LISTED BY SUFFIX: FORMS REFERENCED IN THE PPM Flipbook PDF

LISTED BY SUFFIX: FORMS REFERENCED IN THE PPM (Revised 01/02) Form Suffix Source CA SCO - Division of Accounting CD SCO

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LISTED BY SUFFIX: FORMS REFERENCED IN THE PPM (Revised 01/02) Form Suffix CA CD DE DPA HBD PERS-MEM PPSD PR SCIF SM TC STD VA W

Source SCO - Division of Accounting SCO - Division of Disbursements Employment Development Department - www.edd.ca.gov Department of Personnel Administration - http://www.dpa.ca.gov Public Employees Retirement System – Health Benefits Division Public Employees Retirement System SCO - PPSD SCO - PPSD - Payroll Operations State Compensation Insurance Fund SCO - Systems Management SCO - Division of Accounting Standard Forms - DGS - Central Stores Veterans Administration Internal Revenue Services

LISTED BY NUMBER: FORMS REFERENCED IN THE PPM (Revised 01/02) Form Number

Title

W-2

Wage and Tax Statement

W-2C

Statement of Corrected Income and Tax Amounts

PPSD 8A

Signature Authorization Personnel/Payroll

HBD-12

Health Benefit Plan Enrollment Form

PPSD 21

Deceased Employee Data

CA 21

Remittance Advice

TC 38

Notice of Transfer

CD 38

Payroll Warrant Register

CD 39

Payroll Warrant/Statement of Earnings and Deductions

CD 39A

Direct Deposit Advice/Statement of Earnings and Deductions

CD 048

Student Assistant Attendance Report

SM 62

Payroll Revolving Fund Transfer Notice

PSD 66

Report of Warrants/Payments Held by Controller

CD 88

Payroll Deduction Authorization

CD 88A

Fair Share Payroll Deduction Authorization

CD 102

Notice of Claim Paid

CD 113

Proof of Lost or Destroyed Payroll Warrant and Request for Issuance of Duplicate Warrant A – Block of Warrants B – Single Warrant

CD 155

Transmittal Form (garnishment)

PERS-MEM 155

Notice of Change

STD 242

United States Savings Bonds Purchase/Payroll Deduction

PR 250

Payroll Irregularity Notice

SCIF 290

Temporary Disability Verification of State Employee

PR 345

Outstanding U.S. Savings Bond Memo

PR 352

Notice of Incomplete Deduction Action Request

PPSD 360

Parking Adjustment Notice

PR 370a

OASDI/Retirement Arrears

PR 371

A/R Notice

PR 373a

W-2 Transmittal Form

STD 407

Changes in Payroll Header

CD 413

Garnishment Warrant Action Notice

PR 421

Payroll Header Report (407)

STD 422

Report of Salary Advances Paid/Offset

STD 435

Request For Duplicate Controller's Warrant

STD 436

Request for Duplicate Wage and Tax Statement

CD 446

Payroll Deduction Report

STD 456

Personnel/Payroll Transaction (PPT)

STD 457

Student Payroll Action Request (SPAR)

STD 458

Voluntary Child Support Deduction/Authorization

STD 459

Voluntary Spousal Support Deduction/Authorization

STD 603

Report of Absences Without Pay

STD 607

Change in Established Positions

STD 614

Signature Card

STD 625

Request for Certification

STD 639

Salary Garnishment

STD 650

Miscellaneous Deduction Change Report

STD 666

Report of Exceptions to Payroll

STD 671

Miscellaneous Payroll/Leave Actions

672 (CD)

Time and Attendance Report

STD 674

Payroll Adjustment Notice

STD 674 A/R

Payroll Adjustment Notice, Accounts Receivable (A/R)

STD 674D

Industrial/Non-Industrial Disability Pay/Adjustment Request

STD 675

Supplementary Wage Deductions

STD 676P

Non-USPS Adjustment Request-Payments (Fringe Benefit/Employee Business Expense) Non-USPS Adjustment Request-Values (Fringe Benefit/Employee Business Expense) Personnel Action Request (PAR)

STD 676V STD 680 DPA 682 STD 683

Pre-tax Parking/Third Party Administrator/Reimbursable Account Enrollment Pay Adjustment Request (ADJ)

STD 686

Employee Action Request (EAR)

STD 692

Dental Plan Enrollment Authorization

STD 698

Life Insurance Enrollment Authorization

STD 699

Direct Deposit Enrollment Authorization

STD 700

Vision Plan Enrollment Authorization

STD 701C

Cash Option Enrollment Authorization

STD 701R

Reimbursement Account Enrollment Authorization

STD 702

Consolidated Benefits (CoBen) Cash Enrollment Election

PERS-MEM 823

Authorization for Contribution and/or Rate Adjustment

STD 966

Employee Time Certification (ETC)

STD 995A

Non-USPS -- Agency Collection Accounts Receivable

STD 995R

Non-USPS -- Refund of Over collections

PR 1740A

Notice of Deduction Deletion or Temporary Discontinuance

DE 8500A

Authorization to Pay Nonindustrial Disability Insurance

DE 8501

Nonindustrial Disability Insurance

DE 8517c

Notice of Determination

DE 8545

Information Collection and Access

VA 29-483

Certificate of Renewal

HCRAENR

Pre-tax Parking Deduction Election Authorization (CSU)