Animal and Plant Health Inspection Service (APHIS) Forms

FORM NO.

EDITION DATE

TITLE

CONSTRUCTION

UNIT OF ISSUE

SOURCE OF SUPPLY

APHIS 1-R

03/83

Request and Authorization for Occasional or Irregular Unscheduled Overtime

CS

EA

LRA

APHIS 3

06/93

Request for Clearance/Approval of Issuance

Set 2

EA

PDM

APHIS 4

03/93

Collateral Duty Safety and Health Certification of Training

CD

EA

SHE

APHIS 5-R

06/77

Transmittal of Documents

CS

EA

LRA

APHIS 6-R

06/88

Service Agreements

CS

EA

LRA

APHIS 7-R

01/95

Data for Travel Authorization for Employee to be Transferred

CS

EA

LRA

APHIS 9

07/95

Merit Promotion Interest Statement

CS

PKG(50)

MRPBS (MN)

APHIS 11-R

03/00

Information Systems Security Reporting Form

CS

EA

LRA

APHIS 13-R

04/93

Personal Custody Property Receipt

CS

EA

LRA

APHIS 16-R

03/90

Review and Approval of Document

CS

EA

LRA

APHIS 20-R

09/72

Change in Motor Vehicle Trade-In

CS

EA

LRA

APHIS 22

03/73

APHIS Docket Jacket

FLD

EA

PPD

APHIS 25

05/91

Publication Response Card

CD

PKG(25)

BSC

APHIS 29

03/93

Supervisor's Request for Health Monitoring

Set 5

PKG(50)

BSC

APHIS 30

07/89

Aircraft Use Report-Invoice

Set 3

BKS(25)

BSC

APHIS 31A

02/89

Acknowledgment of Receipt of Application

CD

EA

MRPBS (MN)

APHIS 32

05/00

Notice for Reorder of Form

Set 3

EA

MRPBS

APHIS 36

09/93

Mail Time Survey

CD

EA

PDM

APHIS 38

04/72

Construction Progress and Payment Schedule

CS

EA

MRPBS

APHIS 39-R

04/72

Contractor's Request for Payment

CS

EA

LRA

APHIS 40

07/94

Employee Exit Inventory

Set 2

EA

MRPBS (MN)

APHIS 41-R

11/87

Report of Penalty Mail

CS

EA

LRA

APHIS 43

12/92

Request for Agreements File Completion

Set 4

PKG(50)

MRPBS

APHIS 44

05/92

Conversation Record

CS

PAD(50)

BSC

APHIS 47

01/92

Transmittal and Receipt for Accountable Items

CS

PKG(3)

BSC

APHIS 50

12/91

Certificate of Training

CS

PKG(25)

BSC

APHIS 51-R

08/89

IRM Technical Approval Request

CS

EA

LRA

APHIS 55-R

12/92

Procurement Integrity Certification for Procurement Officials

CS

EA

LRA

APHIS 56-R

07/72

Transmittal of Invoice for Payment

CS

EA

LRA

APHIS 60

08/89

Attendance at Public Hearing

CD

EA

PPD

APHIS 61-R

05/86

Advance Acquisition Plan

CS

EA

LRA

APHIS 63-R

10/82

Justification for Non-Competitive Federal Assistance

CS

EA

LRA

APHIS 64-SC

04/90

Motor Vehicle Operations Report (Scannable Form for APHIS Domestic Vehicles)

CD

BKS(4)

MRPBS (MN)

APHIS 64-S

02/88

Reporte de Operacion de Vehiculos

CD

EA

PPQ (Mex)

APHIS 65

12/90

Annual Vehicle Inspection Checklist

CS

EA

LRA

APHIS 65-S

08/87

Inspeccion Semi-Anual De Vehiculo

Set 2

PKG(50)

PPQ (Mex)

APHIS 66-R

06/93

Job Analysis-Major Duty Identification

CS

EA

LRA

APHIS 67-R

08/84

Job Analysis-Knowledge, Skills, and Abilities Determination

CS

EA

LRA

APHIS 68-R

08/82

Job Analysis-Rating Plan

CS

EA

LRA

APHIS 69

07/96

Collateral Duty Safety Certificate

CS

EA

SHE

APHIS 70

05/93

Application Response Card (Customer Support Services-Riverdale, MD)

CD

EA

MRPBS

APHIS 71

01/96

Summary of Information Collections

CS

EA

MRPBS

APHIS 73-R

03/94

Commitment to Use Privately Owned Vehicle

CS

EA

LRA

APHIS 74

09/93

Vehicle Sharing Checklist

CS

EA

LRA

APHIS 75

03/95

Motor Vehicle Self-Insured Information

CD

PKG(50)

MRPBS (MN)

APHIS 76

10/97

Pilot Identification Card-WS

CD

EA

SHE

APHIS 77

05/97

Pilot Identification Card-IS

CD

EA

SHE

APHIS 78

05/97

Pilot Identification Card-PPQ

CD

EA

SHE

APHIS 79

09/96

Worksheet for Calculating Costs to Federal Government for Information Collection

CS

EA

MRPBS

APHIS 80-R

03/96

Export Certificate Record

CS

EA

LRA

APHIS 81

03/97

Statement of Services (Electronic version only)

APHIS 82-R

07/93

Billings and Collections (BCLO) Account Receivable Transmittal

CS

EA

LRA

APHIS 83-S

11/85

Revision Del Vehiculo-Acuerdo De Inspeccion

LBL

EA

PPQ (Mex)

APHIS 84-S

11/85

Castigo Por El Mal Uso Del Vehiculo Oficial

LBL

EA

PPQ (Mex)

APHIS 89

8/00

Report of Reimbursable Inspection and Quarantine Service

Set 4

BKS(25)

MRPBS (MN)

APHIS 90-R

09/90

Report of Reimbursable Services Rendered

CS

EA

LRA

APHIS 92-R

10/84

Interagency Agreement Review and Analysis Checklist

CS

EA

LRA

APHIS 94

01/89

Record of Public Fund Received (Electronic version available)

Set 3

PKG(50)

BSC

APHIS 96-R

03/98

Forms Survey

CS

EA

LRA

APHIS 98

06/72

Card: "This Is The Material You Asked For"

CD

PKG(25)

BSC

APHIS 100-R

03/90

Telecopier Transmittal Sheet

CS

EA

LRA

APHIS 101-R

04/90

Meeting Attendance

CS

EA

LRA

APHIS 105-R

11/86

Motor Vehicle Authorization

CS

EA

LRA

APHIS 109-R

06/96

Detailed Cost Analysis

CS

EA

LRA

APHIS 110-R

06/96

Summary of Planned Events

CS

EA

LRA

APHIS 114

06/94

Request to Establish, Close, Expand or Release, or Relocate Space

CS

EA

MRPBS (MN)

APHIS 118-R

01/81

Rates for Quarters and Services Furnished Federal Employees

CS

EA

LRA

APHIS 122-1

03/92

Application and Appraisal for Promotion/Reassignment

CS

EA

PPQ

APHIS 122-2

03/92

Application and Appraisal for Promotion/Reassignment (Part II-Experience, Training and Awar

CS

EA

PPQ

APHIS 122-3

05/92

Application and Appraisal for Promotion/Reassignment (Part III-Supervisory Appraisal)

CS

EA

PPQ

APHIS 123-S

08/98

Registro de Operaciones y USO de Vehiculos

Set 2

BKS(15)

IS

APHIS 124

03/90

Safety Checklist for Towing/Carrying Equipment

CS

PKG(25)

MRPBS (MN)

APHIS 125-R

03/90

Defensive Driver Training Log

CS

EA

LRA

APHIS 127-R

09/92

Equal Opportunity/Civil Rights Performance Element Comments of Document for Future Revisions

CS

EA

LRA

APHIS 128-R

10/94

Request for Access to NFC Systems

CS

EA

LRA

APHIS 129-R

10/92

User Registration Form

CS

EA

LRA

APHIS 130

08/85

Preference Sheet (PPQ Firstline Supervisor Work Location)

CS

EA

PPQ

APHIS 132-R

12/93

Metrorail Farecard Control Log

CS

EA

LRA

APHIS 135

05/93

Form Processing and Reproduction Record

Set 2

EA

MRPBS

APHIS 140

07/91

Action Control Transmittal

Set 4

PKG(25)

BSC

APHIS 142

09/94

Application for Designated Handicapped Parking Space

CS

EA

FM

APHIS 143

01/85

Request for Security Clearance

Set 4

PKG(50)

MRPBS (MN)

APHIS 145-R

05/92

Appointments Above the Minimum Rate

CS

EA

LRA

APHIS 146-R

05/92

Statement of Understanding

CS

EA

LRA

APHIS 147-R

05/92

Annual Salary Computation Sheet for Appointments Above the Minimum Rate

CS

EA

LRA

APHIS 148-R

04/95

Application for Carpool/Vanpool Parking Space Permit

CS

EA

LRA

APHIS 150

10/92

Aircraft Approval

CD

PKG(25)

BSC

APHIS 151

12/90

Fixed Wing Aircraft Inspection

Set 4

PKG(25)

BSC

APHIS 152

12/90

Fixed Wing Pilot Proficiency Check

Set 4

PKG(25)

BSC

APHIS 153

12/90

Helicopter Inspection

Set 4

PKG(25)

BSC

APHIS 154

12/90

Helicopter Pilot Proficiency Check

Set 4

PKG(25)

BSC

APHIS 160-R

03/92

Annual Hazardous Materials Inventory

CS

EA

LRA

APHIS 161

04/92

Pesticide Use History - Low Cholinesterase

CS

PAD(25)

BSC

APHIS 162-R

03/92

Serious Accident Preliminary Report

CS

EA

LRA

APHIS 163-R

03/92

Nomination For a National Safety and Health Incentive Award

CS

EA

LRA

APHIS 164

03/92

Hazardous Materials Certification Statement

CS

PAD(50)

BSC

APHIS 166-R

06/80

Authorization/Revocation of Authorization to Administer Oaths, Affidavits, and Affirmations

CS

EA

LRA

APHIS 174-R

12/92

Government Owned Vehicle Usage Log

CS

EA

LRA

APHIS 175-R

02/93

Ticket Log

CS

EA

LRA

APHIS 185-R

05/92

Request for After Hours Access to Federal Building

CS

EA

LRA

APHIS 187-R

07/95

Request for Publication/Material

CS

EA

LRA

APHIS 188

01/87

Printing Request

CS

PAD(50)

PDM

*APHIS 192

12/94

Application for Credit Account and Request for Services

CS

PKG(25)

MRPBS (MN)

APHIS 197

02/94

New Employee Orientation (Supervisor's Checklist)

CS

EA

HR

APHIS 198

02/94

New Employee Orientation (New Employee Checklist)

CS

EA

HR

APHIS 200-R

09/84

Request for Radio Frequency Assignment or Modification

CS

EA

LRA

APHIS 201-R

04/84

Request for Travel Approval to Attend Meetings, Conferences or Training (Electronic version available)

CS

EA

LRA

APHIS 205-R

11/93

Instructions and Worksheet for Calibrating Portable Temperature Sensors

CS

EA

LRA

APHIS 206-R

11/93

Test of the Accuracy of the Permanent RTD Sensors Installed in Hot Water Tanks

CS

EA

LRA

APHIS 207-R

10/95

Sensor Location Diagram, Fruit Weights, and Pulp Temperatures

CS

EA

LRA

APHIS 208

10/95

Performance Test for Mango Hot Water Immersion Tank

MP

PKG(25)

BSC

APHIS 212-R

12/95

Request to Work at Home on Special Assignments/Projects

CS

EA

LRA

APHIS 223-R

04/98

Report of Quarantine Services Rendered

CS

EA

LRA

APHIS 231-R

02/94

Promotion Certificate

CS

EA

LRA

APHIS 237

10/82

APHIS Report Control Log

CS

EA

PDM

APHIS 242-R

11/79

Report of Telephone Call

CS

EA

LRA

APHIS 243-R

12/85

Manuscript for Outside Publication or Presentation

CS

EA

LRA

APHIS 255

08/97

Certificate of Appointment

CD

EA

SHE

APHIS 256-1

04/95

APHIS Safety Inspection Checklist (General Safety)

MP

PKG(50)

BSC

APHIS 256-2

04/95

APHIS Safety Inspection Checklist (Animal Handling Facilities, Bird Quarantine Facilities, and Greenhouses)

MP

PKG(25)

BSC

APHIS 256-3

04/95

APHIS Safety Inspection Checklist (Laboratories)

MP

PKG(25)

BSC

APHIS 256-4

04/95

APHIS Safety Inspection Checklist (Machine/Workshop)

MP

PKG(25)

BSC

APHIS 256-5

06/97

APHIS Safety Inspection Checklist (Hazardous Chemical Storage, Explosives Storage, and Waste Disposal)

MP

PKG(25)

BSC

APHIS 257-R

07/96

Hazard Communication Standard Checklist

CS

EA

LRA

APHIS 258-R

11/98

Respirator Use Approval

CS

EA

LRA

APHIS 260

05/97

Medical Alert Card

CD

PKG(25)

BSC

APHIS 261

03/92

Brucellosis Medical Information

CD

PKG(25)

BSC

APHIS 262

03/92

Psittacosis Medical Information

CD

PKG(25)

BSC

APHIS 263

03/92

Cholinesterase Inhibitors Information

CD

PKG(25)

BSC

APHIS 270-R

04/96

APHIS Hazard Assessment Form

CS

EA

LRA

APHIS 300

03/92

Voluntary Emergency Information

CD

PKG(25)

BSC

APHIS 301-R

08/01

Incident Record - Discharge of a Non-Lethal Personal Protective Device (NLPPD)

CS

EA

LRA

APHIS 302-R

08/01

Inventory Control Record for Non-Lethal Personal Protective Devices (NLPPD)

CS

EA

LRA

APHIS 311

06/76

Official Business Shield

CD

EA

MRPBS (MN)

APHIS 315

12/75

Vehicle Condition Questionnaire

Set 4

PKG(50)

MRPBS (MN)

APHIS 315-S

11/84

Cuestionario Acerca De La Condicion Del Vehiculo

Set 4

PKG(50)

PPQ (Mex)

APHIS 329

08/82

Contract Delivery Receipt

Set 4

PKG(50)

MRPBS (MN)

APHIS 340-R

02/85

Record of Meeting (Labor-Management Relations)

CS

EA

LRA

APHIS 342-R

12/79

Tour of Duty Logsheet

CS

EA

LRA

APHIS 344

02/83

Certificate of Retirement

CS

PKG(50)

MRPBS (MN)

APHIS 347

08/90

Core Time Deviation/Tour Change Worksheet

Set 3

PKG(25)

BSC

APHIS 371-R

02/92

Request for Outside Clinical Practice for APHIS Veterinarians

CS

EA

LRA

APHIS 408

05/96

Credential

CS

EA

MRPBS

APHIS 420-R

04/96

MSD Award Nomination Form

CS

EA

LRA

APHIS 500

02/97

Contractor Sign-In Log

CS

EA

FM

APHIS 501

05/96

Visitors Only Sign-In Security Log

CS

EA

FM

APHIS 502

05/96

Special Meeting Visitors Sign-In Log

CS

EA

FM

APHIS 503

05/95

Access Card Log

CS

EA

FM

APHIS 504

07/96

Recovered Personal Property and Disposition Record

CS

EA

FM

APHIS 505

07/96

Riggs Employee Visitors Sign-In Log (Riverdale Only)

CS

EA

FM

APHIS 506

03/99

Visitor's Sign In Log

CS

EA

FM

APHIS 507

01/97

Returned Access Card Log

CS

EA

FM

APHIS 508

02/00

Employees Only

CS

EA

FM

APHIS 509

02/00

Private Property Log Sheet

CS

EA

FM

APHIS 510

02/00

Facscard Key Log

CS

EA

FM

APHIS 7060

06/91

Official Warning - Violation of Federal Regulations

Set 3

PKG(25)

BSC

APHIS 7070

03/95

Government Exhibit

LBL

PKG(2400)

IES

APHIS 7099

03/92

Investigation Report (Folder)

FLD

PKG(25)

BSC

APHIS 7162

11/92

Affidavit

CS

PAD(25)

BSC

APHIS 7500

03/96

Regulatory Enforcement Monthly Activity Report

CS

EA

IES