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U.S. Coast Guard 
Pay & Personnel Center
444 S. E. Quincy St.
Topeka, KS 66683-3591

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(866) 772-8724
(785) 339-2200

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(785) 339-3780

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Procedures & Development (P&D) Branch
Forms and Worksheets

 

This page lists Forms and Worksheets referenced in the Personnel and Pay Procedures Manual. These forms and worksheets are now published independently of the manual. This allows us to effect needed changes and updates without waiting for a published change to the manual.

This page also provides links to some frequently used forms from Other Government Agencies and Coast Guard (CG) forms.

Click on the form number. The form will open in Adobe Acrobat, fill in fields and print the form.

Adobe Acrobat (.pdf) forms: You need Adobe's free reader program to open Acrobat forms, visit the Adobe web site http://get.adobe.com/reader/ to download the program.

Printing Forms: If you experience any printing problems, please be sure you are using the printer icon (picture of a printer) in the Adobe Acrobat Reader tool bar and not the printer icon in the Internet Explorer tool bar.

HR System User Access Forms

Per ALCGPSC message 141/15, new, interim, versions of the Direct Access User Role Designation, CG Form 7421B ;and the ;T-PAX/WINIATS User Access Authorization/CG Form 7421A are now available. These versions removed the "fax" number and replaced it with e-mail buttons. The forms are designed for electronic signatures. Do not print and sign the forms, they must be submitted using the "Click-Here - Email form to PPC" button next to the authorizing official's signature field in block.

  • If supporting documentation is required (per the directions on the forms), it can be added to the file by clicking the "Attach Miscellaneous" button on the top, left-hand, corner of the form. Click the button, select a PDF file to attach and click "OK".

  • The forms provide for electronic routing from the user to the authorizing official. The user will complete the form, attach any required supporting documents and electronically sign the form. The "Click Here - Email form to AO" button will open an e-mail, the user will enter the AO's e-mail address and forward the form for approval.

  • The AO will complete their sections of the form and electronically sign in block 13. Submit the form to PPC using the button provided. This will open a specially formatted e-mail addressed to PPC's tracking system. Do not make any changes to the message, just click send and dismiss the spell check if it comes up. Contact PPC Customer Care with any questions or to report a problem with the form.

Pay & Personnel Forms by Agency

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CG

Visit the CG-612 Directives and Publications Division Coast Guard (CG) Authorized Forms page to download Coast Guard (CG) forms.

Here are direct links the most frequently used pay and personnel forms and worksheets:

Number Title Revised (MM/YY)
CG-1001 Change in Reserve Component Category (RCC) 01/18
CG-1001A Electronic Based Distributed Learning (EBDL) Course Approval Request 05/17
CG-1002 Lateral Change Request 08/12
CG-1002B Monthly Incapacitation Claim Form (Member) 04/16
CG-1300 Report of Suitability for Overseas Assignment 12/16
CG-1300A Debt to Income Ratio Calculator 12/16
CG-1300B Active Duty Dependents Overseas Screening 12/16
CG-1570 IDT Completion Sheet 08/15
CG-1884 Application For Annuity Under The Survivor Benefit Plan (SBP), Reserve Component Survivor Benefit Plan (RCSPB), Retired Serviceman's Family Protection Plan (RSFPP) And/Or Final Retired Pay Due 07/13
CG-2000 PCS Departing Worksheet 09/14
CG-2001 Departing TDY or PCS/TEMDUINS to "A" School Worksheet 03/10
CG-2002 e-Resume Worksheet 02/10
CG-2003 PCS Entitlements Advance Travel Worksheet

Note: Per the CG Pay Manual, Servicing Personnel Offices (SPO) shall only approve requests for advance pay of up to one month if applicants meet the conditions in paragraph 2 of the message. Any request for two or three months advance pay must be approved by the member's commanding officer in consideration of the guidelines in paragraphs 3.A through 3.E of the message. PCS travel and transportation advances are limited to 80% of the estimated travel and transportation costs to include MALT, per diem, DLA, and TLE. Payment must not be made more than 30 days before the member detaches, except under extenuating circumstances (e.g., member moves dependents before detaching).

 

05/10
CG-2005 PCS Reporting Worksheet

Note: Use Family Separation Housing (FSH) Worksheet (CG-7220) in lieu of completing the SPO Endorsement (Item 10.K) on the PCS Reporting worksheet (CG-2005). Item 10.K will be removed in the next update to this worksheet.

07/18
CG-2010 Advances Worksheet 08/13
CG-2015 Pay Delivery Worksheet
Note: Use the CGFINCEN EFT/ACH Travel Claim Direct Deposit Account Change Form to change the account used for your travel claim payments.
02/10
CG-2016 Request for Duplicate or Replacement IRS Form W-2 03/15
CG-2020 Dependency Worksheet 08/18
CG-2020A Support Statement 02/10
CG-2020B Full-Time Student Statement 02/10
CG-2020C Former Spouse Statement 04/15
CG-2020D Designation of Beneficiaries

Designation of Persons Authorized to Direct Disposition of Remains

Per the National Defense Authorization Act 2012 signed by the President on 31 Dec, the "Designation of Persons Authorized to Direct Disposition of Remains of Members of the Armed Services" (PADD) is now a "member-designated" benefit. As outlined in ALCOAST 427/08 only spouse, adult child, parent or adult sibling were allowed to be designated. If none were known or alive then any relative may have been designated, or finally, a close friend. The new law allows members to designate any person of choice.

No one is required to change any PADD designation as a result of the change in law or to update their form CG-2020D at this time. Existing PADD designations for someone other than a relative--which actually should not have been accepted at the time--will now be acceptable, no update needed. The change supports every Coast Guard member who has reason to designate a PADD other than a relative.

The Personnel Service Center (PSC) is in the process of updating the designation form and will be promulgating an ALCOAST once the revised form is approved.

Note: If a member has a spouse but designates a person other than the spouse to receive all or a portion of the death gratuity pay, the member's Commanding Officer is required to notify the spouse, in writing, about the designation. Here is a template (in MS Word format) for the Memo to notify the member's spouse.

09/10
CG-2025 BAH/Housing Worksheet
Note: Also complete DD Form 2367, Individual Overseas Housing Allowance (OHA) Report, if entitled to OHA.
09/10
CG-2025A Housing Allowance (BAH/OHA) Protection Worksheet 09/17
CG-2025B Member-Married-to-Member BAH Worksheet 02/10
CG-2026 OCONUS Early Return of Dependents (ERD) - Request for TONO/LOA 05/11
CG-2030 Career Development Worksheet 10/17
CG-2035 Family Separation Allowance (FSA) Worksheet 02/10
CG-2040 Allotment Worksheet 02/10
CG-2045 Career Intentions Worksheet 09/13
CG-2046 Application to Sell Special Leave Accrual (SLA) 02/10
CG-2050 Nonreceipt Worksheet 02/10
CG-2055A Reserve Retirement Transfer Requestupdated 02/19
CG-2070 TDY Travel Request/Authorization Worksheet 06/13
CG-2075

Family Subsistence Supplemental Allowance (FSSA) Application

Noted: After September 30, 2016, a member is eligible for a supplemental subsistence allowance only if the member is serving outside the United States, the Commonwealth of Puerto Rico, the United States Virgin Islands, or Guam.

10/16
CG-2426 Career Status Bonus (CSB) Election
Note: The link to this form is not provided because the form prepared PPC (MAS) and mailed to the member six months prior to the member's fifteenth active duty anniversary. Contact PPC Customer Care if the form is not received within in two weeks of this time frame.
N/A
CG-2842 Report of Return of Absentee (CG-2842 is obsolete. Use DD-616.) 12/99
CG-3307 Administrative Remarks 10/08
CG-3600 Designation Of Beneficiary For Payment Of Unpaid Retired Pay 08/12
CG-3788A Enlisted Evaluation Report Nonrated or Rated Seaman/Firemanupdated 02/19
CG-3788B Enlisted Evaluation Report Third Class Petty Officerupdated 02/19
CG-3788C Enlisted Evaluation Report Second Class Petty Officerupdated 02/19
CG-3788D Enlisted Evaluation Report First Class Petty Officerupdated 02/19
CG-3788E Enlisted Evaluation Report Chief Petty Officerupdated 02/19
CG-3788F Enlisted Evaluation Report Senior Chief Petty Officerupdated 02/19
CG-3788G Enlisted Evaluation Report Master Chief Petty Officer 02/19
CG-3799R Reserve Annual Screening Questionnaire (ASQ) 09/11
CG-3867 Claim for Final Retired Pay 02/10
CG-4251 Military Temporary Duty (TDY) or Civilian Temporary Duty (TD) Travel Orders 05/12
CG-4600 Premium-Class Travel Authorization/Approval Request 02/18
CG-4700 Retired (Active or Reserve) Pay Account Worksheet and Survivor Benefit Election (form only)

Note: Download the Retirement Package for the instructions to complete the CG-4700.
12/17
CG-5100 Officer Uniform Allowance Claim Worksheet 02/10
CG-5150 Civilian Clothing Monetary Allowance Worksheet 06/12
CG-5155A Enlisted Supplementary Clothing Allowance Worksheet 11/15
CG-5200A Ethnicity and Race Self-Reporting Worksheet 02/10
CG-5489-1 Remission Application 02/10
CG-5489-2 Waiver Application 09/14
CG-5489B Financial Statement 08/10
CG-7201 Application for Waiver of Collection of Erroneous Payments for Retirees and SBP Annuitants 06/14
CG-7202 Waiver Application for Annuitant 02/10
CG-7220 Family Separation Housing (FSH) Worksheet

Note: Use this worksheet in lieu of completing the SPO Endorsement (Item 10.K) on the PCS Reporting worksheet (CG-2005)

01/16
CG-7220E Critical Skills Retention Bonus (CSRB) Agreement 11/18
CG-7220G Coast Guard Galley Temporary Closure Suspend Collection of CG Standard Meal Rate (CGSM) Deduction 01/16
CC-7220H Family Stability Act BAH/Housing Worksheet 09/18
CG-7221 Retired Allotment Authorization Form 07/10
CG-7270 COLA - Unique Expenses Reimbursement Worksheet 02/15
CG-7421A TPAX/IATS User Role Designation and Authorizing Official (AO) Designation  07/17
CG-7421B Direct Access User Role Designation 08/17
CG-7421C JUMPS User Access Authorization 02-10
CG-7421D ImageNow User Access Authorization 03/16
CG-7421E Direct Access PHS User Access Authorization 02/16
CG-7421F Direct Access II (Retired Global Payroll) User Access Authorization 05/10
CG-7421G Direct Access Work-Life Information Management System (WIMS) User Access Authorization 06/12
CG-7430  Blended Retirement System Election 11/17
CG-7430A Continuation Pay Election 11/17
CG-7543 Statement of Financial Status Submitted for Consideration In Connection with Indebtedness to the United States 02/10
CG-11221 Reserve Component Survivor Benefit Plan (RCSBP) Option - Election Certificate 08/10

 

Department of Defense:

  • DD Form 4/1 (OCT 07) Enlistment/Reenlistment Document Armed Forces of the United States
  • DD Form 139, Pay Adjustment Authorization
  • *DD Form 256 CG, Honorable Discharge (This is not a link, see *below)
  • *DD Form 257 CG, General Discharge  (This is not a link, see *below)
  • *DD Form 259 CG, Bad Conduct Discharge  (This is not a link, see *below)
  • *DD Form 260 CG, Dishonorable Discharge  (This is not a link, see *below)

    *Discharge certificates are limited distribution forms. They are not available on the internet. Only Servicing Personnel Offices (SPOs) and Personnel and Administrative (P&A) Offices are authorized to possess the templates. Download the certificates ",zip" file from https://cg.portal.uscg.mil/communities/yns/YN/CERTIFICATES/DISCHARGE%20CERT. Contact PPC, via e-mail to ppc-pf-pd@uscg.mil, for the password to the discharge certificates zip file.

  • DD 616,  Report of Return of Absentee (Replaces CG-2842)
  • *DD Form 794 CG, Discharge Under Other Than Honorable Conditions. (This is not a link, see *above)
  • DD Form 1299,  Application for Shipment and/or Storage of Personal Property
  • DD Form 1351-2,  Travel Voucher
  • DD Form 1351-2C,  Travel Voucher or Subvoucher (Continuation sheet)
  • DD Form 1351-3,  Statement of Actual Expenses
  • DD Form 1746, Application for Assignment to Housing
  • DD Form 2058,  State of Legal Residence Certificate. 

    General Residency Rules: The general rule is that legal residency is established when an individual is physically present in a state AND has the intent to permanently reside in the state.

    "Intention to permanently reside" can be shown through a combination of several factors: ownership of real property; registering to vote; registering a vehicle; obtaining a driver's license; and declaring of legal residency on legal documents (including DD Form 2058: State of Legal Residence Certificate). One of these factors by itself would probably not be enough to change residency, but if a service member moved to a state and registered to vote, bought a house, registered her car, obtained a new driver's license, and registered her children in the local schools, she would most likely be considered to be a resident of the new state. For example, if you were a legal resident of Delaware when you entered the Armed Forces, you remain a legal resident of Delaware for Delaware state income tax purposes unless you voluntarily abandoned your Delaware residency and established a new legal domicile in another state. A change in legal residence is documented by filing DD Form 2058 with your military personnel office.

  • DD Form 2058-1, Tax Exemption Test Certificate, State Income (This form is currently applicable to the States of New Jersey, New York, and Oregon)
  • DD Form 2058-2,  Native American State Income Tax Withholding Exemption Certificate (complete in-lieu of DD-2058, if applicable)
  • DD Form 2278,  Application for Do It Yourself/Self-Procured Move and Counseling Checklist
  • DD Form 2366,  Montgomery GI BILL Enrollment/Disenrollment, SOI
  • DD Form 2366-1,  Montgomery GI BILL Increased Benefit Contribution Program
  • DD Form 2367, Individual Overseas Housing Allowance (OHA) Report
  • DD Form 2648Service Member Pre-Separation/Transition Counseling and Career Readiness Standards Eform for Service Members Separating, Retiring, Released From Active Duty (REFRAD) (Note DD-2648 and DD-2648-1 are no longer used. See https://www.dodtap.mil/forms.html)
  • DD Form 2760, Qualification to Possess Firearms or Ammunition
  • DD Form 2769 Application for Annuity - Certain Military Surviving Spouses
  • DD Form 2860,  Claim for Combat Related Special Compensation (CRSC)
  • NAVPERS 1336/6-CG,  Special Request/Authorization (Leave Chit)
  • More DOD and DD are available from the DOD Forms Program page - http://www.esd.whs.mil/Directives/forms/

 

 

Click here to expand contentClick here to collapse content  DHS

Department of Homeland Security:

  • DHS-11000-9,  Disclosure and Authorization Pertaining to Consumer Reports Pursuant to the Fair Credit Reporting Act
Click here to expand contentClick here to collapse content  IRS

IRS:

  • IRS W-4,  Employee's Withholding Allowance Certificate
  • IRS W-4P,  Withholding Certificate for Pension or Annuity Payments
Click here to expand contentClick here to collapse content  OPM

OPM:

  • OPM-71,  Request for Leave or Approved Absence
  • OPM RI20-97,  Estimated Earnings During Military Service

Standard Forms:

  • SF-15, Application for 10 Point Veteran Preference
  • SF-600, Chronological Record of Medical Care
  • SF-1038,  Advance of Funds Application and Account
  • OF-1164, Claim for Reimbursement for Expenditures on Official Business

VA/OSGLI:

  • SGLV-8286,  Link to VA Site: SGLI Election And Certificate and other SGLI forms

    Note;: Revision date 10/17. Please be sure to always use the most recent revision when completing new elections or changing beneficiary designations. Elections and designations completed using earlier editions of the SGLV-8286 remain valid. Members do not need to complete a new form if there are no changes to their elections or beneficiary designations.

  • SGLV-8286A,  Link to VA Site: SGLI Family Coverage Election and other FSGLI forms.

    Note: Per E-Mail ALSPO B/16, this form is only to be completed when a member is reducing coverage, declining coverage, increasing coverage, restoring coverage, or applying for coverage when member-married-to-member. This form is not required when a member, who is subject to automatic coverage, accepts the automatic coverage. 

    The form is not intended for use during annual validation or PCS reporting in where the purpose is to “continue” or “validate” previously existing coverage.  Completing the form unnecessarily during these circumstances creates confusion and frequently causes OSGLI to mistakenly deny coverage under the assumption that the member is applying for previously declined or reduced spouse coverage.

  • More SGLI and VGLI Forms

    The health-related questions (SGLV-8286, Item 4, About Your Health or SGLV-8286A, Part III - Spouse Information) on the forms are only required to be completed when the member has previously declined coverage or elected coverage for a reduced amount and wants to reinstate or increase coverage. Please refer Chapter 5, Section A, of the Personnel and Pay Procedures Manual, for additional information on completing forms SGLV-8286 and SGLV-8286A.

 

Last Modified

  ‎       ‎   ‎    2/15/2019 10:22:32 AM