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Forms and Worksheets

HR System User Access Forms

30 NOV 15
UNCLAS //NO7421//
ALCGPSC 141/15

1. The purpose of this ALCGPSC is to communicate a change to procedures for submitting user access forms for the following Coast Guard Human Resource (HR) systems:

  1. Web Travel Preparation and Examination (WEB-TPAX)/CG Form 7421A.
  2. Direct Access (DA)/CG Form 7421B.
  3. Image Now/CG Form 7421D.
  4. DA Work-Life Information Management System (WIMS)/CG Form 7421G.

2. Effective 07 DEC 2015, HR systems user access forms will no longer be accepted via facsimile (fax). After this date, all HR systems user access forms must be submitted via a PPC Customer Care trouble ticket. The fax numbers listed on the forms will no longer function after this date.

3. Users are to continue to fill out the forms as before, get the required signatures, in cursive, and submit them via a trouble ticket to

4. PPC is working with various stakeholders to update the HR systems user access forms with current roles and to allow the use of digital signatures. Interim test and final revised versions of the HR systems user access forms will be posted at as soon as possible.

5. Direct inquiries to PPC Customer Care Branch (CCB) at 785-339-2200/toll free 1-866-772-8724, via e-mail to, or by completing the web form at the address in paragraph 3.

6. Released by: RDML W. G. Kelly, Commander, CG Personnel Service Center. The Service Center for our Most Important Resource - Our People.

7. Internet release authorized.

New And Revised:

Number Title Revised (MM/YY)
CG-1570 IDT Completion Sheet 08/15
CG-2016Request for Duplicate or Replacement IRS Form W-203/15
CG-2020CFormer Spouse Statement04/15
CG-5155AEnlisted Supplementary Clothing Allowance Worksheet 11/15
CG-7220Family Separation Housing (FSH) Worksheet

Note: Use this worksheet in lieu of completing the SPO Endorsement (Item 10.K) on the PCS Reporting worksheet (CG-2005)

CG-7270COLA - Unique Expenses Reimbursement Worksheet02/15
SGLV-8286Servicemembers’ Group Life Insurance Election and Certificate 02/15


These forms are no longer used. Per Art 5.B.2.i, Enlisted Accessions, Evaluations, and Advancements, COMDTINST M1000.2, "No specific form or forum is prescribed for performance feedback." In addition, Art. 5.D.2 does not specify a form for evaluee input - "If desired, providing a list of significant accomplishments."

Number Title Canceled (MM/YY)
CG-3788EEnlisted Performance Evaluation Support Form (Petty Officer)08/05
CG-3788FEnlisted Performance Evaluation Support Form (Master, Senior, Chief Petty Officer)08/05
CG-3788GEnlisted Performance Evaluation Support Form (Non-Rated)08/05


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 and 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 to download the program.

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.

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.

Number Title Revised (MM/YY)
CG-1001Change in Reserve Component Category (RCC) 06/12
CG-1570 IDT Completion Sheet 08/15
CG-1884Application 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 Due07/13
CG-2000PCS Departing Worksheet 09/14
CG-2001Departing TDY or PCS/TEMDUINS to "A" School Worksheet03/10
CG-2002e-Resume Worksheet02/10
CG-2003PCS Entitlements Advance Travel Worksheet

Note: Per ALCOAST 422/12, Servicing Personnel Offices (SPO) shall only approve requests for advance pay of up to one month if applicants meet the conditions in paragraph 2 of the message. Any request for two or three months advance pay must be approved by the member's commanding officer in consideration of the guidelines in paragraphs 3.A through 3.E of the message. PCS travel and transportation advances are limited to 80% of the estimated travel and transportation costs to include MALT, per diem, DLA, and TLE. Payment must not be made more than 30 days before the member detaches, except under extenuating circumstances (e.g., member moves dependents before detaching).

CG-2005PCS Reporting Worksheet

Note: Use Family Separation Housing (FSH) Worksheet (CG-7220) in lieu of completing the SPO Endorsement (Item 10.K) on the PCS Reporting worksheet (CG-2005). Item 10.K will be removed in the next update to this worksheet.

CG-2010Advances Worksheet 08/13
CG-2015Pay Delivery Worksheet
Note: Use the CGFINCEN EFT/ACH Travel Claim Direct Deposit Account Change Form to change the account used for your travel claim payments.
CG-2016Request for Duplicate or Replacement IRS Form W-203/15
CG-2020Dependency Worksheet09/13
CG-2020ASupport Statement02/10
CG-2020BFull-Time Student Statement02/10
CG-2020CFormer Spouse Statement04/15
CG-2020DDesignation 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.

CG-2025BAH/Housing Worksheet09/10
CG-2025AHousing Allowance (BAH/OHA) Protection Worksheet 03/14
CG-2025BMember-Married-to-Member BAH Worksheet02/10
CG-2026OCONUS Early Return of Dependents (ERD) - Request for TONO/LOA 05/11
CG-2030Career Development Worksheet06/14
CG-2035Family Separation Allowance (FSA) Worksheet02/10
CG-2040Allotment Worksheet02/10
CG-2045Career Intentions Worksheet 09/13
CG-2046Application to Sell Special Leave Accrual (SLA)02/10
CG-2050Nonreceipt Worksheet02/10
CG-2055AReserve Retirement Transfer Request02/10
CG-2070TDY Travel Request/Authorization Worksheet 06/13
CG-2075Family Subsistence Supplemental Allowance (FSSA) Application 10/13
CG-2426Career 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.
CG-2842Report of Return of Absentee (CG-2842 is obsolete. Use DD-616.)12/99
CG-3307Administrative Remarks10/08
CG-3600Designation Of Beneficiary For Payment Of Unpaid Retired Pay08/12
CG-3788AEmployee Review Worksheet (Non-Rated)07/12
CG-3788BEmployee Review Worksheet (Petty Officer)07/12
CG-3788CEmployee Review Worksheet (Master, Senior and Chief Petty Officer)07/12
CG-3799RReserve Annual Screening Questionnaire (ASQ)09/11
CG-3867Claim for Final Retired Pay02/10
CG-4251Military Temporary Duty (TDY) or Civilian Temporary Duty (TD) Travel Orders05/12
CG-4600Premium-Class Travel Authorization/Approval Request06/11
CG-4700Retired (Active or Reserve) Pay Account Worksheet and Survivor Benefit Election (form only)
Download the Retirement Package if you want the form and the instructions.
CG-5102Officer Uniform Allowance Claim Worksheet02/10
CG-5150Civilian Clothing Monetary Allowance Worksheet 06/12
CG-5155AEnlisted Supplementary Clothing Allowance Worksheet 11/15
CG-5200AEthnicity and Race Self-Reporting Worksheet02/10
CG-5489-1Remission Application02/10
CG-5489-2Waiver Application09/14
CG-5489BFinancial Statement08/10
CG-7201Application for Waiver of Collection of Erroneous Payments for Retirees and SBP Annuitants06/14
CG-7202Waiver Application for Annuitant02/10
CG-7220Family Separation Housing (FSH) Worksheet

Note: Use this worksheet in lieu of completing the SPO Endorsement (Item 10.K) on the PCS Reporting worksheet (CG-2005)

CG-7221Retired Allotment Authorization Form07/10
CG-7270COLA - Unique Expenses Reimbursement Worksheet02/15
CG-7421AT-PAX/WINIATS User Access Authorization & Approving Official (AO) Designation03/13
CG-7421BDirect Access User Authorization10/13
CG-7421CJUMPS User Access Authorization02/10
CG-7421DImageNow User Access Authorization 09/11
CG-7421EDirect Access PHS User Access Authorization02/10
CG-7421FDirect Access II (Retired Global Payroll) User Access Authorization 05/10
CG-7421GDirect Access Work-Life Information Management System (WIMS) User Access Authorization 06/12
CG-7543Statement of Financial Status Submitted for Consideration In Connection with Indebtedness to the United States02/10
CG-11221Reserve Component Survivor Benefit Plan (RCSBP) Option - Election Certificate08/10

More Coast Guard (CG) Forms

More CG Forms (Internet link. Does not include forms like discharge and advancement certificates)

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

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


  • 41075,  MetLife TRICARE Dental Program, forms and references materials


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


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


  • SGLV-8286,  Link to VA Site: SGLI Election And Certificate and other SGLI forms
  • SGLV-8286A,  Link to VA Site: SGLI Family Coverage Election and other FSGLI forms.
  • More SGLI and VGLI Forms

    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 PDF 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

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.

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Last Modified 11/30/2015