| USPS Forms and Information Checklist for Grievance Handling | |
| Form No. | Name of Form and/or Description |
|---|---|
| CA-1 | Employee Notice of Traumatic Injury |
| CA-2 | Employee Notice of Occupational Disease |
| CA-2A | Employee Notice of Recurrence of Disability |
| CA-8 | Claim for Continuing Compensation |
| CA-16 | Authorization for Examination and/or Treatment |
| 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 |
| **** | Overtime Desired List |
| **** | P.I.'s Reports wen they are involved |
| **** | Record of Discipline |
| **** | Records of Merit |
| **** | Street Supervision Report |
| **** | Vehicle Analyst's Report of Accident |
| **** | Tachograph Record (or any other measuring device records currently being used) |
| **** | WITNESSES statements of non-employees, carriers, clerks and supervisors |
| **** | "Carrier Report - Daily" shows clock rings of carriers in the station. (Used when times are needed relative to route, overtime, comparisons.) |
| **** | "Employee Time Certification" - Time used by all employees in a pay location by pay period. (Hours worked, type leave, etc.) |
| **** | History of Clock Rings - Shows individual employee clock rings and leave for pay period |
| **** | P/T Emplyees Weekly Cumulative Hours - By Pay Locations showing cumulative weekly-to-date work, leave and O.T. totals for PTF's |
| **** | Sick Leave and LWOP Usage Report Lists are employees by pay location using sick leave and LWOP |
| **** | Quarterly print-out on sick leave use |