**November 4, 1997**

**RCS VB-1**

**Part I, Appendix B**

**FORMS/FORM LETTERS INDEX**

1\. All forms and form letters contained in part I of the Records
Control Schedule are listed in this appendix in alphabetical sequence.
Abbreviations as shown as:

> DD Form Department of Defense
>
> GSA Form General Services Administration
>
> NA Form National Archives
>
> OF Optional Form
>
> PO Form Post Office
>
> OPM Office of Personnel Management Standard Form
>
> SF Standard Form
>
> UPS Form United Parcel Service
>
> USPS Form United States Postal Service
>
> VA Form Department of Veterans Affairs
>
> VA Form Letter Department of Veterans Affairs

2\. An asterisk, "\*", beside a form or form letter number indicates
that it is obsolete.

**Form/Form** **Form/Form Letter** **Applicable RCS\
[Letter No.]{.underline}** **[Title/Description Item Number\
]{.underline}**

DD Form 214 Certificate of Release or Discharge From Active Duty
03-132.000\
03-199-100, and\
03-300.000

DD Form 214 Report of Transfer of Discharge 13-076.000\
(Copy 4)\
\
DD Form 215 Correction to DD Form 214 13-052.500\
(Copy 3)\
\
\*GSA Form 154 National Archives and Records Service Loan Receipt
13-072.000

\*GSA Form 163 Permanent Withdrawal Request and Receipt 13-072.000\
\
GSA Form 1152 FMS Vehicle Assignment/Termination Transaction 03-186.700\
\
NA Form 13000 Agency Review for Contingent Records 03-159.000\
\
NA Form 13001 Notice of Intent To Destroy Records 03-159.000

**B-1\
**

**November 4, 1997**

**RCS VB-1**

**Part I, Appendix B**

**Form/Form** **Form/Form Letter** **Applicable RCS\
[Letter No.]{.underline}** **[Title/Description Item Number\
]{.underline}**

NA Form 13016 Notice of Accession Location Change 03-159.100\
\
OF 8 Position Description 05-047.000\
\
OPM 4896 Notice of Transfer of Eligibility 05-090.015\
\
OPM 5000 A/B Admission Notice 05-090.012

OPM 5001-C Register Card 05-090.014\
\
PO Form 3577 Correction of Error in Address of Postal Service
Adjustments 13-051.200\
\
SF 14 Telegraphic Message 03-177.110\
\
SF 39 Request for Referral of Eligibles 05-090.022\
\
SF 39A Request and Justification for Selective Factors and Quality
05-090.022\
Ranking Factors\
\
SF 50B Notification of Personnel Action 05-049.000\
\
SF 59 Request for Approval of Noncompetitive Action 05-090.021\
\
SF 71 Application for Leave 13-045.000\
\
SF 75 Request for Preliminary Employment Data 05-047.000\
\
SF 82 Agency Report of Motor Vehicle Data 03-187.000

SF 85 Authorization for Release of Information Position 01-050.100\
\
SF 86 Questionnaire for Sensitive Positions 01-050.100

SF 88 Report of Medical Examination 03-199.100

SF 115 Request for Records Disposition Authority 03-159.100\
\
SF 135 Records Transmittal and Receipt 03-159.000\
\
SF 171 & SF 171A Application for Federal Employment 05-034.000

**B-2**

**November 4, 1997 RCS VB-1**

**Part I, Appendix B**

**Form/Form** **Form/Form Letter** **Applicable RCS\
[Letter No.]{.underline}** **[Title/Description Item Number\
]{.underline}**\
SF 171A Continuation Sheet for SF 171, Application for 05-034.000\
Federal Employment\
\
SF 1012 Travel Voucher 03-188.700\
\
SF 1120 Transportation Request Accountability Record 03-188.300\
\
SF 1199A Direct Deposit Sign-Up Form 13-099.000\
\
UPS Form 1202N Pickup Register 03-038.004\
\
UPS Form U1203 Pickup Register 03-038.004\
\
UPS Form U1214 Pickup Register 03-038.004

USPS Form 3533 Application and Voucher for Refund of Postage and Fees
03-038.001\
\
USPS Form 3577 Correction of Error in Address Because of Postal Service
13-051.200\
Adjustments\
\
USPS Form 3602A Daily Record of Meter Register Reading 03-038.001\
\
USPS Form 3602PC Statement of Mailing-Bulk Rates 03-038.001\
\
USPS Form 3603 Receipt for Postage Meter Settings 03-038.001\
\
VA Form 22a Appointment of Attorney or Agent as Claimant\'s 08-031.000\
Representative

VA Form 84a Employee Identification Card-Field 13-064.200

VA Form 0245 VA Records Center and Vault (RC&V) Reference Request
03-160.010

VA Form 1098 Request for and Authorization of Overtime Work 13-065.000

VA Form 1426 Request for Assignment of File Number on Overpayment Case
08-042.000\
\
VA Form 2237 Request, Turn-in and Receipt for Property or Services
13-071.000

VA Form 2509 Authorization for Nonemployee Attendant 03-188.101

VA Form 2801 Request for Translation Into English 13-052.200

**B-3**

**November 4, 1997**

**RCS VB-1**

**Part I, Appendix B**

**Form/Form** **Form/Form Letter** **Applicable RCS\
[Letter No.]{.underline}** **[Title/Description Item Number\
]{.underline}**\
VA Form 3011 Reproduction Request 03-030.000\
\
VA Form 3036 Travel Authority for Temporary Duty 03-188.900\
\
VA Form 3036c Travel Authority for Permanent Duty 03-188.900\
\
VA Form 3215 Application of Service Representative for Placement on
03-093.000\
Mailing List\
\
VA Form 3232 General Information Request 03-161.000\
\
VA Form 3242 Forms or Publications Requisition and Shipping Document
13-034.000\
\
VA Form 3542 Authorization To Report-Voucher for Mileage Allowance
03-188.101

VA Form 3771 Record of Lost or Found Article 03-108.000

VA Form 3787 Notice of Shipment-VA Vital Records (Indispensable Records
03-162.000\
Control File)

VA Form 3913 Training Course Record 05-042.100\
\
VA Form 3937 Training Time Table 05-042.200\
\
VA Form 4522 Register Log 03-038.002\
\
VA Form 4530 Accountability Record for Tokens or Tickets 03-188.100

VA Form 4583 Correspondence Control 01-080.000

VA Form 4644a Employee Record Card 13-046.200

VA Form 4644-2 Service Record Card 05-039.000, and

13-046.100

VA Form 4653a Confidential Statement of Employment and Financial
05-060.000

Interests\--Government Employees

VA Form 4653b Confidential Statement of Employment and Financial
05-060.000

Interests\--Special Government Employees

VA Form 5281 Application for Refund of Educational Contributions
07-694.000

**B-4**

**November 4, 1997**

**RCS VB-1**

**Part I, Appendix B**

**FORMS/FORM LETTERS INDEX**

**Form/Form** **Form/Form Letter** **Applicable RCS\
[Letter No.]{.underline}** **[Title/Description Item Number\
]{.underline}**\
VA Form 5849 ADP Stop Payment Card-Insurance Award 09-170.010

VA Form 5850 ADP Extra Hazard Accounting Card 09-170.010\
\
VA Form 7051 Data Sheet 12-060.000\
\
VA Form 7216a Request for and/or Notice of Transfer of Veterans Records
03-144.000, and\
03-161.000\
\
VA Form 7575 Request for Retired Records or Information 03-161.000\
\
\*VA Form 3-3785 Request for Film 03-111.000\
\
\*VA Form 4-5283 Weekly Attendance Record (Flexitime) 13-092.000\
\
\*VA Form 9-361 Premium Record Card 09-130.080

VA Form 9-4878 Deduction Authorization Card-Finance 09-060.121

VA Form 10-7131 Exchange of Beneficiary Information and Request for
03-300.000, and

Administrative and Adjudicative Action 03-400.000

VA Form 20-6560 Notice of Benefit Payment Transaction 13-069.100

\*VA Form 20-8124 DVB/AMIS Input Code Sheet Series 13-059.000

VA Form 20-8270 C&P Master Record-Audit Writeout 08-041.000

VA Form 20-8270a Education Master Record-Audit Writeout 08-041.000

VA Form 20-8271 Notice of Exception-CP&E Input Transaction 08-041.000

VA Form 20-8824 Target Access Request 13-086.000

VA Form 20-8840 Target Processing Problem 13-085.000

VA Form 21-22 Appointment of Veterans Service Organization as
Claimant\'s 08-031.000

Representative

**B-5**

**November 4, 1997**

**RCS VB-1**

**Part I, Appendix B**

**Form/Form** **Form/Form Letter** **Applicable RCS\
[Letter No.]{.underline}** **[Title/Description Item Number\
]{.underline}**\
VA Form 21-22-1 Appointment of Veterans Service Organization as
Claimant\'s 08-031.300

Representative (Copies 2 and 3 of VA Form 21-22)

VA Form 21-3101 Request for Information 03-300.000\
\
\*VA Form 21-4139 Parents Dependency Questionnaire 08-036.200

\*VA Form 21-4151 Veterans Dependency Questionnaire 08-036.200

\*VA Form 21-4179 Parents Income Questionnaire 08-036.100

VA Form 21-4582 Service Department Records Envelope 03-199.100

\*VA Form 21-6747 Adjudication Worksheet 13-077.000

\*VA Form 21-6875 Income Questionnaire 08-036.100

\*VA Form 21-7672 Notice of Death Worksheet 13-070.000

\*VA Form 21-8835 Improved Pension Questionnaire 08-036.100

VA Form 22-8046 Payment Notice (Stop-Suspend-Resume) 08-012.000

VA Form 22-8691 Application for Work-Study Allowance 06-031.000

VA Form 22-8692 Student Work-Study Agreement 06-032.000

\*VA Form 23-3183 Adjustment of Duplicate File Numbers 03-092.000

\*VA Form 23-3767 Missing Claims, R&E, WE or OE Folders 03-191.000

\*VA Form 23-6539 Flash-Temporary Disability Retired List 08-043.000

\*VA Form 23-6554 Records and Filing Equipment Control Card (See below)

Holdings Data File 03-152.000

Holdings History File 03-153.000

> Disposition Control File 03-154.000
>
> Disposition Suspense File 03-155.000
>
> Disposition Diary File 03-156.000
>
> Disposition History File 03-157.000

Equipment Holdings Data File 03-163.000

VA Form 23-6555 Records Series Analysis Sheet 03-158.000

VA Form 23-6582 Automatic Requisition 13-057.000

**B-6**

**November 4, 1997**

**RCS VB-1**

**Part I, Appendix B**

**FORMS/FORM LETTERS INDEX**

**Form/Form** **Form/Form Letter** **Applicable RCS\
[Letter No.]{.underline}** **[Title/Description Item Number\
]{.underline}**\
\*VA Form 23-8680 POW/MIA Survivor Status Card 06-028.000

> (NR)

VA Form 26-1839 Compliance Inspection Report 12-144.000

\*VA Form 26-1872 Annual Status Report-Insured Loans 12-092.200

VA Form 26-1879 Construction Complaint Record 12-151.000

VA Form 26-1880 Request for Determination of Eligibility and Available
Loan 12-060.000

Guaranty Entitlement

\*VA Form 26-1894 Loan Guaranty Application Register 12-070.000\
\
VA Form 26-6356 Buildings Organizational Data Card 12-150.000

VA Form 26-6380 Register of Applications for Release From Liability
Under 12-106.300

Sections 37B and 3720(a)(4) and Substitution of

Entitlement

VA Form 26-6393 Loan Analysis 12-230.000

VA Form 26-6715 Record of Telephone Conversation 12-055.200

\*VA Form 26-6833 Tax Record 12-114.000

VA Form 26-6850 Notice of Default 13-052.300

VA Form 26-6851 Notice of Intention to Foreclose 13-052.300

VA Form 26-8261a Request for Certificate of Veteran Status 12-060.000

VA Form 26-8320 Certificate of Eligibility for Loan Guaranty Benefits
12-060.000, and

12-061.000

\*VA Form 26-8827 Housing Discrimination Complaint 12-055.100\
\
VA Form 26-8981 GIL Lender Name and Address Code Sheet 12-212.000

VA Form 26-8982 Mortgage Loan Information 12-231.000

VA Form 27-555 Certificate of Legal Capacity To Receive and Disburse
Benefits 03-055.000

**B-7**

**November 4, 1997**

**RCS VB-1**

**Part I, Appendix B**

**Form/Form** **Form/Form Letter** **Applicable RCS\
[Letter No.]{.underline}** **[Title/Description Item Number\
]{.underline}**

VA Form 27-4274 Compliance Report of Proprietary Institutions 06-030.100

VA Form 27-4706 Annual\--Final Report and Accounting 06-016.100

VA Form 27-4706b Federal Fiduciary\'s Account 06-016.100

VA Form 27-4706c Court Appointed Fiduciary\'s Account 06-016.100

VA Form 27-4709 Certificate as to Securities 06-016.100

VA Form 27-4718a Certificate of Balance on Deposit 06-016.100

VA Form 27-8734 Equal Opportunity Compliance Review Report 06-030.200

VA Form 27-8734a Supplement to Equal Opportunity Compliance Review
Report 06-030.200, and\
06-030.300

VA Form 27-8734b Self-Evaluation Supplemental to Equal Opportunity
Compliance 06-030.200\
Review Report

VA Form 29-348 Debit Slip-Uncollectable Remittance 09-130.030

VA Form 29-5970 Allotment Identification Work Card 09-130.011

VA Form 30-3044 Message Number Sheet 03-177.700

VA Form 30-9909 Target Hardware Incident 13-083.000

VA Form 50-4236 Certificate of Eligibility 01-050.200

VA Form 50-4245 Classified Document Accountability Record 13-004.000

\*VA Form 70-3542B Authorization To Report-Voucher for Mileage Allowance
03-188.101\
(Reverse)\
\
VA Form 70-4535 Notice of Employment, Transfer or Separation of Veteran
03-600.000

**B-8**