Forms | Iowa Department of Administrative Services

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A

Acknowledgment of Driver License Requirement
Administrative Leave Extension Request
Administrative Rule Waiver Request
Administrative Rule Waiver Request: Extension of Eligible List
Affidavit of State of Iowa Warrant Fraud
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

B

Background Check Policy Template
Building Access Identification Cards

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
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

D

Delta Dental Insurance Application
Departure Survey Employee Information
Dependent Disability Certification
Dig Application Direct Pay Continuation Form
Domestic Partner
Declaration of Domestic Partnership
Domestic Partner Termination
Domestic Partnership: Cancellation of Health and Dental Coverage
Domestic Partnership: Reenrollment in Health and Dental Insurance
Donated Leave

Donated Leave for Catastrophic Illness Application
Donated Leave for Catastrophic Illness Immediate Family Member Application
Donated Leave for Catastrophic Illness Request (for Agency HR use)
Donated Leave for a Catastrophic Illness Immediate Family Member Request (for Agency HR use)
Donated Leave Tracking
Donated Leave Tracking (Family Members)

E

Education Payments: Agreement for Recouping Education Payments 552-0707
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

F

First Report of Injury or Illness

Non-Workday Agencies - FMLA forms
Application and Intent to Return to Work
Certification of Healthcare Provider for a Serious Health Condition
Certification of Healthcare Provider for Family Member's Serious Health Condition
Employee Rights and Responsibilities
Leave Retention
Return to Work Certification

Certification of Military Family Leave
Qualifying Exigency
Military Caregiver Leave of a Current Servicemember
Military Caregiver Leave of a Veteran

Designation Notice
Notice of Eligibility and Right & Responsibilities
Servicemember Family Leave Application

G

GAX - General Accounting Expenditure

H

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

I

IDOM Equipment/Service Justification Form

Insurance Adjustment
  Trustee Report Adjustments (TRA)
  State Share Transfer - Health & Dental
Refund Form - Health & Dental
Transfer Between Carriers
  State Share Transfer - Life & LTD
  Supplemental Life Payment
  Refund Form Life & LTD

J

Job Evaluation Questionnaire

K

L

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

M

MD-Manual Disbursement Document
Military Leave Checklist for State of Iowa Employees (552-0796)
Military Leave of Absence Request (Exceed 30 Days) (552-0797)
Military Leave Performance/Increase (552-0799)
Military Leave Request for Leave Dates (552-0798)
Military Service Voluntary Written Notice of Intent Not to Return (552-0800)
Motor Vehicle Law Conviction Notice
Moving Company Bid Sheet

N

Non-SLIP Retirement Process Checklist

O

P

Parking Decal Application
Pay Grade Study Questionnaire
PDS Certificate Program Enrollment Forms
Talent Development Certificate
  Advanced Talent Development Certificate
  Leadership Capacity Building Development Certificate
  Management Development Certificate

PDS Course Registration Form
Performance Plan and Evaluation Form
Personnel Mobility Assignment Agreement
Personnel Services Pre-Contract Questionnaire
Position Description Questionnaire NOTICE (See Instructions.)
Pre-Auditor's Authorized Signator Form

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 to Deny Peer Assistance
Request to Establish New Fund
Request for Selective Certification Additions or Changes
Request for Warrant Cancellation
Request for Warrant Stop Payment/Rescind Stop
Requisition for Goods & Services Form
Retention Point Calculation Worksheet
Retirement - Continuation of Benefits
Application for the Retired/Disabled Health and Dental Insurance Group
Wellmark Group Retiree Application (use for Iowa Choice, National Choice, Group Program F, and Group Program N)
Group MedicareBlue Rx - Iowa/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

S

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

T

Temporary Staffing Services Vendor Request
TP - Travel Payment
TPN - Travel Payment Non-Reverted
TPO - Travel Payment Overpayment
TP (RELO-EXP) - Travel Payment for Relocation Expenses
TP (RELO-SUB) - Travel Payment for Relocation Subsistence
TPR - Travel Payment Reverted

U

V

Vehicle Accident Report Form
Vendor Complaint Form
Vendor Conversion Form (I/3)

W

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

X

Y

Z

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Open Google Chrome.
Click on the Menu icon (three vertical dots illustrate 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.

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updated 04/14/23