Forms and Worksheets
Instructions:
This page lists PSC Forms and Worksheets referenced in the Personnel and Pay Procedures Manual. These forms and worksheets are now published independently of the manual. This allows us to effect needed changes and updates without waiting for a published change to the manual.
This page also provides links to some frequently used forms from Other Government Agencies (like the VA for insurance forms) and to Coast Guard (CG) forms.
Click on the form number. The form will open in Adobe Acrobat, fill in fields and print the form.
Adobe Acrobat (.pdf) forms: You need Adobe's free reader program to open Acrobat forms, visit the Adobe web site http://www.adobe.com/products/acrobat/readstep2.html to download the program.
PSC Forms and Worksheets
Important Notes:
Printing Forms: If you experience any printing problems, please be sure you are using the printer icon (picture of a printer) in the Adobe Acrobat Reader tool bar and not the printer icon in the Internet Explorer tool bar.
Unnumbered Worksheets:
- USCG Privacy Act Release Exhibit 5-C-1 of the Personnel and Pay Procedures Manual. This statement must accompany all requests for Statements of Creditable Service (SOCS).
- Federal Tax Withholding Worksheet
Numbered Worksheets
- CG PSC-1570, Individual Monthly IDT Tracking Worksheet
- CG PSC-1884, Application For Annuity Under The Survivor Benefit Plan (SBP), Reserve Component Survivor Benefit Plan (RCSPB), Retired Serviceman's Family Protection Plan (RSFPP) And/Or Final Retired Pay Due
- CG PSC-2000, PCS Departing Worksheet (Revised 08/04)
- CG PSC-2001, Departing TDY or PCS/TEMDUINS to "A" School Worksheet
- CG PSC-2002, CG Human Resources Management System Assignment Data Worksheet
- CG PSC-2003, PCS Entitlements Advance Travel Worksheet Revised July 2008: PCS mileage rate changed.
- CG PSC-2005, PCS Reporting Worksheet Revised August 2008: Added block to record PCS reporting time.
- CG PSC-2010, Advances Worksheet
- CG PSC-2015, Pay Delivery Worksheet
- CG PSC-2020, Dependency Worksheet Revised November 2005. New fields added for non-custodial parents to complete
- CG PSC-2020A, Support Statement
- CG PSC-2020B, Full-Time Student Statement
- CG PSC-2020C, Former Spouse Statement
- CG PSC-2020D, Designation of Beneficiaries
- CG PSC-2025, BAH/Housing Worksheet (Revised July 2008.)
- CG PSC-2025A, Housing Allowance (BAH/OHA) Protection Worksheet (Revised May 2008.)
- CG PSC-2025B, Member-Married-to-Member BAH Worksheet (Introduced July 2008.)
- CG PSC-2030, Career Development Worksheet
- CG PSC-2035, Family Separation Allowance (FSA) Worksheet
- CG PSC-2040, Allotment Worksheet
- CG PSC-2045, Career Intentions Worksheet (Revised June 2008 (SRB Payment Election).)
-
CG PSC-2046,
Application to Sell Special Leave Accrual (SLA) New August 2008.
(See ALCOAST 396/08 for policy).) - CG PSC-2050, Nonreceipt Worksheet
- CG PSC-2055A, Reserve Retirement Transfer Request
- CG PSC-2060, Bond Worksheet
-
CG PSC-2070,
TDY Travel Request/Authorization Worksheet Revised August 2008.
TDY mileage rate changed. -
CG PSC-2071,
T-PAX Profile Request Form. Discontinued.
Effective 30 June 2008, profiles for non-CG employees can be requested on
form CG PSC-7421. - CG PSC-2075, Family Subsistence Supplemental Allowance (FSSA) Application
-
CG PSC-2426,
Career Status Bonus (CSB) Election
- CG PSC-3600, Designation Of Beneficiary For Payment Of Unpaid Retired Pay
- CG PSC-3799R, Reserve Annual Screening Questionnaire (ASQ)
- CG PSC-3867, Claim for Final Retired Pay
-
CG PSC-4700,
Retired (Active or Reserve) Pay Account Worksheet and Survivor Benefit
Election
Please follow these instructions when completing CG PSC-4700 - CG PSC-5007, Modalls Transmittal Sheet
- CG PSC-5100, Officer Uniform Allowance Claim Worksheet
- CG PSC-5150, Civilian Clothing Monetary Allowance Worksheet (Revised May 2008)
- CG PSC-5155, Enlisted Supplementary Clothing Allowance Worksheet
- CG PSC-5200, Ethnicity and Race Self-Reporting Worksheet
- CG PSC-5238, Modall Documentation Sheet
-
CG PSC-7210,
Designation as Payment Approving Official (PAO). Discontinued. Effective
15 April 2005, PAO designations can be made on form CG PSC-7421/2. - CG PSC-7221, Retired Allotment Authorization Form
- CG PSC-7270, COLA - Unique Expenses Reimbursement Worksheet
- CG PSC-7421, (Rev. 06/2008) T-PAX Approving Official (AO) Designation
-
CG PSC-7421/2,
DA User Authorization/Revocation
Please follow these instructions when completing CG PSC-7421/2
Effective 26 March 2007 the fax number for DA and JUMPS User Access Authorizations is 785-339-2297. -
CG PSC-7421/3, JUMPS User Access Authorization
Effective 26 March 2007 the fax number for DA and JUMPS User Access Authorizations is 785-339-2297. - CG PSC-7543, Statement of Financial Status Submitted for Consideration In Connection with Indebtedness to the United States
- CG PSC-11221, Reserve Component Survivor Benefit Plan (RCSBP) Option - Election Certificate
Printing Forms: If you experience any printing problems, please be sure you are using the printer icon (picture of a printer) in the Adobe Acrobat Reader tool bar and not the printer icon in the Internet Explorer tool bar.
Other Government Agency Forms
Department of Defense:
- DD-616, Report of Return of Absentee (Replaces CG-2842)
- DD Form 139, Pay Adjustment Authorization
- DD Form 1299, Application for Shipment and/or Storage of Personal Property
- DD Form 1351-2, Travel Voucher
- DD Form 1351-3, Statement of Actual Expenses
- DD Form 2058, State of Legal Residence Certificate
- DD Form 2278, Application for Do It Yourself/Self-Procured Move and Counseling Checklist
- DD Form 2366, Montgomery GI BILL Enrollment/Disenrollment, SOI
- DD Form 2366-1, Montgomery GI BILL Increased Benefit Contribution Program
- DD Form 2648, Preseparation Counseling Checklist for Active Component Service Members
- DD Form 2648-1, Preseparation Counseling Checklist for Reserve Component Service Members Released From Active Duty
- DD Form 2860, Claim for Combat Related Special Compensation (CRSC)
- DD Form 2895, Agreement to Serve in the Selected Reserve for TRICARE Reserve Select
- More DOD and DD are available from the DOD Forms Program page http://www.dtic.mil/whs/directives/infomgt/forms/formsprogram.htm
Department of Homeland Security:
- DHS-11000-9, Authorization for Credit Check
Standard Forms:
- SF-1038, Advance of Funds Application and Account
TRICARE:
- 5579A, United Concordia TRICARE Dental Program, forms and references materials
IRS:
- IRS W-4, Employee's Withholding Allowance Certificate
- IRS W-4P, Withholding Certificate for Pension or Annuity Payments
OPM:
- OPM-71, Request for Leave or Approved Absence
- OPM RI20-97, Estimated Earnings During Military Service
VA/OSGLI:
- SGLV-8286, Link to VA Site: SGLI Election And Certificate
- SGLV-8286A, Link to VA Site: SGLI Family Coverage Election
- More SGLI and VGLI Forms
More government agency forms (GSA, IRS, etc.) are available from the Federal Forms Program page http://www.fedforms.gov
Coast Guard (CG) Forms
Printing Forms: If you experience any printing problems, please be sure you are using the printer icon (picture of a printer) in the Adobe Acrobat Reader tool bar and not the printer icon in the Internet Explorer tool bar.
- CGFINCEN, EFT/ACH Travel Claim Direct Deposit Account Change Form
- CG-2842/DD-616, Report of Return of Absentee (CG-2842 is obsolete, replaced by DD-616)
- CG-3307, Administrative Remarks (templates in MS Word format)
- CG-3788A, Employee Review Worksheet (Non-Rated)
- CG-3788B, Employee Review Worksheet (Petty Officer)
- CG-3788C, Employee Review Worksheet (Master, Senior and Chief Petty Officer)
- CG-3788E, Enlisted Performance Evaluation Support Form (Petty Officer)
- CG-3788F, Enlisted Performance Evaluation Support Form (Master, Senior, Chief Petty Officer)
- CG-3788G, Enlisted Performance Evaluation Support Form (Non-Rated)
- CG-4178A, Good Conduct Award Certificate
- CG-4251, Military Temporary Duty (TDY) or Civilian Temporary Duty (TD) Travel Orders
CG-5489, Waiver/Remisson Application-- Cancelled (Replaced by 5489-1 and 5489-2, below)- CG-5489-1, Remission Application, (Revised June 2007, see below)
- CG-5489-2, Waiver Application (Revised June 2007, see below)
-
CG-5489A, SPO's Endorsement Waiver/Remission ApplicationCancelled, see below. -
The CG-5489A was canceled on 4 June 2007. The new waiver and remission forms (above) eliminate the SPO endorsement. This should reduce overall processing time. The following is a summary of the changes:
- Added marital status (including member to member)
- Added years of sea service and sea time
- Reformatted section on enclosures to clarify which are mandatory
- Added "SPO Information" block on second page to provide a contact
- Eliminated Home Phone & Address blocks
Last Modified 9/15/2008