A
Acknowledgment of Driver License Requirement (52.5 KB) .doc
Administrative Leave Extension Request (35.92 KB) .docx
Administrative Rule Waiver Request (30.52 KB) .docx
Administrative Rule Waiver Request: Extension of Eligible List (49.65 KB) .docx
Affidavit of State of Iowa Warrant Fraud (47.07 KB) .docx
Affidavit of Common Law Marriage (214.68 KB) .pdf
Agreement for Recouping Education Payments (39.93 KB) .docx
Agreement for Recouping Relocation Payments (114.26 KB) .pdf
Alternative Duty Assignment (1.6 MB) .pdf
Alternative Duty Notice to Employee (24.17 KB) .docx
B
Background Check Policy Template (52.38 KB) .docx
Building Access Identification Cards
C
Calculate Market Value Differential (23.65 KB) .docx
Calculating Mortgage Interest Differential (66.12 KB) .docx
Calculation of Income Tax Assistance Payment (32.96 KB) .docx
Capitol Complex Events Form
Capitol Complex Grounds/Administration Buildings Form
Certified Public Manager (CPM) Application
COBRA Notification/Election form (529.55 KB) .pdf
Commercial Driver License Supplement Application
Complaint Form, Employee (3.02 MB) .pdf
Confidential Personal Data Form (30.14 KB) .pdf
D
Delta Dental Insurance Application
Departure Survey Employee Information (42.01 KB) .docx
Dependent Disability Certification (336.89 KB) .pdf
Domestic Partner
Declaration of Domestic Partnership (316.58 KB) .pdf
Domestic Partner Termination (912.1 KB) .pdf
Domestic Partnership: Cancellation of Health and Dental Coverage (495.95 KB) .pdf
Domestic Partnership: Reenrollment in Health and Dental Insurance (609.63 KB) .pdf
Donated Leave
Donated Leave for Catastrophic Illness Application (1.05 MB) .pdf (employee)
Donated Leave for Catastrophic Illness Immediate Family Member Application (1023.04 KB) .pdf
Donated Leave for Catastrophic Illness Request (for Agency HR use) (234.06 KB) .pdf
Donated Leave for a Catastrophic Illness Immediate Family Member Request (for Agency HR use) (228.78 KB) .pdf
Donated Leave Tracking (58.58 KB) .pdf
Donated Leave Tracking (20.69 KB) .docx (Family Members)
E
Education Payments: Agreement for Recouping Education Payments 552-0707 (39.93 KB) .docx
Education Leave and/or Education Financial Assistance Application (64.5 KB) .doc
Employee Complaint Form (3.02 MB) .pdf
Employee Grievance Form (54.58 KB) .docx
Employee Separation Form (1.46 MB) .pdf
Evacuation Assistance form, Employee Request for (162.7 KB) .pdf
Exit Information Questionnaire (25.52 KB) .docx
F
First Report of Injury or Illness (138.29 KB) .pdf
Full-Time Student Certification Status Form (343.63 KB) .pdf
Non-Workday Agencies - FMLA forms
Application and Intent to Return to Work (30.77 KB) .docx
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 (967.77 KB) .pdf
Return to Work Certification (1014.02 KB) .pdf
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 (24.38 KB) .docx
G
GAX - General Accounting Expenditure
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Health Insurance Applications
Health Insurance Application: Iowa Choice or National Choice PDF
Alliance Select (460.45 KB) .pdf (SPOC-covered only)
Wellmark Automatic Payment Authorization (455.43 KB) .pdf
Health Insurance - Prescription Reimbursement Claim Form (546.74 KB) .pdf
I
IDOM Equipment/Service Justification Form (35.13 KB) .pdf
Insurance Arrears & Adjustments
Arrears Payoff Form (97.61 KB) .pdf
J
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Layoff Plan - Contract-Covered Employees (SPOC) (14.28 KB) .docx
Layoff Plan - Merit-Covered Employees (8.59 KB) .docx
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 (129.46 KB) .pdf
Military Leave Checklist for State of Iowa Employees (118.36 KB) .docx (552-0796)
Military Leave of Absence Request (Exceed 30 Days) (125.34 KB) .docx (552-0797)
Military Leave Performance/Increase (416.3 KB) .pdf (552-0799)
Military Leave Request for Leave Dates (510.31 KB) .pdf (552-0798)
Military Service Voluntary Written Notice of Intent Not to Return (430 KB) .pdf (552-0800)
Motor Vehicle Law Conviction Notice
Moving Company Bid Sheet (34.02 KB) .docx
N
Non-SLIP Retirement Process Checklist (199.46 KB) .pdf
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Parking Decal Application
PDS Course Registration Form (160.69 KB) .pdf
Performance Plan and Evaluation Form (24.84 KB) .docx
Personnel Mobility Assignment Agreement (144 KB) .doc
Personnel Services Pre-Contract Questionnaire (181.48 KB) .pdf
Position Description Questionnaire (3.67 MB) .pdf NOTICE (See Instructions.)
Pre-Auditor's Authorized Signator Form (229.42 KB) .pdf
Q
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Reasonable Accommodation Request (48.2 KB) .docx
Request for Adaptive Google Software (37.82 KB) .docx
Relocation: Agreement for Recouping Relocation Payments 552-0751 (114.26 KB) .pdf
Relocation Expense Recap (154.48 KB) .pdf
Request for Exception to Statewide Policies (386.56 KB) .pdf
Request to Deny Peer Assistance (53.38 KB) .docx
Request to Establish New Fund
Request for Warrant Cancellation (155.86 KB) .pdf
Request for Warrant Stop Payment/Rescind Stop (182.58 KB) .pdf
Requisition for Goods & Services Form
Retention Point Calculation Worksheet (18.93 KB) .docx
Retirement - Continuation of Benefits
Application for the Retired/Disabled Health and Dental Insurance Group (171.86 KB) .pdf
Wellmark Group Retiree Application (624.4 KB) .pdf (use for Iowa Choice, National Choice, Group Program F, and Group Program N)
Group MedicareBlue Rx - Iowa/National Choice (739.67 KB) .pdf
Group MedicareBlue Rx (739.66 KB) .pdf (use with Group Program F or Group Program N)
RIC Inactive Provider Beneficiary Form (126.25 KB) .pdf
RIC Inactive Provider/In-service Distribution Form (330.28 KB) .pdf
RIC Unforeseeable Emergency Form
S
Safety Glasses Form and Instructions
Short Form SS-8 (214.79 KB) .pdf
SLIP - Enrollment Form (212.42 KB) .pdf
SLIP - Calculation Worksheet (22.5 KB) .xls
SLIP - Retiree Rehire Authorization
Sole Source Purchase Form
Space Allocation Form
Special Pay/Appointment Action (247.1 KB) .pdf
SPOC Vacation to Sick Leave Conversion (47.49 KB) .docx
Statement of Ownership of Principle Residence (40.23 KB) .docx
Summary of Internal Policies for Claims Crossing FY (203.69 KB) .pdf
T
Temporary Staffing Services Vendor Request (104.47 KB) .xlsx
TP - Travel Payment (1.65 MB) .pdf
TPN - Travel Payment Non-Reverted (1.66 MB) .pdf
TPO - Travel Payment Overpayment (1.65 MB) .pdf
TP (RELO-EXP) - Travel Payment for Relocation Expenses (876.11 KB) .pdf
TP (RELO-SUB) - Travel Payment for Relocation Subsistence (66.32 KB) .pdf
TPR - Travel Payment Reverted (1.65 MB) .pdf
U
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Vehicle Accident Report Form (128.37 KB) .pdf
Vendor Complaint Form
Vendor Conversion Form (I/3) (282.46 KB) .pdf
W
Workers' Comp Benefit Election Form (235.91 KB) .pdf
Workers' Comp Travel Reimbursement Request
Workers' Comp Wage Statement
Workplace Violence Report (see Complaint Form, Employee)
X
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