CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
BLM
1112-03
1112-04
1114-04
1114-07
1114-09
1165-68
1221-02
1223-06
1223-07
1260-10
1264-03
1271-01
1271-01a
1271-01b
1271-01c
1271-01d
1272-07
1273-02
1274-07
1274-11
1275-07
1279-01
1279-02
1279-03
1310-05
*1310-11
1323-01
1323-02
1340-02
1340-14
1370-16
1370-21
CURRENT
DATE
10/84
03/93
04/92
01/88
09/91
12/87
06/69
04/77
09/84
03/89
10/99
08/94
05/95
06/92
02/93
04/93
08/89
10/84
01/65
06/74
12/94
06/82
04/79
06/84
09/86
11/89
06/83
02/85
09/84
06/99
09/64
10/64
FORM TITLE
*nbcweb.blm.gov
Job Hazard Analysis
Employee Report of Unsafe or Unhealthful Working Condition
Individual Volunteer Services Agreement
Volunteer and Hosted-Worker Report
Volunteer Appreciation Certificate
Public Lands Under Exclusive Jurisdiction of BLM
Manual Transmittal Sheet
Forms Requisitioning Control Card
Request for a New or Revised Form
User Master Catalog and Charge Code Action Request
Individual Computer User’s Statement of Responsibility w/General Rules
Official File Cover, Blue (FY 2003)
Official File Cover, Salmon (FY 2004)
Official File Cover, Yellow (FY 2001)
Official File Cover, Pink (Long Term Permanent Records)
Official file Cover, Green (FY 2002)
Records Request (National Archives)
Proprietary/Confidential Information (Record Cover)
Future Action Suspense Card
Examination of Case/Card Record Request
Request for Use of Land Status and Use Records
Periodical Index Card
Library Search Request
Borrower’s Card
Document Face Sheet
Construction Project Completion Report
Reimbursable Project Log
Right-of-Way Cost Recovery Category and Fee Determination Record
Final Salary Clearance Report
Supplemental Time and Attendance Report
Un-deposited Remittances Register
Notice of Return of Remittance
1
LAST
ORDER
DATE
11/95
10/95
01/99
10/95
09/99
10/98
06/93
07/01
05/95
06/86
02/00
06/02
08/03
09/00
10/02
08/03
11/90
07/01
12/98
08/96
03/02
02/94
02/98
08/03
12/98
11/95
09/00
09/00
11/01
06/01
10/97
07/98
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
CURRENT
DATE
1370-32
1380-01
1380-06
01/95
01/85
12/89
1380-07
1380-09
1382-02
1400-12
1400-56
1400-64
1400-68a
1400-70
1400-71
1400-72
1400-73
1400-75
1400-86a
1400-93
1400-94
1400-98
1400-99
1400-100
1400-105
1400-110
1510-05
1510-07
1510-10
1510-30
1510-42
1510-48
1510-53
1510-55
1510-57
04/85
10/76
08/86
03/74
04/73
02/78
03/84
11/69
06/88
10/93
08/70
05/97
10/84
04/76
02/88
05/84
03/84
04/84
12/84
05/94
11/94
**03/96
04/98
**06/01
04/96
03/76
02/91
12/85
09/96
FORM TITLE
Land Acquisition Voucher Certificate
Personnel Travel Data
Employee Application for Reimbursement of Expenses Incurred Upon
Sale or Purchase (or Both) of Residence Upon Change of Official Station
Employee and Immediate Family Subsistence Expenses
Employment Agreement
Request for Contractor Provided Relocation Services
Certificate of Training
CPDF Supervisory and Educational Questionnaire
Overtime/Holiday Pay Request and Authorization
Candidate Referral Roster
Special Achievement Award
Personal Emergency Information Card
Basic Workweek Request
Incentive Awards Program (Suggestions)
Name Plate (Meetings/Training/etc)
Supervisor’s Employee Appraisal
Appreciation Award
Applicant Log and Qualifications Rating Sheet
Position Analysis Worksheet
Rating Plan
Candidate Rating Sheet
Explanation of Prohibitions for BLM Employees
On-the-Spot Award
Procurement Request
Notice to Proceed
Certificate for Contract Payment/Invoice
Pre-work Conference Record and Contractor’s Authorization
Oral Quotations
Special Conditions
Small Purchase Pricing and Negotiation Memorandum
Contract Estimate Work Sheet
Contract Diary
2
LAST
ORDER
DATE
10/03
02/94
02/98
01/96
01/00
01/96
10/98
07/97
09/94
04/95
04/99
07/03
04/02
06/92
04/03
07/95
03/93
02/95
02/95
07/01
07/97
07/97
10/96
11/95
12/01
04/96
02/00
05/98
09/95
07/99
05/96
02/00
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
CURRENT
DATE
1510-57a
1510-58
1510-59
1511-01
1511-02
08/86
12/85
10/94
02/89
02/89
1520-10
1520-27
03/99
05/97
1520-34
1520-42
1541-01
1542-02
*1550-08
*1556-01
1681-03
1788-01
1822-04
1842-01
*1842-02
1850-01
1860-01
1860-1a
1860-1b
1860-1c
1860-02
1860-08
1860-10
2060-03
2520-01
2530-02
2540-01
2540-02
**07/98
06/01
09/88
10/92
**09/02
**04/01
**07/98
04/87
**09/87
04/02
07/99
03/74
07/99
10/90
10/90
10/90
**03/89
08/99
08/99
08/93
**11/01
08/70
**11/00
**11/00
FORM TITLE
Contract Diary Continuation Sheet
Notice of Noncompliance/Instruction to Contractor
Labor Compliance Interview
Assistance Agreement
Amendment of Request for Application/Modification of Assistance
Agreement
Request for Use of Government Vehicle
Request for Overnight Storage of Government Vehicle at Employee’s
Residence
Available Property Report
Utilization Record
Short Note Transmittal
Mailing Label
05/03
Printed Materials Distribution Section Publications Requisition Form
Reimbursable Work Job Authorization
Request and Authorization to Attend Non-Government Meeting
Cash Bond (Assured Payment)
Information on Taking Appeals to the Board of Land Appeals
Memorandum – Board of Land Appeals
Transmittal of Contest or Other Proceeding for Hearing
Mineral Entry Final Certificate
Second Half – Mineral Entry Final Certificate
Continuation Sheet – Mineral Entry Final Certificate
Supplemental Patent Second Half – Mineral Entry Final Certificate
Certificate (Compliance w/Acts of …)
Letter of Patent
Letter of Patent – Continuation Sheet
Certificate of Inspection and Possession
Desert Land Entry Application
Certificate of Allotment
Color-of-Title Application
Conveyances Affecting Color or Claim of Title
3
LAST
ORDER
DATE
09/91
10/02
10/02
11/97
04/99
11/99
01/99
07/97
07/03
03/93
06/03
01/95
01/99
04/87
12/93
11/99
02/00
04/93
04/00
12/93
02/91
12/93
12/93
02/00
02/00
10/95
08/99
03/99
09/99
08/99
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
CURRENT
DATE
2540-03
2740-01
2800-16
2800-17
2910-01
2912-01
2920-01
3000-02
3000-03
**11/00
**11/00
02/89
02/89
**05/01
**05/01
11/01
**11/01
**02/02
3000-3a
02/02
3000-04
3000-4a
3060-01
3100-07
3100-11
3104/03
3108-02
3108-02a
3108-02b
3200-09
3200-24
3260-02
3260-03
3260-04
3260-05
3504-04
06/88
06/88
07/84
11/70
10/92
07/74
11/90
11/90
02/89
11/01
11/01
09/01
09/01
09/01
09/01
09/70
3510-01
*3600-09
3830-02
08/02
**04/02
**02/03
FORM TITLE
Color-of-Title Tax Levy and Payment Record
Application for Land for Recreation or Public Purposes
Right-of-Way Surety Bond
Right-of-Way Personal Bond, Cash and Book Entry Deposits
Public Airport Lease
Recreation or Public Purposes Lease
Land Use Application and Permit
Competitive Oil and Gas or Geothermal Resources Lease Bid
Assignment of Record Title Interest in a Lease for Oil and Gas or
Geothermal Resources
Transfer of Operating Rights (Sublease) in a Lease for Oil and Gas or
Geothermal Resources
Oil and Gas or Geothermal Lease Bond
Oil and Gas or Geothermal Exploration Bond
Mineral Report
Title Report Request
Offer to Lease and Lease for Oil and Gas
Statewide or Nationwide Mineral Lease Bond
Notice Oil and Gas Lease Terminated
Notice Oil and Gas Lease Terminated Class II Reinstatement Procedures
Notice Oil and Gas Lease Terminated Class I Reinstatement Procedures
Notice of Intent to Conduct Geothermal Resource Exploration Operations
Offer to Lease and Lease for Geothermal Resources
Geothermal Drilling Permit
Geothermal Sundry Notice
Geothermal Well Completion Report
Monthly Report of Geothermal Operations
Statewide or Nationwide Personal Mineral Bond for Prospecting Permits
and Leases
Prospecting Application and Permit
Contract for the Sale of Mineral Materials
Maintenance Fee Waiver Certification
4
LAST
ORDER
DATE
08/99
02/99
12/93
12/93
10/95
12/93
03/02
03/02
08/01
02/03
03/01
09/88
04/99
08/03
10/00
04/99
10/95
05/89
05/89
03/02
02/02
03/02
03/02
03/02
03/02
12/93
04/03
03/00
03/00
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
CURRENT
DATE
3830-03
**02/03
3860-02
3860-05
3860-11
3890-01
3890-03
4120-09
4710-10
8370-01
9110-08
9110-8a
9130-03
9230-10
9230-14
9230-24
9260-03
9260-06
9260-07
9260-08
9260-11
9260-12
9260-13
9260-14
9260-16
9260-18
9260-18a
9260-18b
9260-19
9260-20
9260-21
9260-22
07/81
**02/01
03/91
11/89
11/91
10/89
**10/02
**01/02
09/78
09/78
**04/01
03/94
09/93
02/93
08/93
09/96
08/93
09/93
09/96
09/96
**02/02
09/96
09/96
04/94
04/94
04/94
09/96
09/96
09/96
09/96
FORM TITLE
Notice of Intent to Locate a Lode or Placer Mining Claim(s) and/or a
Tunnel Site(s) on Lands Patented Under the Stock Raising Homestead Act
of 1916, as Amended by the Act of April 16, 1993
Certificate of Title on Mining Claims
Application for Survey of Mining Claim
Certificate of Expenditures, Improvements, and Mineral Survey
Mineral Sample Record
Placer Sample Field Record
Proffer of Monetary Contribution
Application for Adoption of Wild Horses(s) or Burro(s)
Special Recreation Application and Permit
Major Culvert Condition Survey Record
Bridge Condition Survey Record
Bureau Sign Shop Requisition
Initial Report of Unauthorized Use
Notice and Order to Remove Unauthorized Structures/Property
Unauthorized Use Investigative Report
Inventory Record (Property/Evidence)
Evidence Storage Facility Log
Evidence Label
Investigative Report
Request for Special funds
Administratively Uncontrollable Overtime Report
Advice of Rights
Consent to Search
Domiciled Vehicle Use Log
Voluntary Statement
Voluntary Statement (Continuation Sheet)
Voluntary Statement (Signature Sheet)
Source of Information Personal History
Source of Information Ledger
Source of Information Agreement and Waiver
Purchase of Information/Evidence Transaction Receipt
5
LAST
ORDER
DATE
03/00
03/97
10/95
12/93
04/99
04/99
12/01
07/02
12/99
07/86
09/95
09/95
10/95
10/95
10/95
08/95
05/02
01/99
08/96
08/98
08/98
08/02
08/98
07/98
04/95
04/95
04/95
08/98
08/98
08/98
08/98
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
CURRENT
DATE
FORM TITLE
*9260-30
09/96
Firearms Qualification/Familiarization Record
BLM Denver
SC-1510-61
06/94
Service Center Branch of Procurement Bidder Application for Work in the
State of – California – etc.
Compensation
Act Forms
*CA-1
04/99
*CA-3
*CA-7
CA-10
CA-11
CA-13
CA-16
CA-17
Department
of Interior
DI-1
DI-1a
DI-17
DI-83
DI-84
DI-103
DI-103a
DI-104
*DI-105
DI-451
DI-550
DI-570
DI-1866
06/88
**11/99
08/87
10/88
07/87
01/97
01/97
07/94
12/61
01/72
01/72
06/88
06/88
06/88
05/88
02/96
08/91
07/65
09/82
*www.dol.gov/esa
Federal Employee’s Notice of Traumatic Injury and Claim for
Continuation of Pay/Compensation
Report of Termination of Disability and/or Payment
Claim for Compensation
What a Federal Employee Should Do When Injured at Work
When Injured at Work (pamphlet)
Notice to Employee (re OWCP Benefits) (wallet card)
Authorization for Examination and/or Treatment
Duty Status Report
*nbcweb.blm.gov
Requisition
Requisition (Continuation Sheet)
Special tag
Notice of Assignment
Instrument of Assignment
Report of Survey
Certificate of Unserviceable Property
Transfer of Property
Receipt for Property
Award Certification
Publications Approval Request and Control Document
Employee Claim for Loss or Damage to Personal Property
Request for Reprographic Equipment
6
LAST
ORDER
DATE
08/98
08/95
12/02
09/97
12/99
08/96
08/96
10/00
10/01
09/97
02/98
11/91
02/00
11/95
03/95
07/97
04/98
03/97
09/98
03/92
02/00
03/99
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
CURRENT
DATE
DI-1935
01/03
Applicant Background Survey
LAST
ORDER
DATE
08/01
Dept. of
Treasury
*FMS-2231
11/92
*www.fms.treas.gov
Fast Start Direct Deposit
02/00
FORM TITLE
7
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
GPO Forms
*GPO-2511
CURRENT
DATE
FORM TITLE
LAST
ORDER
DATE
01/89
*nbcweb.blm.gov
Print Order
09/97
03/88
*www.gsa.gov
Reimbursable Work Authorization
11/94
I-9
11/91
Employment Eligibility Verification
07/97
OAS Forms
OAS-87
02/76
Helicopter Power Check Turbine Engine
07/97
01/85
07/87
01/94
07/90
03/83
10/84
**01/01
09/90
07/94
09/94
*www.gsa.gov
Position Descriptions
Reference Request – Federal Records Centers
Routing and Transmittal Slip
Fax Transmittal
Emergency Firefighter Time Report
Emergency Equipment Rental Agreement
Declaration for Federal Employment
Procurement Integrity Certification
Memorandum of Call
Optional Application for Federal Employment
06/96
12/90
08/02
06/97
03/03
01/90
01/01
11/95
02/02
09/01
GSA Forms
*GSA-2957
Dept. of
Justice
Optional
Forms
*OF-8
*OF-11
*OF-41
OF-99
OF-288
OF-294
*OF-306
OF-333
*OF-363
*OF-612
SB Form
SB-2152
Standard
Forms
*SF-15
United States Savings Bonds – Authorization for Purchase and Request for 07/99
Change
02/90
*www.gsa.gov
Application for 10-Point Veteran Preference
8
06/95
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
CURRENT
DATE
*SF-18
*SF-30
*SF-33
*SF-39
*SF-52
*SF-61
*SF-71
SF-78
*SF-85
*SF-85P
*SF-86
*SF-86A
SF-87
*SF-91
*SF-94
*SF-95
*SF-98
*SF-98a
06/95
10/83
**09/97
11/88
07/91
**08/02
12/97
10/69
09/95
09/95
09/95
09/95
02/02
02/93
02/83
07/85
02/73
02/73
*SF-122
*SF-129
*SF-135
*SF-144
SF-177
*SF-180
*SF-181
*SF-182
SF-182
*SF-252
*SF-254
*SF-255
06/74
**12/96
07/85
10/95
09/84
**02/02
05/82
12/79
12/79
10/83
11/92
11/92
*SF-256
08/87
FORM TITLE
Request for Quotation
Amendment of Solicitation/Modification of Contract
Solicitation, Offer and Award
Request for Referral of Eligibles
Request for Personnel Action
Appointment Affidavits
Request for Leave or Approved Absence
Certificate of Medical Examination
Security Investigation Data Non/Sensitive
Questionnaire for Public Trust Positions
Questionnaire for National Security Positions
Continuation Sheet for Questionnaires SF-86, SF-85P, and SF-85
Fingerprint Chart
Motor Vehicle Accident Report
Statement of Witness
Claim for Damage, Injury, or Death
Notice of Intention to Make a Service Contract and Response to Notice
Notice of Intention to Make a Service Contract and Response to Notice
(Attachment A)
Transfer Order Excess Personal Property
Solicitation Mailing List Application
Records Transmittal and Receipt
Statement of Prior Federal Service
Statement of Physical Ability for Light Duty Work
Request Pertaining to Military Records
Race and National Origin Identification
Request, Authorization, Agreement and Certification of Training (5-Part)
Request, Authorization, Agreement and Certification of Training (10-Part)
Architect-Engineer Contract
Architect-Engineer and Related Services Questionnaire
Architect-Engineer and Related Services Questionnaire for Specific
Project
Self-Identification of Handicap
9
LAST
ORDER
DATE
09/97
02/00
07/98
08/99
11/99
10/93
11/95
03/03
03/02
03/02
08/98
04/96
07/95
11/95
07/99
08/83
11/98
02/95
11/95
05/96
01/99
01/99
06/95
11/97
10/97
04/00
11/95
09/95
11/92
04/98
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
CURRENT
DATE
*SF-258
09/95
*SF-279
**01/02
*SF-298
*SF-362
*SF-1012
*SF-1080
*SF-1081
*SF-1152
*SF-1153
*SF-1164
*SF-1198
**08/98
**05/97
10/77
04/82
09/82
11/91
04/82
11/77
03/82
*SF-1199A
*SF-1413
*SF-1420
*SF-2800
*SF-2801
06/87
06/89
10/83
**05/00
01/90
*SF-2802
SF-2802B
01/91
01/91
*SF-2803
*SF-2804
*SF-2808
*SF-2809
*SF-2810
*SF-2817
*SF-2818
*SF-2819
*SF-2821
*SF-2822
06/92
**01/95
02/99
07/99
06/95
06/00
05/01
05/95
05/95
**01/02
FORM TITLE
Agreement to Transfer Records to the National Archives of the United
States
Federal Procurement Data System (FPDS) Individual Contract Action
Report
Report Documentation Page
U.S. Government Freight Loss/Damage Claim
Travel Voucher
Voucher for Transfers Between Appropriations and/or Funds
Voucher and Schedule of Withdrawal and Credits
Designation of Beneficiary
Claim for Unpaid Compensation of Deceased Civilian Employee
Claim for Reimbursement for Expenditures on Official Business
Request by Employee for Allotment of Pay for Credit to Savings Account
With a Financial Organization
Direct Deposit Sign-Up Form
Statement and Acknowledgement (Contractor)
Performance Evaluation – Construction Contracts
CSRS Application for Death Benefits
CSRS Application for Immediate Retirement Under the Civil Service
Retirement System
CSRS Application for Refund of Retirement Deductions
CSRS Current/Former Spouse’s Notification of Application for Refund of
Retirement Deductions
CSRS Application to Make Deposit or Redeposit
CSRS Application to Make Voluntary Contributions
CSRS Designation of Beneficiary
Employee Health Benefits Election Form
Notice of Change in Health Benefits Enrollment
FEGLI Life Insurance Election
FEGLI Continuation of Life Insurance Coverage
FEGLI Notice of Conversion Privilege
FEGLI Agency Certification of Insurance Status
FEGLI Request for Insurance
10
LAST
ORDER
DATE
11/97
03/97
03/98
01/92
06/02
09/98
05/96
03/00
05/95
11/91
01/97
07/97
01/96
09/94
07/97
08/03
11/93
11/93
04/95
02/94
11/01
01/02
07/01
10/02
10/01
12/97
09/98
12/92
NEEDED
NOT
NEEDED
CALIFORNIA STATE OFFICE
FORMS IN STOCK
*Electronic Form Available
**Previous Edition in Stock
FORM
NUMBER
CURRENT
DATE
*SF-2823
*SF-3102
*SF-3104
*SF-3104B
04/01
**06/02
05/98
05/98
*SF-3106
SF-3106A
08/00
03/96
*SF-3108
*SF-3881
11/00
12/90
FORM TITLE
FEGLI Designation of Beneficiary
FERS Designation of Beneficiary
FERS Application for Death Benefits
FERS Documentation and Elections in Support of Application for Death
Benefits When Deceased Was an Employee at the Time of Death
FERS Application for Refund of Retirement Deductions
FERS Current/Former Spouse’s Notification of Application for Refund of
Retirement Deductions
FERS Application to Make Service Credit Payment
ACH Vendor/Miscellaneous Payment Enrollment Form
11
LAST
ORDER
DATE
12/01
05/02
02/99
02/99
02/99
03/02
07/92
02/99
NEEDED
NOT
NEEDED