Forms and Worksheets

Collection of Information

Forms accessed through this web page are a collection of information (COI) targeted only to USCG personnel, retired USCG members, and dependents. If you are not a member of one of the targeted groups, please do not submit information to the Coast Guard through these forms. The Coast Guard will immediately delete any submissions that it receives from persons who do not fit into one of these categories.

Any “collection of information” as defined in the Paperwork Reduction Act of 1995 (codified at 44 U.S.C. 3501 et seq) on these forms has not been approved by the Director of the Office of Management and Budget (OMB) and does not display a valid control number assigned by the Director. Therefore, no person shall be subject to any penalty for failing to comply with any such collection of information.

Instructions:

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 (like the VA for insurance forms) and to 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.

Forms and Worksheets listed in Enclosure (1) to the Personnel & Pay Procedures Manual, PPCINST M1000.2(series)

Transition to "CG" forms:

All "PPC" forms and worksheets that are meant for use by field units have been converted to "CG" forms. Use the table below to locate the new "CG" form number. The revision dates on some of the forms below differ from the revisions dates found on CG web sites. Due to funding constraints there will be a delay in updating the CG forms Library.

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.

Number	Title	Revised (MM/YY)
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	02/10
CG-2000	PCS Departing Worksheet Replaced Personnel Manual references with COMDTINST M1000.8(series). Added Mode of Travel options Added Option to request to hand carry SPO-PDR Clarified guidance on weight tickets for Personally Procured Moves	05/12
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	05/10
CG-2005	PCS Reporting Worksheet	05/10
CG-2010	Advances Worksheet	02/10
CG-2015	Pay Delivery Worksheet	02/10
CG-2016	Request for Duplicate or Replacement IRS Form W-2	02/10
CG-2020	Dependency Worksheet	09/10
CG-2020A	Support Statement	02/10
CG-2020B	Full-Time Student Statement	02/10
CG-2020C	Former Spouse Statement	02/10
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	09/10
CG-2025A	Housing Allowance (BAH/OHA) Protection Worksheet	05/11
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	02/10
CG-2035	Family Separation Allowance (FSA) Worksheet	02/10
CG-2040	Allotment Worksheet	02/10
CG-2045	Career Intentions Worksheet The following changes are pending: Block 5 - References to CG Personnel Manual, 1.G, need to be changed to Enlisted Accessions, Evaluations, and Advancements, COMDTINST M1000.2 (series), 1.A (for reenlistments) or 1.B (for extensions) Block 5 - Reference to CG Personnel Manual, 12.B.5, needs to be changed to Military Separations, COMDTINST M1000.4 (series), 1.B.5 Block 5.d (CO's Recommendation) Need to enable digital signature on this field. Block 7 - The Indefinite Reenlistment option is no longer offered. Block 24 - This block may be used by Reservists desiring to sell leave upon release from active duty, discharge (from either active duty or inactive duty status), or transfer to IRR, ISL or RET-2 status Block 28 - References to CG Personnel Manual, 12.C.1 need to be change to Military Separations, COMDTINST M1000.4 (series),1.C.1	02/10
CG-2046	Application to Sell Special Leave Accrual (SLA)	02/10
CG-2047 (Test)	Consolidation of Special Pay for Selected Health Professions Officers (HPOS) of the U.S. Coast Guard Contract Request (Test)	10/10
CG-2050	Nonreceipt Worksheet	02/10
CG-2055A	Reserve Retirement Transfer Request	02/10
CG-2070	TDY Travel Request/Authorization Worksheet	05/10
CG-2075	Family Subsistence Supplemental Allowance (FSSA) Application Block 14: Updated USDA Gross Monthly Income Eligibility Limits for FY12.	01/12
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-3600	Designation Of Beneficiary For Payment Of Unpaid Retired Pay	02/10
CG-3799R	Reserve Annual Screening Questionnaire (ASQ)	09/11
CG-3867	Claim for Final Retired Pay	02/10
CG-4600	Premium-Class Travel Authorization/Approval Request	06/11
CG-4700	Retired (Active or Reserve) Pay Account Worksheet and Survivor Benefit Election (form only) Download the Retirement Package if you want the form and the instructions.	08/10
CG-5102	Officer Uniform Allowance Claim Worksheet	02/10
CG-5150	Civilian Clothing Monetary Allowance Worksheet Corrected Note "A" to read "Officers. By law, an officer is authorized a civilian clothing allowance only if the officer's permanent duty station is outside the United States." Added SPO action/approval signatures and filing instruction	05/12
CG-5155A	Enlisted Supplementary Clothing Allowance Worksheet Added field for effective date of assignment/qualification Changed "Duty as a Commandant - Designated Command Master/Senior Chief ("Gold Badge")" to "Gold Badge Command Master Chief (CMC)" Removed "Duty as LANTAREA CMC, PACAREA CMC, or Reserve Force CMC"	05/12
CG-5200A	Ethnicity and Race Self-Reporting Worksheet	02/10
CG-7201	Waiver Application for Retiree	04/11
CG-7202	Waiver Application for Annuitant	02/10
CG-7221	Retired Allotment Authorization Form	07/10
CG-7270	COLA - Unique Expenses Reimbursement Worksheet	02/10
CG-7421A	T-PAX/WINIATS User Access Authorization & Approving Official (AO) Designation Note: New fax number - (785) 339-2296	06/11
CG-7421B	Direct Access User Authorization	02/11
CG-7421C	JUMPS User Access Authorization	02/10
CG-7421D	ImageNow User Access Authorization	09/11
CG-7421E	Direct Access PHS User Access Authorization	02/10
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	05/12
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

Other Government Agency Forms

Department of Defense:

DD Form 4/1 (OCT 07) Enlistment/Reenlistment Document Armed Forces of the United States
A new version of DD Form 4/1 (October 2007) has been released by the DoD. The October 2002 version, which is generated by Direct-Access, remains valid for Coast Guard and Coast Guard Reserve reenlistments. The October 2007 version of the form will be added to Direct-Access in a future software update.
DD Form 139, Pay Adjustment Authorization
DD-616, Report of Return of Absentee (Replaces CG-2842)
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 2058, State of Legal Residence Certificate
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 2648, Preseparation Counseling Checklist for Active Component Service Members
DD Form 2648-1, Transition Assistance Program (TAP) Checklist For Deactivating/Demobilizing National Guard and Reserve Service Members
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.dtic.mil/whs/directives/infomgt/forms/formsprogram.htm

Department of Homeland Security:

DHS-11000-9, Disclosure and Authorization Pertaining to Consumer Reports Pursuant to the Fair Credit Reporting Act

Standard Forms:

SF-15 Application for 10 Point Veteran Preference
SF-1038, Advance of Funds Application and Account
SF-1164, Claim for Reimbursement for Expenditures on Official Business

TRICARE:

5579A, United Concordia TRICARE Dental Program, forms and references materials

IRS:

IRS W-4, Employee's Withholding Allowance Certificate
IRS W-4P, Withholding Certificate for Pension or Annuity Payments

OPM:

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

VA/OSGLI:

SGLV-8286, Link to VA Site: SGLI Election And Certificate
SGLV-8286A, Link to VA Site: SGLI Family Coverage Election
More SGLI and VGLI Forms
The Office of Servicemembers' Group Life Insurance (OSGLI) has developed new forms that consolidate the Servicemembers' Group Life Insurance forms SGVL 8285(series) & 8286(series). The new combined form eliminates section II of the 8285. Subsequently, one of the benefits, from a procedural perspective, is the new form will NOT require Commanding Officer's (CO) signature as is now required on the 8285 - up until recently, the CO had to certify that:
- The member's statements are true
- The member is physically qualified to perform all duties of his or her position
- The member signed the form
- The member is eligible to apply for the additional insurance
The VA has eliminated, effective immediately, the requirement for form SGLV 8285 to be completed and signed by the member's commanding officer. Members' requests for reinstatement or increased SGLI or FSGLI coverage are now submitted on forms SGLV-8286 (for SGLI) and SGLV-8286a (for FSGLI). The health-related questions on the new forms are only required to be completed when the member has previously declined coverage or elected coverage for a reduced amount. In these cases, when the member is applying to reinstate or increase coverage, the health-related questions must be answered. If the answers to all the health-related questions are "No", the unit may accept the form and coverage begins. If the answers to any of the heath-related questions are "Yes", the form must be forwarded to the OSGLI for approval. Approval must be received from the OSGLI, before coverage can begin.
Elections and designations made on previous editions of forms SGLV-8286 and SGLV-8286A remain valid. Command/OSGLI approvals recorded on the SGLV-8285, which is no longer used, are also valid. A member, currently participating in SGLI or FSGLI is not required to submit a new form at this time. However, forms are required for newly eligible members (e.g. Accession into the service or upon marriage or divorce). A member, currently participating in SGLI or FSGLI, must use the new forms if they desire to change their election or beneficiaries.

The June 2011 version of form SGLV-8286 and the December 2010 version of form SGLV-8286A are available at http://www.insurance.va.gov/sgliSite/forms/forms.htm.
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 to this Quick Reference Guide and Chapter 5, Section A, of the Personnel and Pay Procedures Manual, for additional information on completing forms SGLV-8286 and SGLV-8286A.

More government agency forms (GSA, IRS, etc.) are available from the Federal Forms Program page http://www.fedforms.gov

Other Coast Guard (CG) Forms

CGFINCEN, EFT/ACH Travel Claim Direct Deposit Account Change Form
CG-2842/DD-616, Report of Return of Absentee (CG-2842 is obsolete, replaced by DD-616)
CG-3307 Administrative Remarks
Administrative Remarks example entries (templates in MS Word format) from enclosure (6) of the Personnel & Pay Procedures Manual
CG-3788A, Employee Review Worksheet (Non-Rated)
CG-3788B, Employee Review Worksheet (Petty Officer)
CG-3788C, Employee Review Worksheet (Master, Senior and Chief Petty Officer)
CG-3788E, Enlisted Performance Evaluation Support Form (Petty Officer)
CG-3788F, Enlisted Performance Evaluation Support Form (Master, Senior, Chief Petty Officer)
CG-3788G, Enlisted Performance Evaluation Support Form (Non-Rated)
CG-4251, Military Temporary Duty (TDY) or Civilian Temporary Duty (TD) Travel Orders
~~CG-5489, Waiver/Remisson Application~~ -- Cancelled (Replaced by 5489-1 and 5489-2, below)
CG-5489-1, Remission Application, (Revised June 2007, see below)
CG-5489-2, Waiver Application (Revised June 2007, see below)
~~CG-5489A, SPO's Endorsement Waiver/Remission Application~~ Cancelled, see below.

The CG-5489A was canceled on 4 June 2007. The new waiver and remission forms (above) eliminate the SPO endorsement. This should reduce overall processing time. The following is a summary of the changes:
- Added marital status (including member to member)
- Added years of sea service and sea time
- Reformatted section on enclosures to clarify which are mandatory
- Added "SPO Information" block on second page to provide a contact
- Eliminated Home Phone & Address blocks

CG-5489B, Financial Statement
More CG Forms (Internet link. Does not include forms like discharge and advancement certificates)

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Last Modified 5/1/2012