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