Public Works and Government Services Canada
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Forms - Alphabetical Listing
Notice
The forms listed below are available in an Portable Document Format (PDF). To access the Portable Document Format (PDF) version you must have a PDF reader installed. If you do not already have such a reader, there are numerous PDF readers available for free download or for purchase on the Internet such as :
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Notes:
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- Fillable forms are marked with an asterisk - * .
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- 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
(September 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 [an error occurred while processing this directive] ) 2437 * -
Common Architecture Security Request
(April 2010)(PDF 867K ) 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)
(May 2010)(PDF 383K ) 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
(March 2010)(PDF 352K ) 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 -
Document Issued as Evidence that the Person Named Herein is an
Elective Participant under Part II of the Public Service Superannuation Act
(February 2010) (PDF 6.9K ) 2042 -
Document Issued as Evidence that the Person Named Herein is an
Elective Participant under Part II of the Public Service Superannuation Act
(January 2010) (PDF 6.9K ) 2043 -
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
(April 2010)(PDF 105K) 5136 * -
Members of Parliament Retiring Allowance Act
(December 2004)(PDF 108K) 4175 -
Miscellaneous Deductions - Code 64
(December 2004)(PDF 337K) 1872 * -
Miscellaneous Deductions - Code 64
(May 2010)(PDF 337K) 1872-1 * -
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
(May 2010)(PDF 313K) 2019 * -
Notice of Cancellation - Public Service Health Care Plan (PSHCP)
(November 2009)(PDF 333K) 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)
(April 2010)(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 (March 2010) (PDF 217K) 437 * - Pensioners' Dental Services Plan (PDSP) Form - April 1, 2006 (March 2010) (PDF 125K) 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 [an error occurred while processing this directive]) 577 -
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
(August 2010)(PDF 385K) 2075 * -
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 312K) 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 781K) 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
(May 2010)(PDF 433K) 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
(March 2010)(PDF 837K) 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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