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A

Accidental Death & Dismemberment Claim Form
Acknowledgment of Driver License Requirement 
Administrative Leave Extension Request 
Administrative Rule Waiver Request 
Administrative Rule Waiver Request: Extension of Eligible List 
Affidavit as to Forged Endorsement
Affidavit of Common Law Marriage
Agreement for Recouping Education Payments
Agreement for Recouping Relocation Payments
Alternative Duty Assignment 
Alternative Duty Notice to Employee 
Appeal Board Administrative Form
Authorized Signator Form

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B

Background Check Policy Template
Building Access Identification Cards

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C

Calculate Market Value Differential
Calculating Mortgage Interest Differential
Calculation of Income Tax Assistance Payment
Capitol Complex Events Form
Capitol Complex Grounds/Administration Buildings Form
Certificate Program Enrollment Forms
Certification of Full-Time Student Status
Certified Public Manager (CPM) Application
COBRA Notification/Election form
Commercial Driver License Supplement Application
Complaint Form, Employee
Confidential Personal Data Form
Confined Space Entry Permit (Permit Required)
Confined Space Pre-Entry Checklist (Non-Permit Spaces)
Correction Document Expenditure - Excel Version
Correction Document Expenditure - Word Version
Correction Document Revenue - Word Version
Correction Document Revenue - Excel Version
CR Cash Receipt Treasurer's Document

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D

Delta Dental Insurance Application
Departure Survey Employee Information
Dig Application
Direct Pay Continuation Form
Donated Leave Application
Donated Leave Application for Family Members
Domestic Partner Affidavit
Domestic Partner Termination
Donated Leave Contributions (Employee)
Donated Leave Contributions (Family Members)
Donated Leave Request (Employee)
Donated Leave Request (Family Members)
Donated Leave Tracking
Donated Leave Tracking (Family Members)
Duplicate Warrant Affidavit

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E

Education Payments: Agreement for Recouping Education Payments 552-0707
Educational Directory order form
Education Leave and/or Education Financial Assistance Application
EFT Authorization State of Iowa Vendor Use Only (Not for Employee Payroll Use) 
Emergency Procurement Justification Form 
Employee Complaint Form
Employee Grievance Form 
Employee Separation Form 
Evacuation Assistance form, Employee Request for 
Exit Information Questionnaire

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F

First Report of Injury or Illness
FMLA - Employee Rights and Responsibilities
FMLA - Leave Retention
FMLA - Return to Work Certification
FMLA forms for use only by Community-Based Corrections (CBC), Judicial Branch, and State Fair employees.
   Application and Intent to Return to Work
   Cert. of Health Care Provider for Employee's Serious Health Condition
   Cert. of Health Care Provider for Family Member's Serious Health Condition
   Cert. of Qualifying Exigency for Military Family Leave
   Cert. for Serious Injury/Illness of Covered Service Member for Military Family Leave
   Certification for Serious Injury or Illness of a Veteran for Military Caregiver Leave
   Designation Notice 
   Notice of Eligibility and Right & Responsibilities

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G

General Accounting Expenditure - Word Version
General Accounting Expenditure - Excel Version
GAXN-Excel Version
GAXN-Word Version
GAXR-Excel Version
GAXR-Word Version

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H

Health Insurance Application - Alliance Select  (SPOC-covered employees)
Health Insurance Application  - Iowa Choice/National Choice (active employees)
Health Insurance Application  - Iowa Choice/National Choice/Group Program F/Group Program N (retirees)
Health Insurance - Prescription Reimbursement Claim Form 

Hiring Justification  (Interactive form. Click to see instructions at the bottom of the page.)
Hot Work Permit

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I

IET Internal Exchange Transfer-Excel Version
IET Internal Exchange Transfer-Word Version
IET for PROD Interfaces - Word Document
IET for PROD Interfaces - Excel Document 
Insurance Billing Reconciliation 
   Employee and/or State Share Transfer between Carriers
   Employee Supplemental Life Payment
   Health and Dental Insurance Trustee Report Adjustments (Excel)
   Health and Dental Insurance Trustee Report Adjustments (Word)
   Payroll Journal Reconciliation Worksheet
   Refund for Health, Dental and Life Insurance 
   State Share Transfer for Health and Dental
   State Share Transfer for Life and LTD

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J

Job Evaluation Questionnaire
JV1 Correcting Journal Voucher-Excel Version
JV1 Correcting Journal Voucher-Word Version
JV1N-Excel Version
JV1N-Word Version
JV1R-Excel Version
JV1R-Word Version

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K

L

Layoff Plan - Contract-Covered Employees (SPOC) 
Layoff Plan - Merit-Covered Employees
Lease Agreement, State of Iowa 
Life Insurance - Life Insurance Claim Application (to be completed by agency)
Life Insurance - Beneficiary Designation 
Life Insurance - Beneficiary Statement (method of benefit payment) 
Life Insurance - Enrollment   

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M

MD-Excel Version
MD-Word Version
MedicareBlue Rx Group Participant Enrollment
Motor Vehicle Law Conviction Notice
Mover Planner Worksheet
Moving Company Bid

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N

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O

Office Space Allocation Form 
Online Learning Registration Form

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P

P17 Electronic Work Comp
P-30
Parking Decal Application
Pay Grade Study Questionnaire
PDS Course Registration Form
Performance Plan and Evaluation Form
Permit-Required Confined Space Entry Permit 
Personnel Mobility Assignment Agreement
Personnel Services Pre-Contract Questionnaire
Position Description Questionnaire  (Interactive form. Click to see instructions at the bottom of the page.)
Pre-Auditor's Authorized Signator Form
Pre-Entry Checklist for Non-Permit Confined Spaces

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Q

R

Reasonable Accommodation Request 
Request for Adaptive Google Software
Relocation: Agreement for Recouping Relocation Payments 552-0751
Relocation Expense Recap
Request for Classification, Compensation and Selection Changes
Request for Exception to Statewide Policies
Request for Flat WH Rates
Request for Outstanding Warrant Action 
Request to Deny Peer Assistance
Request to Establish New Fund
Request for Selective Certification Additions or Changes
Requisition for Goods & Services Form
Retention Point Calculation Worksheet 
Retireement - Continuation of Benefits 
     Application for the Retired/Disabled Health and Dental Insurance Group  
     State of Iowa Group Retiree Application (use for Iowa Choice, National Choice, Group Program F, and Group Program N) 
     Group MedicareBlue Rx - Iowa (use with Iowa Choice or National Choice) 
     Group MedicareBlue Rx (use with Group Program F or Group Program N) 

RIC Inactive Provider Beneficiary Form 
RIC Inactive Provider/In-service Distribution Form 
RIC Unforeseeable Emergency Form

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S

Safety Glasses Form and Instructions
Separation Checklist
Short Form SS-8
Signature Authorization form
SLIP - Enrollment Form
SLIP - Calculation Worksheet
SLIP - Executive Branch Non Contract SLIP Retiree Wellness Participation
SLIP - Enrollment Checklist for Human Resources Associates
SLIP - Retiree Rehire Authorization
Sole Source Purchase Form
Space Allocation Form 
Special Pay/Appointment Action
SPOC Retiree Vacation to Sick Leave Conversion
SPOC Vacation to Sick Leave Conversion 
Statement of Ownership of Principle Residence
Substitute W-9 Vendor
Summary of Internal Policies for Claims Crossing FY

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T

TAPE Cover Sheet
TE-Excel Version
TE-Word Version
Temporary Staffing Services Vendor Request 
TP (Travel Payment)-Excel Version
TP (Travel Payment)-PDF Version
TPN-Excel Version
TPN-Word Version
TPO-Excel Version
TPO-Word Version
TP-RELO-EXP-Travel Payment for Relocation Expenses
TP-RELO-SUB-Travel Payment for Relocation Subsistence
TPR-Excel Version
TPR-Word Version

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U

V

Vehicle Accident Report Form
Vendor Complaint Form
Vendor Conversion Form

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W

Wallace Auditorium Reservation Form
Workers' Comp Benefit Election Form
Workers' Comp Travel Reimbursement Request
Workers' Comp Wage Statement 
Workplace Violence Report (see Complaint Form, Employee)

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X

Y

Z

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Download Interactive Forms

Interactive PDFs, such as DAS-HRE's forms, must be downloaded and opened in Adobe Acrobat Reader.  By default, Google Chrome opens PDFs in the browser. To download PDFs instead of opening in the browser, change Google Chrome browser settings per the steps below.
  • Open Google Chrome.
  • Click on the Menu icon (  ) in the top-right corner of the Window.
  • Click Settings.
  • Scroll down to the bottom of the Settings window and click Advanced.
  • In the Privacy and security section, click Content Settings.
  • Scroll down and click the PDF documents option.
  • Slide the Download PDF files instead of automatically opening them in Chrome setting right to the on position (blue) from the off position (grey).
  • Close the browser window. 
This will allow you to download () the PDF form and open it in your Adobe viewer. The PDF can also be found in your Chrome downloads folder. You may save it there once completing the form or to any drive location you prefer. If your default PDF application is not Adobe, please contact the OCIO Service Desk for assistance.