National Association of Letter Carriers - Back to Branch 4985 HOME

 PS-or
 Form    #'s

Name of Form and /or Description

CA-1

Employee Notice of Traumatic Injury

 

CA-2

Employee Notice of Occupational Disease

 

CA-2A

Employee Notice of Recurrence of Disability

 

CA-4

Claims for compensation on Account of occupational Illness

 

CA-7

Claims for Compensation on Account of Traumatic Injury

 

CA-8

Claim for Continuing Compensation

 

CA-16

Authorization for Examination and/or Treatment-Text ONLY info.

 

CA-17

Duty Status Report

 

CA-20

Attending Physician's Report

 

Form 13

Office Routing Slip (Buck Slip)

 

Form 50

Notification of Personnel Action

 

NLRB

Fill and Print National Labor Relations Board Forms (501,502,508,509,601,4480,4701,5081)

 

Notice 11

Information for Apartment House Customers

 

Notice 25

Maximum Time Allowance for Routing Mall

 

Notice 70

Privacy Act Notice

 

Notice 76

Expanded Vehicle Safety Check

 

OF 346

U.S. Government Motor Vehicle Operator's Identification Card (obsolete)

 

Poster 43

Your Rights under the Family And Medical Leave Act of 1993

 

Pub. 71

Notice for Employees Requesting Leave for Conditions Covered by FMLA

 

SF 46

U.S. Government Motor Vehicle Operator's Identification Card

 

SF 91

Operator's Report of Motor Vehicle Accident

 

SF 94

Statement of Witnesses

 

SF 95

Tort Claim-Damages/Injury

 

313

Requisition for Printed Carrier Case Labels

 

991

Application for Promotion or Assignment

 

1017-A

Time Disallowance Record

 

1017-B

Unauthorized Overtime Record

 

1164

Mileage and Parking

 

1187

Dues Withholding -- Regular Member

 

1188

Revocation of Voluntary Authorization for Dues Withholding

 

1189

Dues Withholding -- Retirees

 

1192

Authorization for Purchase of U.S. Savings Bonds

 

1199-A

Direct Deposit

 

1216

Employee's Current Mailing Address

 

1221

Advanced Sick Leave Authorization

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1223-A

Earnings Statement

 

1223-B

Earnings Statement - Net to Bank

 

1224

Court Duty Leave Statement

 

1230

Time Card

 

1230-A

Time Card -- Wk. 1

 

1230-B

Time Card -- Wk. 2

 

1230-C

Other Duty Card

 

1234

Trip Card

 

1260

Non-Transactor Card

 

1261

Non-Transactor Report

 

1270

Idea Proposal

 

1311

Carrier Transportation Agreement

 

1375

Employee Identification Card

 

1503

Claim for Abandoned Property

 

1507

Request to Provide Proper Mail Receptacle

 

1512

Delivery Service Notice

 

1542

Service Point Delivery Requirements

 

1564

Address Change Sheet

 

1564-A

Carrier Route Book -- Route Instructions

 

1564-B

Orders to Box Section or Other Special Orders

 

1571

Report of Curtailed / Undelivered Mail, Etc.

 

1608

Emergency Salary Authorization & Receipt

 

1621

Carrier Route Report

 

1623

Change in Delivery, Relay and Collection

 

1627

Analysis of Curtailed Mail, of Auxiliary Routes &Late Leaving

 

1639

Carriers Report of Recurring Missorted Mail

 

1700

Vehicle Accident/Investigation Worksheet

 

1709

Acceptance of Medical Treatment at USPS Medical Facility

 

1716

Notice of Vacancy in Assignment(s)

 

1717

Bid for Preferred Assignment

 

1723

Assignment Order

 

1727

Award Recommendation/Authorization

 

1750

Employee Probationary Period Evaluation Report

 

1766

Hazard Warning Card

 

1767

Report of Hazard, Unsafe Condition or Practice

 

1768

Safe Driver Award Committee Decision

 

1769

Accident Report

 

1770

Hazardous Materials Incident Report

 

1772

Accident Log

 

1773

Report of Hazard Log

 

1778

Dog Warning Card

 

1813

Late Leaving and Returning Report

 

1838

Carrier's Count of Mail (Management Summary)

 

1838-A

Carrier's Count of Mail -- P.P./Combination Services Worksheet

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1838-B

Parcel Post Firm Delivery Worksheet

 

1838-C

Carrier's Count of Mail -- Letter Carrier Routes Worksheet

 

1839

Payment Record for Carrier Drive-out Agreements

 

1840

Summary of Count and Inspection -- Letter Carrier's Route

 

1840-A

Summary of Count and Inspection, Mail, P.P. and Combination

 

1840-B

Carrier Time Card Analysis

 

1961

Employee Uniform Allowance Statement

 

1994

Employee's Work Schedule

 

2045

Agreement to Take Polygragh Exam

 

2110

Polygragh Data Sheet

 

2146

Employee Claim Forms - Personal Property

 

2181

Authorization and Release of Personal Information

 

2188

Subrogation Receipt

 

2198

Accident Report -- Tort Claim

 

2205

Court Request

 

2240

Pay Adjustment Request

 

2240-F

FSLA Overtime Ajustment Request

 

2243

Payroll Adjustment

 

2249

Severance Pay Computation Form

 

2341

Notice of Ajustment-Separated Employee

 

2430

EEO Investigation Report

 

2480

Driving Record

 

2488

Authorization for Medical Report

 

2545

PAR Case Card

 

2546

PAR Correspondence

 

2547

PAR Reports

 

2548

Individual Training Record

 

2550

Interview Notice

 

2565

Formal Regional Appeal of EEO Complaint

 

2591-C

Application for former Casual (non-Career) Employment Eligibility

 

2608

Grievance Summary Step 1

 

2609

Grievance Summary Step 2

 

2610

Grievance Summary Step 3

 

2800

Application for Death Benefits

 

2801

Application for Retirement

 

2801-A

Superior Officer's Statement, Application for Disability Retirement

 

2801-B

Physician's Statement, Application for Total Disability Retirement

 

2802

Application for Refund of Retirement Deductions

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2806

Individual Retirement Record

 

2808

Designation of Beneficiary, CSRS

 

2809

Health Benefits Registration Form

 

2810

Notice of Change in Health Benefits Enrollment

 

2944

Receipt for Customs Duty Mail

 

3074

Request for Waiver of Claim for Erroneous Payment of Pay

 

3076

Request to Cancel or Change Salary Allotment

 

3189

Request for Temporary Change of Schedule

 

3521

Carrier's Report on House Numbers and Mail Receptacles

 

3546

Notice to Change Forwarding Order

 

3547

Notice to Mailer of Correction in Address

 

3570

Notice of Attempt to Deliver Mail

 

3575

Change of Address Order  ( Online Form )

 

3579

Undeliverable 2nd, 3rd, 4th or Controlled Circulation Matter

 

3582-A

Postage Due Bill

 

3582-B

Carrier's Due Bill

 

3801-A

Agreement for Non-Restricted Delivery to Apartment Building Manager, Business or Hotel

 

3811

Return Receipt, Regular/Certified/Insured Mail

 

3816

COD Tag and Sender's Receipt

 

3821

COD, Bulk Receipt for Mail and Funds

 

3849-A

Delivery Notice or Receipt

 

3849-B

Delivery Reminder or Receipt

 

3867

Registered and Certified Matter Received for Delivery

 

3868

Carrier's Clearance Receipt

 

3877

(Page from) Firm Mailing Book for Accountable Mail

 

3883

Delivery Notice or Receipt

 

3921

Daily Volume Recording Worksheet

 

3922

Delivery Volume Unit Recap

 

3923

Daily Delivery Operation Analysis

 

3968

Daily Mail Collection Record

 

3971

Request for Leave

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3972

Absence Analysis

 

3973

Military Leave Control

 

3981

Roster Sheet

 

3982

Change of Address (Carrier's Case)

 

3996

Carrier - Auxiliary Control

 

3997

Unit Daily Summary, Record of Carrier Work Hours, Absences

 

3997-B

Daily Delivery Analysis

 

3998

Unit Summary of City Delivery Routes

 

3999

Inspection of Letter Carrier Routes - Supervisor Street Observation

 

3999-A

Record of Deliveries -- Worksheet

 

3999-B

Inspection of Collection Route

 

4003

Official Rural Route Description

 

4003-A

Official Rural Route Description, Continuation Sheet

 

4027

Petition for Change in Rural Delivery

 

4098

Employee Identification Card

 

4239

Count of Mail (Rural Route)

 

4240

Rural Carrier Trip Report

 

4241

Rural Delivery Statistics Report

 

4241-A

Rural Route Evaluation

 

4248

Rural Route Inspection Report

 

4516

Emergency Vehicle Hire Use

 

4528

Vehicle Defect Report

 

4564

Vehicle Repair Tag

 

4570

Vehicle Time Record

 

4582

Operator's Record

 

4582-A

Summary of Driving Record

 

4584

Observation of Vehicle Operator

 

4585

Postal Driver Accident Information

 

4586

Accident Information

 

7020

Authorized Absence from Workroom Floor

 

8076

Authorization to Hold Mail (30 Day Max.)

 

8190

USPS-NALC Joint Step A Grievance Form

 

8191

USPS-NRLCA Joint Step 1 Grievance Form

 

8200

Flexible Spending Account Form

 

Overtime Desired List

 

P.I.'s Reports when they are involved

 

Record of Discipline

 

Records of Merit

 

Street Supervision Report

 

P/T Emplyees Weekly Cumulative Hours - By Pay Locations showing cumulative weekly-to-date- work, leave and O.T. totals for PTF's

 

Tachograph Record (or any other measuring device records currently being used)

 

Sick Leave and LWOP Usage Report Lists are employees by pay location using sick leave and LWOP

 

WITNESSES statements of non-employees, carriers, clerks and supervisors

 

"Employee Time Certification" - Time used by all employees in a pay location by pay period. (Hours worked, type leave, etc.)

 

Vehicle Analyst's Report of Accident

 

History of Clock Rings - Shows individual employee clock rings and leave for pay period

 

"Carrier Report - Daily" shows clock rings of carriers in the station. (Used when times are needed relative to route, overtime, comparisons.)

 
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