NALC Branch 193

Form No.	Not all forms are available on line. Click on the HIGHLIGHTED Forms to Type & Print up!
*USPS Forms and Information Checklist for Grievance Handling*
CA-1	Employee Notice of Traumatic Injury
CA-2	Employee Notice of Occupational Disease
CA-2A	Employee Notice of Recurrence of Disability
CA-7	Claim for Compensation
CA-16	Authorization for Examination and/or Treatment-Text ONLY info.
CA-17	Duty Status Report
Form 13	Office Routing Slip (Buck Slip)
Form 50	Notification of Personnel Action
Notice 11	Information for Apartment House Customers
Notice 25	Maximum Time Allowance for Routing Mall
Poster 43	Your Rights under the Family And Medical Leave Act of 1993
Notice 70	Privacy Act Notice
Publication 71	Notice for Employees Requesting Leave for Conditions Covered by FMLA
Notice 76	Expanded Vehicle Safety Check
OF 346	U.S. Government Motor Vehicle Operator's Identification Card (obsolete)
SF 46	U.S. Government Motor Vehicle Operator's Identification Card
SF 91	Operator's Report of Motor Vehicle Accident
SF 94	Statement of Witnesses
SF 95	Tort Claim
313	Requisition for Printed Carrier Case Labels
1017-A	Time Disallowance Record
1017-B	Unauthorized Overtime Record
1164	Mileage and Parking
1187	Dues Withholding -- Regular Member
1188	Revocation of Voluntary Authorization for Dues Withholding
1189	Dues Withholding -- Retirees
1192	Authorization for Purchase of U.S. Savings Bonds
1216	Employee's Current Mailing Address
1223-A	Earnings Statement
1221	Advanced Sick Leave Authorization
1224	Court Duty Leave Statement
1230	Time Card
1230-A	Time Card -- Week 1
1230-B	Time Card -- Week 2
1230-C	Other Duty Card
1234	Trip Card
1260	Non-Transactor Card
1261	Non-Transactor Report
1311	Carrier Transportation Agreement
1375	Employee Identification Card
1507	Request to Provide Proper Mail Receptacle
1512	Delivery Service Notice
1564	Address Change Sheet
1564-A	Carrier Route Book -- Route Instructions
1564-B	Orders to Box Section or Other Special Orders
1571	Report of Undelivered Mail, Etc.
1621	Carrier Route Report
1623	Change in Delivery, Relay and Collection
1627	Analysis of Curtailed Mail
1627	Analysis of Auxiliary Assistance and Overtime on Route
1627	Analysis of Auxiliary Routes
1627	Analysis of Late Leaving
1639	Carriers Report of Mis-sorted Mail
1700	Vehicle Accident Investigation Worksheet
1700	Vehicle Accident Worksheet
1709	Acceptance of Medical Treatment at USPS Medical Facility
1717	Bid for Preferred Assignment
1723	Assignment Order
1750	Employee Probationary Period Evaluation Report
1767	Report of Hazard, Unsafe Condition or Practice
1768	Safe Driver Award Committee Decision
1769	Accident Report
1813	Late Leaving and Returning Report
1838	Carrier's Count of Mail (Management Summary)
1838-A	Carrier's Count of Mail -- P.P./Combination Services Worksheet
1838-B	Parcel Post Firm Delivery Worksheet
1838-C	Carrier's Count of Mail -- Letter Carrier Routes Worksheet
1839	Payment Record for Carrier Drive-out Agreements
1840	Summary of Count and Inspection -- Letter Carrier's Route
1840-A	Summary of Count and Inspection, Mail, P.P. and Combination
1840-B	Carrier Time Card Analysis
2146	Employee Claim Forms
2181	Authorization and Release of Personal Information
2188	Subrogation Receipt
2198	Accident Report -- Tort Claim
2240	Pay Adjustment Request
2243	Payroll Adjustment
2480	Driving Record
2545	PAR Case Card
2546	PAR Correspondence
2547	PAR Reports
2548-A	Training Record
2565	Formal Regional Appeal of EEO Complaint
2608	Grievance Summary Step 1
2609	Grievance Summary Step 2
2610	Grievance Summary Step 3
2800	Application for Death Benefits
2801	Application for Retirement
2801-A	Superior Officer's Statement, Application for Disability Retirement
2801-B	Physician's Statement, Application for Total Disability Retirement
2802	Application for Refund of Retirement Deductions
2806	Individual Retirement Record
2808	Designation of Beneficiary, CSRS
2809	Health Benefits Registration Form
2810	Notice of Change in Health Benefits Enrollment
2944	Receipt for Customs Duty Mail
3074	Request for Waiver of Claim for Erroneous Payment of Pay
3076	Request to Cancel or Change Salary Allotment
3189	Request for Temporary Change of Schedule
3521	Carrier's Report on House Numbers and Mail Receptacles
3546	Notice to Change Forwarding Order
3570	Notice of Attempt to Deliver Mail
3575	Change of Address Order
3579	Undeliverable 2nd, 3rd, 4th or Controlled Circulation Matter
3582-A	Postage Due Bill
3582-B	Carrier's Due Bill
3811	Return Receipt, Regular/Certified/Insured Mail
3816	COD Tag and Sender's Receipt
3821	COD, Bulk Receipt for Mail and Funds
3849-A	Delivery Notice or Receipt
3849-B	Delivery Reminder or Receipt
3867	Registered and Certified Matter Received for Delivery
3868	Carrier's Clearance Receipt
3883	Delivery Notice or Receipt
3921	Daily Volume Recording Worksheet
3922	Delivery Volume Unit Recap
3923	Daily Delivery Operation Analysis
3968	Daily Mail Collection Record
3971	Request for Leave
3972	Absence Analysis
3973	Military Leave Control
3981	Roster Sheet
3982	Change of Address (Carrier's Case)
3996	Carrier Auxiliary Control
3997	Unit Daily Summary, Record of Carrier Work Hours, Absences
3997-B	Daily Delivery Analysis
3998	Unit Summary of City Delivery Routes
3999	Inspection of Letter Carrier Routes
3999-A	Record of Deliveries -- Worksheet
3999-B	Inspection of Collection Route
4003	Official Rural Route Description
4003-A	Official Rural Route Description, Continuation Sheet
4027	Petition for Change in Rural Delivery
4098	Employee Identification Card
4239	Count of Mail (Rural Route)
4240	Rural Carrier Trip Report
4241	Rural Delivery Statistics Report
4241-A	Rural Route Evaluation
4248	Rural Route Inspection Report
4516	Emergency Vehicle Hire Use
4528	Vehicle Defect Report
4565	Vehicle Repair Tag
4570	Vehicle Time Record
4582	Operator's Record
4582-A	Summary of Driving Record
4584	Observation of Vehicle Operator
4585	Postal Driver Accident Information
4586	Accident Information
7020	Authorized Absence from Workroom Floor
8190	USPS - NALC Joint Informal Step A Grievance Form