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Forms - Alphabetical Listing

Notice

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Alphabetical Listing of Forms
Numeric Listing of Forms
Other Forms

Notes:

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Alphabetical Listing of Forms

A B C D E F G H I J K L

M N O P Q R S T U V W X Y Z

Form Name	Form No.
A
Accounts Reconciliation (April 1996)(PDF 10K )	8240-1
Affidavit (April 1998)(PDF 11K )	540
Application for Certification of a Provisional Past Service Pension Adjustment (December 2009)(PDF 458K )	2468
Application for Diversion from a Public Service Pension (December 2009)(PDF 303K )	2460
Application for Division of a Public Service Superannuation Act Pension in Accordance with the Pension Benefits Division Act (December 2009)(PDF 257K )	2486 *
Application for the Refund of PSAC Dues (March 2006) (PDF 271K )	2595 *
Arrears of Payment Calculation (December 2009)(PDF 278K )	2068 *
C
Call Back Control Form (March 2005)(PDF 389K )	2432 *
Cash Receipts Register (May 1995)(PDF 8.8K )	8638
Central Accounting Journal Voucher (February 2005)(PDF 134K )	1849
Certificate of Entitlement (July 2009)(PDF 69K )	2232 *
Certification and Reconciliation of Superannuation Contributions (January 2005)(PDF 451K )	51 *
Certification Notice - Pension Support System (December 2009) (PDF 528K )	2386 *
Certification of Leave Without Pay (for prior contributory service) (December 2009)(PDF 293K )	2123 *
Certification of Lock-in for Purposes of the Public Service Superannuation Act or the Pension Benefits Division Act (December 2009)(PDF 225K )	2347-18 *
Certification of Lock-In for Purposes of the Members of Parliament Retiring Allowance Act or the Pension Benefits Division Act (January 2004) (PDF 148K )	2347-19
Certification of Operational Service - Correctional Service of Canada (December 2009)(PDF 364K )	2471 *
Certification of Waiver of Reduction of Annual Allowance (To certify the eligibility of employees for whom Treasury Board is not the employer) (December 2009)(PDF 208K )	2429-1
Certification of Waiver of Reduction of Annual Allowance (To certify the eligibility of employees for whom Treasury Board is the employer) (March 2005)(PDF 272K )	2429 *
CFSA/RCMPSA Report of Pensionable Service (December 2009)(PDF 327K )	2073 *
Cheque Issue List Summary (June 1996)(PDF 11K )	7456
Client Inquiry - Survivors Case Checklist (December 2009)(PDF 195K )	2437 *
Common Architecture Security Request (October 2006)(PDF 513K )	8882-4 *
Common-Law Partner Declaration - Isolated Posts and Government Housing Directive (IPGHD) (March 2004)(PDF 150K )	7631-1
Compensation Client Address (October 2001)(PDF 145K )	2719 *
Confidential Questionnaire - Employee Group Insurance, Declaration of Personal Insurability (November 2009) (PDF 102K )	2229
Contributor Identification Card (October 2003) (PDF 70K )	2439-4
Contribution Remittance for Period of Leave Without Pay (Public Service Health Care Plan - PSHCP) (July 2009)(PDF 379K )	2278 *
Contributor System - Correction Request (December 2009) (PDF 457K )	110 *
Contributor System - Public Service Corporations Annual Pro Forma (October 1997)(PDF 37K )	2343
Contributor System - TOS - Screening (September 2003)(PDF 407K )	2276 *
Control Notice (April 2004)(PDF 65K )	2287
Correction Form - Personnel - Pay Data (June 1998) (PDF 12K )	2551
D
Daily Cheque Listing (April 1999)(PDF 8.2K )	2364
Declaration of Attendance at an Educational Institute (October 2004)(PDF 291K )	2002 *
Details of Transfer under a Reciprocal Agreement (December 2009)(PDF 425K )	2077 *
Deductions from Annuity or Annual Allowance (December 2009)(PDF 259K )	1422 *
Default Notice (December 2009)(PDF 357K )	1871 *
Description du fichier de données des relevés (Available in French only) (January 2006)(PDF 126K )	463-05 *
Determination of Eligible Survivors - Deceased Contributor with Two or More Years of Pensionable Service (December 2009)(PDF 266K )	2008-1 *
Determination of Contact Person and Amount of Supplementary Death Benefit Payment (December 2009)(PDF 541K )	2014 *
Determination of Payee for Return of Contributions - Deceased Contributor with Less than Two Years Pensionable Service (December 2009)(PDF 285K )	2008 *
Direct Deposit - Electronic Deposit of Your Monthly Pension Benefits (December 2003) (PDF 119K )	2430
Direct Deposit - Intercept Request - Pension (March 2005)(PDF 309K )	8432-1 *
Direct Deposit - Intercept or Recall Request - Pay (May 2005)(PDF 379K )	8432-2 *
Direct Deposit Enrolment Request [Public Service Pay / RCMP Pay] (June 2009) (PDF 742K )	8437 *
Disability Insurance (February 1999)(PDF 175K )	2026 *
Disability Insurance - Part-time Employee Only (October 1999)(PDF 9.6K )	2026-1
Disposal of Dormant Files Under the Public Service Superannuation Act Administration (April 2002) (PDF 6.9K )	2090-1
E
Election for Spousal Benefit Coverage and a Reduced Pension Entitlement for a Marriage After Retirement (December 2009)(PDF 281K )	2477 *
Election Form for Elective Pensionable Service (December 2009)(PDF 312K )	3006 *
Election Not to Count Leave Without Pay as Pensionable Service (December 2009)(PDF 241K )	2480 *
Election to Become a Contributor to the Public Service Pension Plan (October 2004)(PDF 284K )	2478 *
Election to Continue as Participant Under Supplementary Death Benefit (SDB) Plan (December 2009)(PDF 220K )	2017 *
Election to Continue to Pay Extra Contributions for all Additional Years of Non-Operational Service (March 2000)(PDF 14K )	2469
Election To Reduce Benefit to $10,000 (December 2009)(PDF 206K )	2041-1 *
Elective Non-Contributory Pensionable Service Record (December 2009)(PDF 272K )	2001 *
Elective Pensionable Service Record for Operational Services (December 2009)(PDF 272K )	2001-1 *
Eligibility to Contribute (December 2004)(PDF 416K )	4170 *
Employment or Termination Advice (June 2004)(PDF 90K )	2120
Enrolment Information and Acknowledgement of Plan Membership (December 2009)(PDF 185K )	571 *
Estimate of Cost for a Service Buyback (December 2009)(PDF 185K )	2057 *
Estimate Request and Information Release Authorization for Reciprocal Transfer Agreement Purposes (December 2009)(PDF 233K )	2472 *
Evidence of Medical Examination (December 2009)(PDF 209K )	2081 *
F
Form 1 - Election For Prior Sessions Members of Parliament Retiring Allowances Act (April 2006)(PDF 216K )	380 *
Form 3 - Election Under Subsection 9 (2), Members of Parliament Retiring Allowances Act (November 2005)(PDF 407K )	435 *
Form 5 - Election to Contribute on Additional Remuneration Received During Prior Sessions (May 2006) (PDF 480K )	426 *
Form Letter - Acknowledgement of Receipt of Your Request (August 2005)(PDF 26K )	2015
Form Letter - Acknowledgment of Retirement (May 2006) (declared obsolete)	2348
Form Letter - Authorization for Recoveries of Debts due to the Crown (December 2009)(PDF 300K )	2074 *
Form Letter - Beneficiary Card Invalid (March 2006)(PDF 168K )	2355 *
Form Letter - Claim for Disability Insurance (November 2009) (PDF 331K )	2203 *
Form Letter - Claim for Long-term Disability Insurance (November 2009)(PDF 67K )	2203-1 *
Form Letter - Designation of Beneficiary Card (June 2004)(PDF 129K )	2355-1
Form Letter - DFT, Change of Bank Account Number (July 2004) (PDF 100K )	4033
Form Letter - Direct Deposit (May 2005)(PDF 454K )	2410 *
Form Letter - Disability Insurance Application (November 2009)(PDF 215K )	2204 *
Form Letter - Disability Insurance Claim (November 2009)(PDF 234K )	2188 *
Form Letter - Invalid Naming or Substitution of Beneficiary (November 2004) (declared obsolete)	2355-4
Form Letter - Life Insurance (June 2005) (PDF 379K )	2380 *
Form Letter - Long-term Disability Insurance (November 2009) (PDF 16K )	2380-1
Form Letter - Long Term Disability Insurance Claim (November 2009)(PDF 181K )	2207 *
Form Letter - Long Term Disability Insurance Claim (November 2009)(PDF 40K )	2188-1 *
Form Letter - Locating of Pension Cheques (August 2004) (PDF 108K )	2037
Form Letter - Naming or Substitution of a Beneficiary (August 2004)(PDF 87K )	2355-3
Form Letter - Outstanding Cheque (June 2005)(PDF 354K )	2388 *
Form Letter - Pensionable Employment With (December 2009)(PDF 219K )	2268-1
Form Letter - PSMIP - Assessment of Applications More Than One Year Old (March 2006) (PDF 84K )	2395
Form Letter - Request for Screening Documents (February 2004) (PDF 111K )	2347
Form Letter - Requesting Additional Information to Positively Identify a Person (contributor) (May 2004)(PDF 129K )	2093
Form Letter - Requesting Additional Information to Positively Identify a Person (contributor) (July 2004)(PDF 129K )	2093-1
G
I
Information Request - Canada Pension Plan/Quebec Pension Plan (December 2009) (PDF 211K )	2302 *
Interpretation of Superannuation Medical Examination (December 2009)(PDF 277K )	2012 *
Isolated Posts and Government Housing (October 2003)(PDF 103K )	7631
L
Long Term Disability Insurance - Public Service Management Insurance Plan (December 2009)(PDF 65K )	2027
Long Term Disability Insurance - Public Service Management Insurance Plan (Part-time Employee Only) (December 1998)(PDF 13K )	2027-1
M
Mainframe User ID Security Request (November 2005)(PDF 718K )	5136 *
Members of Parliament Retiring Allowance Act (December 2004)(PDF 108K )	4175
Miscellaneous Deductions - Code 64 (December 2004)(PDF 337K )	1872 *
Monthly Remittance of Superannuation Contributions (Public Service Corporation) (July 2000)(PDF 31K )	2292
N
Naming or Substitution of a Beneficiary (December 2009)(PDF 235K )	2196 *
Notice of 35 Years of Pensionable Service (December 2009)(PDF 313K )	2019 *
Notice of Cancellation - Public Service Health Care Plan (PSHCP) (November 2009)(PDF 31K )	2397
Notice of Termination and Option for Benefit (November 2004)(PDF 457K )	4168 *
Notice of Termination and Option for Benefit - Employees with Two or More Years of Pensionable Service (December 2009)(PDF 261K )	2011 *
Notice of Termination and Option for Benefit - Employees with Less than Two Years of Pensionable Service (December 2009)(PDF 277K )	2011-3 *
Notice to Repay Pension of Canadian Forces, RCMP or Members of Parliament (December 2009)(PDF 260K )	2221 *
Notice to Start Service Buyback Deductions (December 2009) (PDF 393K )	2270 *
Notification of Plan Membership (December 2009) (PDF 262K )	2018 *
O
Option for Benefit - Operational Service, Correctional Service Canada (December 2009)(PDF 255K )	2011-2 *
P
Payroll Transfer Journal Voucher (July 2006)(PDF 319K )	4023 *
Pay System Problem Report - Observation (December 1999)(PDF 12K )	2579
PBDA Information Request Worksheet (June 2004)(PDF 160K )	2055
PBDA Information Request Worksheet - Public Service Corporations/Operational Service (July 2000)(PDF 15K )	2055-1
Pension Adjustment Reversal (PAR) (December 2006)(PDF 765K )	61 *
Pension Adjustment Reversal (PAR) (January 2004)(PDF 110K )	61-03
Pension Benefits Division - Certification of Leave Without Pay (May 2006)(PDF 446K )	2493 *
Pension Deductions (Members of Parliament) (October 2004)(PDF 27K )	4142
Pension Information Release (December 2009)(PDF 239K )	2265 *
Pensionable Employment Questionnaire (December 2009)(PDF 613K )	2069 *
Pensioners' Dental Services Plan (PDSP) Form - April 1, 2006 Pensioners Entitled to the Veterans Affairs Canada (VAC) Dental Services Program (May 2009) (PDF 347K )	437 *
Pensioners' Dental Services Plan (PDSP) Form - April 1, 2006 (May 2009) (PDF 177K )	439 *
Personal Documentation Certification Form (May 2008)(declared obsolete)	2004
Personal - Pay Input and Time Summary Form (October 1997)(PDF 33K )	2549
Personnel - Pay Input Form (March 2005)(PDF 441K )	2517-1 *
Personnel - Pay Input Transmittal and Batch Control Form (October 2000)(PDF 18K )	2546
Plan Member Contact Information (February 2010)(PDF 457K )	577
Post Age 65 Election for Elective Pensionable Service - Annuitant (December 2009)(PDF 457K )	2473 *
Post-Retirement Life Insurance Plan (February 2005)(PDF 532K )	2451 *
Post-Retirement Life Insurance Plan - Certificate of Insurance Members Entitled to Employer-Paid Coverage (August 2005)(PDF 33K )	2451-2 *
Production Control File Location System (May 2005)(PDF 21K )	2219-2
Production Control Requisition (November 2004)(PDF 166K )	4002 *
Proof of Contributor Effective Date (November 2004) (PDF 105K )	2459
PSMIP Certificate of Insurance (June 2005)(PDF 47K )	2029*
PSMIP Certificate of Insurance - Members Entitled to Employer-Paid Coverage (June 2005)(PDF 34K )	2029-1 *
PSSA Refund (Cash) (September 1999)(PDF 135K )	7011 *
Public Service Health Care Plan (PSHCP) Application for Designation of Additional Dependant for Comprehensive Coverage (June 2006)(PDF 193K )	2028-8 *
Public Service Management Insurance Plan (December 2002) (PDF 70K )	2028
Public Service Management Insurance Plan (Change of Name or of Beneficiary) (November 2002)(PDF 317K )	2028-1 *
Public Service Management Insurance Plan - Declaration of Health	2028-2
Public Service Management Insurance Plan - Members Entitled to Government-Paid Coverage (September 1995)(PDF 20K )	2028-7
Public Service Management Insurance Plan - Part-time employee only (March 2000)(PDF 12K )	2028-5
Public Service Management Insurance Plan Post-Retirement Life Insurance - Certificate of Insurance Judges Plan (August 2005)(PDF 29K )	398
Public Service Management Insurance Plan (PSMIP) - Certificate of Insurance Judges Plan (August 2005)(PDF 74K )	400 *
Q
R
Reason for Termination and Option for Benefit Air Traffic Controllers (ATC) Operational Service (May 2004)(PDF 345K )	2011-1 *
Regional Pay System - Pay Office Input Form (August 1998)(PDF 13K )	7340
Regional Pay System - Personnel-Pay Input Form (August 1998)(PDF 15K )	7340-1
Release Authorization (December 2009)(PDF 183K )	2268 *
Remittance of Dental Care Plan (DCP) Contributions For a Period of Leave Without Pay (June 2004)(PDF 355K )	2278-1 *
Statutory Declaration (December 2009)(PDF 84K )	2032 *
Request for Division of Members of Parliament pension benefits in accordance with the Pension Benefits Division Act (February 2009) (PDF 136K )	2485 *
Request for documents (December 2009)(PDF 385K )	2075-1
Request for Estimate - Transfer Value (December 2009)(PDF 105K )	2031 *
Request for Estimate of Service Buyback Paid to Date for Transfer Value (December 2009)(PDF 238K )	2030 *
Request for Estimate of Spousal Benefit Coverage and a Reduced Pension Entitlement for a Marriage after Retirement (December 2009)(PDF 213K )	2476 *
Request for Pension Benefits Division Information with respect to a Public Service Superannuation Act Pension in Accordance with the Pension Benefits Division Act (January 2009)(PDF 316K )	2488
Request for Pension Benefits Division Information with Respect to Members of Parliament Pension Benefits in Accordance with the Pension Benefits Division Act (January 2009) (PDF 183K )	2487 *
Request for Return of Superannuation Contributions (December 2009)(PDF 307K )	2577 *
Request for Service Records (July 2004)(PDF 88K )	2238
Request for Shipping (October 1997)(PDF 5.9K )	109
Request to Certify a Salary Rate (December 2009)(PDF 237K )	2201
Request to Deposit Superannuation Cheques in a Financial Institution (December 2009)(PDF 240K )	2033 *
Requisition for Interdepartmental Settlement (December 1996)(PDF 11K )	8756
Requisition for Payment - Supplementary Death Benefits (December 2009)(PDF 492K )	2007 *
S
Supplementary Death Benefit - Notice Of Payment Due (December 2009)(PDF 383K )	2170 *
Salary Service Information - Pension Support System (December 2009)(PDF 869K )	2020 *
Screening Form for Public Service Corporations - Public Service Superannuation Act (December 2009)(PDF 268K )	2013 *
Service Buyback Form for Transfer Value Service (December 2009) (PDF 219K )	2005 *
Service Buyback Notice (December 2009)(PDF 210K )	2097 *
Service Buyback Payment Transmittal for Plan Member on Leave Without Pay (December 2009)(PDF 206K )	570 *
Specimen Signature (June 2004)(PDF 66K )	GC-136
Statement of Earnings - Deceased Pensioner (June 2004)(PDF 513K )	2171 *
Statement of Option - Leave Without Pay (March 2005)(PDF 334K )	2481 *
Statement of Qualifying Retroactive Lump-Sum Payment (QRLSP) (December 2006)(PDF 566K )	37 *
Statutory Declaration (December 2009)(PDF 84K )	2032 *
Statutory Declaration for Common Law Relationship (December 2009)(PDF 101K )	2016 *
Statutory Declaration - In the matter of an Application for Division of Pension Benefits under the Pension Benefits Division Act (December 2009)(PDF 677K )	2484 *
Statutory Declaration - In the Matter of Provision of Pension Benefits Information under the Pension Benefits Division Act (December 2009)(PDF 1.0M )	2483 *
Statutory Declaration - In the Matter of the Public Service Superannuation Act (October 2004)(PDF 1.5M )	2010 *
Statutory Declaration - Public Service Superannuation Act Subsections 25(4), 25(4.1) and 25(10) - Claimant's Statement (November 2007)(PDF 272K )	2467 *
Statutory Declaration - Public Service Superannuation Act - Subsection 25(4) - Supporting Statement (December 2009)(PDF 264K )	2467-1 *
Statutory Declaration - Public Service Superannuation Act Administration (June 2004)(PDF 537K )	2040
Superannuation Directorate - Pension and Deductions Paylist (January 2000)(PDF 18K )	7241
Superannuation Directorate - Production Control File Relocation System (August 2002)(PDF 7.5K )	2219
Superannuation Documentation Transmittal Slip (December 2009)(PDF 384K )	2241 *
Superannuation Remittance for Employees on Leave Without Pay (December 2009)(PDF 235K )	4005 *
Supplementary Death Benefit Control (December 2009)(PDF 245K )	2096
Supplementary Death Benefit Claim Form (December 2009)(PDF 205K )	2223 *
Surrender of Benefits (December 2009)(PDF 259K )	2092 *
Surrender of Rights Under a Government Annutiy Contract (December 2009)(PDF 144K )	2066 *
T
Tax Credit Input Form (February 2005)(PDF 25K )	2053-1
Termination and Contributions Advice (December 2009) (PDF 274K )	2321
Training - Advance Reimbursement Request (April 2005)(PDF 563K )	371 *
Transfer Service Record (December 2009)(PDF 213K )	2482
U
Undertaking and Indemnity (August 2005)(PDF 300K )	535 *
Undertaking and Indemnity (February 1997)(PDF 11K )	536
Union Deductions - Dues and Insurance (December 2004) (PDF 472K )	2584 *
V
Void Cheques (March 1996)( 6.1K )	7456-1
W
Withdrawal Allowance (Members of Parliament)* (August 2005)(PDF 578K )	4144

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Forms - Alphabetical Listing

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