAL WORKERS 1/1/2001 UNION HEALTH BENEFIT OO-RI 71-4 EA *OBSOLETE* AMER. POSTAL WORKERS UNION 1/1/2000 HEALTH BENEFIT

Friday, April 30, 2004 Page 29 of 41

Page 31: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

OO-RI 71-5 EA *OBSOLETE* SERVICE BENEFIT PLAN (BLUE 1/1/2001 CROSS/ BLUE SHIELD) OO-RI 71-6 EA *OBSOLETE* GOVT EMPLOYEES HOSPITAL 1/1/2002 ASSOCIATION BENEFIT PLAN OO-RI 72-1 EA 2003- FOREIGN SERVICE BENEFIT PLAN 1/1/2003 OO-RI 72-11 EA SSEHA HEALTH BENEFIT PLAN 1/1/1993 OO-RI 72-3 EA NAPUS HEALTH BENEFIT PLAN 1/1/1993 OO-RI 72-4 EA PANAMA CANAL AREA BENEFIT PLAN 1/1/1993 OO-RI 72-5 EA RURAL CARRIER BENEFIT PLAN 1/1/1993 OO-RI 72-6 EA SAMBA HEALTH BENEFIT PLAN 1/1/2000 OO-RI 72-8 EA BACE HEALTH BENEFIT PLAN 1/1/1993 OO-RI 73-146 EA "FREESTATE HEALTH PLAN, INC." 1/1/1998 OO-RI 73-20 EA "COLUMBIA MEDICAL PLAN, INC." 1/1/1996 OO-RI 73-268 EA CAREFIRST (BLUECROSS AND BLUE SHIELD) 1/1/1996 OO-RI 76-10 EA ASSIGNMENT OF FEDERAL EMPLOYEES' GROUP 1/1/1995 LIFE INS. OO-RI 76-12 EA FEDERAL EMPLOYEES GROUP LIFE INSURANCE 6/1/1992 OO-RI 76-21 EA FEDERAL EMPLOYEES GROUP LIFE INSURANCE 4/1/1999 OO-RI 76-24 EA FEDERAL EMPLOYEES GROUP LIFE INSURANCE 4/1/1999 OO-RI 76-27 EA FEGLI '99 ELECTION FORM - OPEN 4/1/1999 ENROLLMENT PERIOD OO-RI 79-2 EA CIVIL SVC RETIREES & SURVIVOR ANNUITANTS 7/1/1996 OO-RI 79-27 EA TEMPORARY CONTINUATION OF COVERAGE 6/1/1992 (TCC) UNDER THE OO-RI 83-1 EA RETIREMENT FACTS PAMPHLET ON CSRS 3/1/1995 OO-RI 83-10 EA RETIREMENT FACTS ON VOLUNTARY 3/1/1995 OO-RI 83-11 EA THINKING ABOUT RETIREMENT 4/1/1991

Friday, April 30, 2004 Page 30 of 41

Page 32: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

OO-RI 83-13 EA INFORMATION FOR SEPARATING CSRS 9/1/1996 EMPLOYEES WHO ARE OO-RI 83-16 EA INSTRUCTIONS FOR THE SEMINAR LEADER OR 1/1/1993 COUNSELOR OO-RI 83-18 EA INFORMATION ABOUT REEMPLOYMENT FOR 9/1/1996 CSRS ANNUITANTS OO-RI 83-19 EA CSRS OFFSET RETIREMENT (RETIREMENT 9/1/1996 OO-RI 83-2 EA RETIREMENT FACTS PAMPHLET ON MILTARY 3/1/1995 SERVICE OO-RI 83-3 EA RETIREMENT FACTS PAMPHLET ON DEPOSITS 3/1/1995 OO-RI 83-4 EA RETIREMENT FACTS PAMPHLETS ON 9/1/1996 DISABILITY RETIREMEN OO-RI 83-5 EA RETIREMENT FACTS PAMPHLET ON SURVIVOR 9/1/1996 BENEFITS OO-RI 83-6 EA RETIREMENT FACTS PAMPHLET ON EARLY 9/1/1996 RETIREMENT OO-RI 83-7 EA RETIREMENT FACTS ON COMPUTING 9/1/1996 OO-RI 83-8 EA RETIRMENT FACTS ON CREDIT FOR USED 9/1/1996 OO-RI 83-9 EA RETIREMENT FACTS ON REFUNDS 3/1/1995 OO-RI 84-1 EA COURT-ORDERED BENEFITS FOR FORMER 9/1/1996 SPOUSES CSRS OO-RI 84-2 EA FEDERAL PAYMENTS THAT MAY BE AVALIABLE 9/1/1996 TO FEDERAL OO-RI 84-3 EA LIFE EVENTS AND YOUR RETIREMENT AND 9/1/1996 INSURANCE OO-RI 90-1 EA FEDERAL EMPLOYEES RETIREMENT 9/1/1996 OO-RI 90-11 EA INFORMATION FOR SEPARATING FERS 9/1/1996 EMPLOYEES WHO ARE OO-RI 90-12 EA INFORMATION FOR FERS SURVIVOR ANNUITANTS 10/1/1993 OO-RI 90-18 EA INFORMATION ABOUT REEMPLOYMENT FOR 3/1/1995 FERS ANNUITANTS OO-RI 90-3 EA FERS TRANSFER 9/1/1996

Friday, April 30, 2004 Page 31 of 41

Page 33: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

OO-RI 90-8 EA INFORMATION FOR FERS ANNUITANTS 3/1/1991 OO-RI 98-2 EA INFO. FOR FERS DISABILITY ANNUITANTS 10/1/1995 OPM-FSATRI EA INTRODUCING THE FEDERAL FLEXIBLE 5/1/2003 SPENDING ACCOUNT - PGM FOR 2003 SF-2800 EA APPL FOR DEATH BENFTS-CIVIL SVC 3/1/1992 RETIREMENT SYSTEM SF-2801 EA (CSRS) APPLICATION FOR IMMEDIATE 1/1/1990 SF-2808 EA DESIGNTN OF BENEFICY-CIV SVC RETIREMENT 5/1/1993 SYSTEM SF-2809 EA HEALTH BENEFITS REGISTRATION FORMS 7/1/1999 SF-2810 EA NOTIFICATION OF CHANGE IN HEALTH 6/1/1995 SF-2817 EA LIFE INSURANCE ELECTION Jun-00 SF-2818 EA CONTINUATION OF LIFE INSURANCE COVERAGE 1-May AS A SF-2819 EA NOTICE OF CONVERSION PROVILEGE 5/1/1995 SF-2821 EA AGENCY CERTIFICATION OF INSURANCE STATUS 5/1/1995 SF-2822 EA REQUEST FOR INSURANCE 1/1/1993 SF-2823 EA DESIGNATION OF BENEFICIARY 1-Apr SF-3104 EA APPLICATION FOR DEATH BENEFITS 8/1/2002 SF-3104B EA DOCUMENTATION AND ELECTIONS IN SUPPORT 5/1/1998 SF-3106 EA APPLICATION FOR REFUND OF RETIREMENT 3/1/1996 DEDUCTIONS SF-3106A EA CURRENT-FORMER SPON.APP. REFUND 2/1/1987 RETIREMENT DEDUCTN SF-3107 EA (FERS) APPLICATION FOR IMMEDIATE 4/1/2000 SF-3108 PKG25 APPLICATION TO MAKE SERVICE CREDIT 2/1/1999 PAYMENT FOR CS SF-3109 EA ELECTION OF COVERAGE FERS 7/1/1989 TENT-CD EA "OPEN ENROLLMENT APR 24 - JUNE 30, 1999" 4/1/1999

Friday, April 30, 2004 Page 32 of 41

Page 34: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

TSP-0502 EA "*OBSOLETE* TSP OPEN SEASON MAY 15- JULY 5/1/2002 31, 2002 FOR FERS AND CSRS E" TSP-0503 EA "TSP OPEN SEASON APRIL 15-JULY 31, 2003" 5/1/2003 TSP-0599 EA "*OBSOLETE* TSP OPEN SEASON MAY 15 - JULY 1/1/1999 31,1999" TSP-1 EA THRIFT SAVINGS PLAN ELECTION FORM 8/1/2002 TSP-1002 EA *OBSOLETE* TSP OPEN SEASON OCT 15- DEC 10/1/2002 31-2002 TSP-1003 EA "TSP OPEN SEASON - OCT 15 - DEC 31, 2003" 3-Oct TSP-1101 EA "*OBSOLETE* TSP OPEN SEASON - UPDATE MAY 2001 15,2001 - JULY 31, 2001" TSP-15 EA CHANGE IN MARITAL STATUS 11/1/1994 TSP-16 EA REQUEST WAIVER OF NOTICE SPOUSE/SPOUSES 3/1/1997 CONSENT TSP-17 EA APPLICATION FOR ACCOUNT BALANCE OF 5/1/2000 DECEASED TSP-20 EA TSP-LOAN APPLICATION 2/1/1998 TSP-20H EA HARDSHIP LOAN APPLICATION 6/1/1996 TSP-3 EA TSP DESIGNATION OF BENEFICIARY FORM 8/1/2002 TSP-30 EA *OBSOLETE* TSP INTERFUND TRANSFER 7/1/1995 TSP-4 EA "TSP OPEN SEASON APRIL 15 - JUNE 30, 2003" 4/1/2003 TSP-50 EA THRIFT SAVINGS PLAN INVESTMENT 5/1/2001 TSP-536 EA IMPORTANT TAX INFORMATION ABOUT PYMTS 7/1/2001 FROM YOUR TSP-70 EA THRIFT SAVINGS PLAN WITHDRAWAL REQUEST 8/1/2002 TSP-75/75T EA AGE-BASED IN-SERVICE WITHDRAWAL 5/1/1998 TSP-76/75T EA TSP- FINANCIAL HARDSHIP IN-SERVICE 5/1/1998 WITHDRAWAL TSP-77 EA TSP REQUEST FOR PARTIAL WITHDRAWAL 2-Aug TSP-9 EA TSP-CHANGE OF ADDRESS 6/1/1994

Friday, April 30, 2004 Page 33 of 41

Page 35: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

TSPBK-01 EA TSP WITHDRAWAL INFORMATION 11/1/1994 TSPBK-02 EA WITHDRAWING YOUR TSP ACCOUNT BALANCE 8/1/2002 TSPBK-03 EA AFTER LEAVING FEDERAL SERVICE GUIDE TO 8/1/2002 TSPBK04 EA TSP-LOAN PROGRAM 8/1/2002 TSPBK-05 EA TSP-ANNUITIES 6/1/2003 TSPBK-08 EA SUMMARY OF THE THRIFT SAVINGS PLAN FOR 5/1/2001 FEDERAL TSPBK-09 EA TSP AT A GLANCE 5/1/2001 TSPBK-10 EA WITHDRAWING YOUR TSP ACCOUNT 12/1/1992 BALANCE-ADDENDUM 1989 TSPBK-11 EA TSP INFORMATION ABOUT COURT ORDERS 2/1/2001 TSPBK-12 EA TSP IN-SERVICE WITHDRAWALS 6/1/2003 TSP-LF-01 EA TSP START ON THE RIGHT TRACK TO YOUR 5/1/2001 TSP-LF-03 EA CSRS EMPLOYEES: THE THRIFT SAVINGS PLAN 9/1/1991 TSP-LF-04 EA YOU MAY THINK THE THRIFT SAVINGS PLAN 5/1/1996 ISN'T FOR TSP-LF-05 EA UNDERSTANDING YOUR THRIFT SAVINGS PLAN 11/1/2001 PARTICIPANT TSP-LF-06 EA UNDERSTANDING YOUR THRIFT SAVINGS PLAN 12/1/1997 TSP-LF-07 EA CSRS EMPLOYEES - TAKE A CLOSER LOOK AT 5/1/2001 THE TSP TSP-LF-08 EA MISSING ANYTHING IN THE MOVE? 6/1/1996 TSP-LF-09 EA TSP WEB SITE - WWW.TSP.GOV 5/1/2001 TSP-PL EA TSP OPEN SEASON POSTER - LARGE 4/15/2003 TSP-PS EA TSP OPEN SEASON POSTER - SMALL 5/1/2003 TSP-U-50 EA THRIFT SAVING PLAN - INVESTMENT 8/1/2002 VIDEO-30 EA VIDEO EXPLAINING THE FEGLI 99 OPEN ENROLLMENT

Friday, April 30, 2004 Page 34 of 41

Page 36: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

VIDEO-90 EA VIDEO EXPLAINING THE ENTIRE FEGLI 4/1/1999 PROGRAM (90 MIN) ZP00-33 EA THE CSRS AND FERS HANDBOOK FOR 12/1/1995 PERSONNEL AND

OSEC AD-1087A EA "USDA LOGO DECAL, 1-5/8 X 2-3/16"", PEEL AND 4/1/1993 STICK" AD-1087B EA "3 INCH USDA SEAL DECAL, PEEL AND STICK" 4/1/1993 AD-1087C EA "USDA LOGO DECAL, 3 X 4-5/16"", PEEL AND 4/1/1993 AD-1087D EA "USDA LOGO DECAL, 5-3/16 X 7-3/8"", PEEL AND 4/1/1993 STICK" AD-1087E EA "USDA LOGO DECAL, 8-3/8 X 13-5/16"", PEEL AND 4/1/1993 STICK" AD-114 PKG100 EXECUTIVE CORRESPONDENCE JACKET 9/1/1981 AD-469 EA INVENTORY OF EMERGENCY & VITAL RECORDS 10/1/1973 AD-580 EA CERT OF APPOINTMENT (TO PUBLIC ADVISORY 12/1/1970 COMMITTEE) AD-690 PKG100 TRANSMITTAL RECORD 1/1/1976 AD-736 PK100 OSEC SUBPOENA 1-Jan AD-737 PK100 OSEC SUBPOENA DUCES TECUM 1-Jan AD-755 PD50 ADVISORY COMMITTEE MEMBERSHIP 2-Oct BACKGROUND INFORMATION OF-41 PD100 ROUTING & TRANSMITTAL SLIP 7/1/1976 POD CB-01 PKG 50 CARDBOARD 8-1/2 X 11 PPD AD-1112 EA *OBSOLETE* USDA APC LAPC 10/1/1997 INSTRUCTION/REFERNECE GUIDE AD-1113 EA USDA - PCMS - TRAINING WORKBOOK 10/1/1997

Friday, April 30, 2004 Page 35 of 41

Page 37: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-1114 PKG 5 "CARDHOLDER INSTRU. PCMS - NFC 9/1/1998 PROCEDURES TITLE VI," AD-1115 EA MICRO-PURCHASE SELF STUDY COURSE 10/1/1997 -INSTRUCTION AD-1117 EA UNITED STATES OF AMERICA I.M.P.A.C. 9/1/1996 AD-1118 EA USDA PURCHASE CARD PROGRAM (INSERT) AD-1119 EA USDA - VINYL REGISTER 9/1/1996 AD-1119A EA CHECK REGISTER (REFILL) AD-1120 EA *OBSOLETE* THE USDA PURCHASE CARD 3/1/1997 PROGRAM (VIDEO) AD-1130 EA DOING BUSINESS WITH USDA (KIT) 9/1/2001 AD-1139 EA CHECKBOOK COVER AD-1140 EA REGISTER FOR CHECKBOOKS 1/1/1999 GSADC-8911101946 EA RULES AND REGULATIONS GOVERNING PUBLIC 1/1/1996 BUILDING GSADC8911101946S EA RULES AND REGULATIONS GOVERNING PUBLIC 1/1/1996 BLDGS.

PPM/PDSD AD-1184 PK 25 SENSITIVE SECURITY INFORMATION 01//04 PPMD "AMENDMENT, R-5" EA AGRICULTURE PROPERTY MANAGEMENT REGULATIONS 53-B-24480-10 EA "SHELF-STORAGE, GRAY FIBER WITH METAL STAYS" 8-T-100 EA "TAGS, LICENSE PLATES, AUTOMOBILE, SET OF 8-T-110 EA "TAG, LICENSE PLATE, MOTORCYCLE" AD-106 PKG 50 PROPERTY RECORD 12/1/1950 AD-107 PKG100 RPT OF TRANSFER/DISPOSITION/CONSTRUCTION 11/1/1989 OF PPTY

Friday, April 30, 2004 Page 36 of 41

Page 38: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AD-1071 PK250 "USDA EXCESS PROPERTY TAG (3-1/8"" X 3/1/1991 6-1/4"")PKG-250" AD-1071A PK500 "USDA PROPERTY ISSUED TAG (3-1/8"" X 6-1/4"")" 3/1/1991 AD-112 PKG 50 "REPORT OF UNSERVICEABLE, LOST OR 3/1/1994 DAMAGED PROPERTY" AD-113 PD 50 PHYSICAL INVENTORY REPORT FOR PERIOD 6/1/1966 ENDING AD-113A PD 50 PHYSICAL INVENTORY REPORT (CONTINUATION 6/1/1966 SHEET) AD-14A PD 25 " REQUEST FOR SUPPLIES,FORMS,AND/OR 12/1/1981 PUBLICATIONS" AD-178 EA FORMS STOCKING & REORDER CARD 4/1/1984 AD-182 EA STOCK HISTORY RECORD 12/1/1964 AD-183 PKG100 STOCK ISSUE RECORD 4/1/1959 AD-185 PKG100 PENALTY FOR UNOFFICIAL USE OF A GOVT. 5/1/1970 VEHICLE AD-53 EA USDA PHOTO IDENTIFICATION CARD 3/1/1981 AD-54 EA USDA NON-PHOTO IDENTIFICATION CARD 3/1/1981 AD-651 EA MOTOR VEHICLE ACCIDENT REPORT ENVELOPE 10/1/1974 AD-719 PD 50 MACHINE SERVICE REQUEST 11/1/1976 AD-728 PD 50 REQ/AUTH FOR HOME TO WORK 12/1/1988 AD-732 PD 100 REQ FOR SVC OR MOVEMENT OF PROPERTY 3/1/1977 AD-792 EA DEPARTMENTAL LEGEND AND IDENTIFICATION 6/1/1985 DECAL AD-865 BX 750 *OBSOLETE* STRAIGHT BILL OF LADING (OO 9/1/1982 USE ONLY) AD-869 BX2000 *OBSOLETE* U.S. GOVERNMENT SHIPMENT 11/1/1982 GSA-2485 PD 100 COST COMPARISON FOR SHIPPING HOUSEHOLD 3/1/1983 GOODS OF-1127 PKG100 INDIVIDUAL PAY CARD 12/1/1979

Friday, April 30, 2004 Page 37 of 41

Page 39: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

OF-23 PKG100 CHARGEOUT RECORD 2/1/1962 OF-345 PKG100 PHYSICAL FITNESS INQUIRY FOR MOTOR 11/1/1985 VEHICLE OPERATO OF-346 PKG100 U.S.GOVT. MTR. VEHICLE OPERATORS ID CARD 11/1/1985 OF-7 PKG100 PROPERTY PASS 9/1/1988 OF-95 PKG100 OPEN/LOCKED SIGN FOR RESTRICTED FILES 7/1/1975 PPMD-100 EA MOTOR VEHICLE FLEET OPERATIONS REVIEW 11/1/1990 GUIDE SF-1034A PKG100 PUBLIC VOUCHER FOR PURCHASES & SERVICES OTHER THAN SF-1145A PK100 VOUCHER FOR PAYMENT UNDER FED. TORT 9/1/1973 SF-1184 PK100 UNAVAILABLE CHECK CANCELLATION 11/1/1975 SF-120 PKG100 REPORT OF EXCESS PERSONAL PROPERTY 4/1/1957 SF-120A PKG100 REPORT OF EXCESS PERSONAL PROPERTY 6-PT 4/1/1957 SNAP-OUT SF-122 PKG 50 TRANSFER ORDER - EXCESS PERSONAL 6/1/1974 SF-126 PKG100 REPORT OF PERSONAL PROPERTY FOR SALE 7/1/1978 SF-146 PKG100 CHANGES IN TELEPHONE LISTING 11/1/1976 SF-361 PD100 DISCREPANCY IN SHIPMENT REPORT 3/1/1984 SF-82 PK100 AGENCY REPORT OF MOTOR VEHICLE DATA 4/1/1987 SF-91 PK100 OPERATOR'S REPORT OF MOTOR VEHICLE 2/1/1993 ACCIDENT SF-91A PKG 25 INVESTIGATION REPORT OF MOTOR VEHICLE 6/1/1978 ACCIDENT SF-97 PK100 US GOVT CERT OF RELEASE OF A MOTOR 4/1/1991 PROC AD-700 PKG100 PROCUREMENT REQUEST 4/1/1982 AD-760 PD REPORT OF INDIVIDUAL PROCUREMENT 5/1/1985

Friday, April 30, 2004 Page 38 of 41

Page 40: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

AH-1 EA *OBSOLETE* SELLING TO THE USDA 5/1/1987 SF-18 PKG100 REQUEST FOR QUOTATIONS 10/1/1983 SF-2 PKG100 US GOVT LEASE FOR REAL PROPERTY 2/1/1965 RPMD AD-1017 PKG25 REAL PROPERTY UTILIZATION SURVEY 1/1/1985 DM-5100-1 EA DEPARTMENTAL REAL PROPERTY LEASING 3/1/1991 MANUEL SF-114 PK100 SALE OF GOVERNMENT PROPERTY-BID & 5/1/1978 SF-114A PK100 SALE OF GOVERNMENT PROPERTY-ITEM 1/1/1970 PAGE-SEALED BID SF-114B PK100 SALE OF GOVERNMENT PROPERTY-SEALED BID 1/1/1970 SF-118A PK100 "BLDG,STRUCTRS,UTILITS AND MISC 5/1/1996 SF-118B PK100 LAND -SCHEDULE B- TO RPT OF EXCESS REAL 5/1/1996 PROPERTY SF-118C PK100 RELATED PERSONAL PROPERTY 5/1/1996 SF-81A PKG100 SPACE REQUIREMENT WORKSHEET 10/1/1983 SHMD CA-1 PKG25 FED EMP NOTICE OF TRAUMATIC INJURY 4/1/1999 CA-10 EA WHAT A FED-EMP SHOULD DO WHEN INJURED 8/1/1987 AT WORK CA-11 PKG50 WHEN INJURED AT WORK 4/1/1999 CA-16 PK100 AUTHORIZATION FOR EXAMINATION AND/OR 1/1/1997 TREATMENT CA-17 EA DUTY STATUS REPORT 1/1/1997 CA-2 PK 25 NOTICE OF OCCUPATIONAL DISEASE AND CLAIM 1/1/1997 FOR CA-20 PK50 ATTENDING PHYSICIAN'S REPORT 11/1/1999 CA-20A PKG 50 *OBSOLETE* ATTENDING PHYSICIAN'S 1/1/1997 SUPPLEMENTAL REPORT

Friday, April 30, 2004 Page 39 of 41

Page 41: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

CA-2A PK100 FEDERAL EMPLOYEE'S NOTICE OF 9/1/1996 RECURRENCE OF DISAB. CA-3 EA *OBSOLETE* REPORT OF TERMINATION OF 6/1/1988 DISABILITY AND/OR PAYMENT CA-35A PKG25 GENERAL CHECKLIST (PROCESSING 8/1/1988 OCCUPATIONAL DISEASE CA-35B PKG25 HEARING LOSS CHECKLIST 8/1/1988 CA-35C PKG25 ASBESTOS RELATED ILLNESS CHECKLIST 10/1/1987 CA-35D PKG25 CORONARY/VASCULAR CONDITIONS 8/1/1988 CA-35E PKG25 SKIN DISEASE CHECKLIST 8/1/1988 CA-35F PKG25 PULMONARY/RESPIRATORY CHECKLIST 8/1/1988 CA-35G PKG25 PSYCHIATRIC ILLNESS CHECKLIST 8/1/1988 CA-35H PKG25 WORK-RELATED CARPAL TUNNEL SYNDROME 10/1/1987 CA-5 EA "CLAIM FOR COMP BY WIDOW,WIDOWER, OR 1/1/1997 CHILDREN" CA-550 EA FEDERAL INJURY COMPENSATION Jan-99 CA-5B EA "CLAIM FOR COMPENSATION BY PARENTS, BRO. 1/1/1997 SIS., ETC." CA-6 EA REPORT OF FATALITY 1/1/1997 CA-7 EA CLAIM FOR COMPENSATION 11/1/1999 CA-7&20 PKG50 CLAIM FOR COMPENSATION 11/1/1999 CA-7A EA TIME ANALYSIS FORM 6/1/1996 CA-7B PK50 LEAVE BUY BACK (LBB) 6/1/1996 WORKSHEET/CERTIFICATION AND CA-8 EA *OBSOLETE* CLAIM FOR CONTINUING 1/1/1997 COMPENSATION ON ACCOUNT OF CA-8&20A EA *OBSOLETE* CLAIM FOR CONTINUING COMP ON 10/1/1995 ACCOUNT OF DISABILITY CA-810 EA INJURY COMPENSATION FOR FEDERAL 1/1/1999 CA-915 PK50 CLAIMANT MEDICAL REIMBURSEMENT FORM Feb-99

Friday, April 30, 2004 Page 40 of 41

Page 42: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Sponsor Stk-No UIS Desc Edition

WASC AD-1105A EA CONFERENCE FACILITIES IN THE WASHINGTON 3/1/1996 MET. AREA AD-1105B EA USDA CONFERENCE FACILITIES IN THE 3/1/1996 WASHINGTON MET. AD-733 PD 100 IDENTIFICATION CARD CONTROL RECORD 5/1/1977

Page 43: FORMS STOCKED AT THE BELTSVILLE SERVICE CENTER · forms stocked at the beltsville service center sponsor stk-no uis desc edition ams/gipsa ... ad-359 pd100 cashier account audit 6/1/1990

Friday, April 30, 2004 Page 41 of 41