State of Connecticut  

Comptroller's Forms

For the PDF files included in this index:

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Click here for a separate index of Retirement Services Division Forms.
 
FORM NUMBER CATALOG NUMBER FORM NAME FILE SIZE SOURCE DOCUMENT
N/A N/A Direct Deposit Authorization and Input Form - Vendor - WORD97  format 33Kb Comptroller's Memorandum 2001-18
N/A  N/A EQUIPMENT TRANSFER FORM 148KB  
PDF format WORD format
N/A N/A GAAP Closing Package - 2014   -  EXCEL format 1399KB  
N/A N/A Grant Award Report - WORD97 format 29KB  
N/A N/A Payroll Information Release Form
EXCEL format
18Kb Comptroller's Memorandum 2001-65
N/A N/A REQUEST FOR FEDERAL OR NON-FEDERAL RESTRICTED GRANT APPROPRIATION NUMBER 11 Kb State Accounting Manual - Grants
N/A N/A REQUEST FOR INFORMATION EMPLOYEES RETURNING TO STATE SERVICE FROM ACTIVE MILITARY SERVICE - WORD format 32KB  
N/A N/A REQUEST FOR INFORMATION REGARDING STATE EMPLOYEES IN THE RESERVES OF THE ARMED FORCES OF THE UNITED STATES - WORD format 4KB  
N/A



 
N/A Schedule of Federal Awards (SEFA) 528KB  
Instructions for FYE June 30, 2014
- PDF format
SEFA Forms
- EXCEL format
N/A N/A SUMMARY LICENSED SOFTWARE REPORT - WORD format 193Kb  
CO-17
Rev 10/2010
102-01 VENDOR INVOICE FOR GOODS OR SERVICES RENDERED TO STATE OF CONNECTICUT 123 Kb  
PDF format WORD format
CO-17RPC
Rev 7/03
107-01 REQUEST TO REPLENISH PETTY CASH FUND 101 Kb  
PDF format html format
CO-17RPC/ADV
Rev 7/03
108-01 Record of Outstanding Petty Cash Advances 20 Kb  
PDF format   word format
CO-17XPA
Rev 1/2004
800-01 EMPLOYEE VOUCHER- ADDENDUM 29 Kb Comptroller's Memorandum 97-57
PDF format   word format
CO-17XPPR
Rev 12/2003
800-02 EMPLOYEE PAYROLL REIMBURSEMENTS 38 Kb Comptroller's Memorandum 98-32
PDF format   word format
CO-59
Rev 5/10
N/A ASSET MANAGEMENT/INVENTORY REPORT/GAAP REPORTING FORM   EXCEL format 140 Kb  
PDF format WORD format
CO-64
Rev 7/05
N/A INTER-UNIT TRANSFER OF ASSETS 117 Kb  
PDF format WORD format
CO-65
Rev 7/05
N/A MASS CHANGE OF ASSETS REQUEST FORM 87 Kb  
PDF format WORD format
CO-101
Rev 5/14
 
N/A Application for Tuition Reimbursement          Instructions in WORD format

54KB

 
WORD format  
CO-102 Rev
8/2012
N/A Tuition Priority Log - WORD format 33KB  
CO-112
Rev 5/2014
NA Travel Authorization Request 86 Kb State Accounting Manual - Commitments
WORD format  
CO-501
Rev 7/2003
N/A P-Card Log Sheet 53KB PURCHASING CARD CARDHOLDER WORK RULES
PDF format WORD format
CO-502
Rev 7/2003
N/A Air Travel Log Sheet 53KB AGENCY PURCHASING CARD
COORDINATOR MANUAL
PDF format WORD format
CO-503D N/A  Department Card Purchase Log Sheet - WORD format 44KB  
CO-504D N/A  Department Card User Log Sheet      -  WORD format 58KB  
CO-507
Rev 5/09
N/A Lease and Rent Account Control     -       EXCEL format 37Kb State Accounting Manual - Commitments
CO-512
Rev 4/2006
N/A Claims Authorization Form
EXCEL Format
546 Kb State Accounting Manual - Commitments
CO-608
Rev 6/2010
N/A INTRA-DEPARTMENT TRANSFER INVOICE 27 Kb  
PDF format WORD format
CO-610
Rev 4/91
137-01 RECORD OF PENDING RECEIPT 14 Kb State Accounting Manual - Receipts
CO-638
Rev 2/2011
NA Notice of Death - State Employee
WORD format
42Kb  
CO-648B
Rev 04/2009
N/A SUMMARY MOTOR VEHICLE REPORT
EXCEL format
43 Kb Property Control Manual
Appendix B
CO-671 N/A ADVICE OF BAD CHECKS /ACC. SYSTEM 15 Kb State Accounting Manual - Receipts
CO-692
Rev 4/91
N/A COMPTROLLER'S ADJUSTMENT 12 Kb State Accounting Manual - Receipts
CO-744
REV 4/2014
N/A Choice of Health Services After Retirement  - WORD format 124Kb  
CO-747
Rev 6/2012
N/A Application For Substitution of Securities For Retainages
WORD format
212K  
CO-780
Rev. 2/2008
N/A Subscription-Order and Remittance Advice
EXCEL format
25 Kb  
CO-790
Rev 5/2009
N/A Payment Cancellation
EXCEL format
531KB  
CO-790S
Rev 4/2006
N/A Payment Cancellation Statement
EXCEL format
524KB  
CO-802A
Rev 2/2008
N/A PERSONAL SERVICE AGREEMENT 35KB PSA Standards and Procedures
PDF format WORD format
CO-819
Rev 7/2007
N/A APPLICATION FOR WAIVER OF GROUP LIFE INSURANCE PREMIUM PAYMENTS 808 Kb  
PDF format word format
CO-826
Rev 9/07
NA REIMBURSABLE COST RECOVERY REPORT (Federal and Other Funds) 51 Kb  
Excel format  
CO-853
Rev 7/2014
N/A REPORT OF LOSS OR DAMAGE TO STATE OWNED REAL AND PERSONAL PROPERTY 32 Kb  
word format
CO-860
Rev 5/2009
N/A Request for Payment Information
EXCEL format
523KB  
CO-863
Rev 2/99
N/A Fringe Benefit Variance 9 Kb Indirect Cost and Fringe Benefit Cost Recovery Manual
CO-924
Rev 11/2003
478-01 Postal Service Transaction 51 Kb State Accounting Manual - Expenditures
PDF format HTML format
CO-929
Rev 1/2007
N/A BANK ACCOUNT ESTABLISHMENT REQUEST 679 Kb State Accounting Manual - Receipts
PDF format WORD format
CO-931
Rev 11/2013
N/A DESIGNATION OF RETIREMENT SYSTEM TIER PLAN BENEFICIARY               WORD format 266 Kb  
CO-959
Rev 6/2006
N/A VEHICLE USAGE FRINGE BENEFIT COMPUTATION RECORD EXCEL format 28 Kb  
CO-960
Rev 6/2006
N/A VEHICLE USAGE FRINGE BENEFIT COMPUTATION RECORD/CENTS PER MILE METHOD  EXCEL format 28 Kb  
CO-961
Rev 6/2006
N/A VEHICLE USAGE FRINGE BENEFIT COMPUTATION RECORD/LEASE VALUE METHOD  EXCEL format 34 Kb  
CO-1040
Rev 6/2008
N/A DIRECT DEPOSIT AUTHORIZATION AND INPUT FORM   - PDF format - (Link to Core-CT website)    
CO-1048NQ
Rev 5/2012
N/A NON-QUALIFIED CHILD (FORMER WARD) ENROLLMENT APPLICATION
WORD format
419K  
CO-1048QR
Rev 5/2012
N/A QUALIFIED DEPENDENT (FORMER WARD) ENROLLMENT APPLICATION
WORD format
420K  
CO-1052
Rev 3/2009
N/A TRUSTEE ACCOUNT    
PDF format WORD format
CO-1057
Rev 2/2001
N/A AGENCY ONLINE SECURITY FORM
 EXCEL format
51 Kb  
CO-1057A
Rev 10/2009
N/A COMPTROLLER'S FINANCIAL SYSTEMS AGENCY CONTACT PERSON FOR AGENCY ON-LINE SECURITY - WORD format 65.4Kb N/A
CO-1079
Rev 6/2010
N/A RECORD OF EQUIPMENT ON LOAN 226 Kb Property Control Manual - Appendix B
PDF format WORD format
CO-1081
New 10/94
706-01 AGENCY MULTI-PURPOSE PAYROLL REPORT 12 Kb Comptroller's Memorandum 95-13
CO-747
Rev 8/2008
N/A Application For Substitution of Securities For Retainages
WORD format
212K  
CO-1300
Rev 11/2011
N/A Enrollment Form - Retiree Health Fund
WORD format
519 Kb  
CO-1301
Rev 9/2012
N/A Application for Refund - Retiree Health Contributions
WORD format
517 Kb  
CO-1302
New 3/2010
N/A Repayment of Retiree Health Fund For Prior Service Credit  -  WORD format 519 Kb  
CO-1303
Rev 11/2011
N/A Affidavit   -  WORD format 198 Kb  
CO-1304
Rev 1/2012
N/A Waiver of Retiree Health Plan Participation
WORD format
168 Kb  
CO-1305
New 3/2010
N/A Rehired Employee's Waiver of Right to Restore Prior Service Credit for Retiree Healthcare Eligibility  
WORD format
166 Kb  
CO-1306
Rev 9/2014
N/A MEDFLEX Open Enrollment Form 2015 -WORD Format    
CO-1306
Rev 3/2014
N/A 2014 MEDFLEX ENROLLMENT/STATUS CHANGE FORM (NOT TO BE USED FOR 2015 ENROLLMENT)    
CO-1307
Rev 03/2014
N/A MEDFLEX Claim Reimbursement Form -WORD Format    
CO-1308
Rev 03/2014
N/A MEDFLEX Medical Necessity Form Letter -WORD Format    
CO-1309
Rev 03/2014
N/A MEDFLEX Capital Expense Form -WORD Format    
CO-1310
Rev 9/2014
N/A Dependent Care Assistance Program Open Enrollment Form 2015-
WORD Format
   
CO-1310
Rev 3/2014
N/A 2014 Dependent Care Assistance Program    
CO-1311
Rev 03/2014
N/A Dependent Care Assistance Program Claim Reimbursement Form -
WORD Format
   
CO-1312
Rev 9/2014
N/A Enrollment Form - Qualified Transportation Account
WORD Format
   
CO-1313
Rev 03/2014
N/A PBS Claim Form - Qualified Transportation Account
WORD Format
84 Kb  
CO-1314
Rev 8/2011
N/A HEP Enrollment Form
PDF format
25 Kb  
CO-1315
REV 2/2014
N/A Emergency Room Copayment Waiver Request PDF format    
CO-1317
Rev 5/2013
N/A For Doctors: Physician Notification Form  PDF format 37 Kb  
CO-1318
New 5/2012
N/A Legal Guardianship Notification and Dependency Verification
WORD format
382 Kb  
CO-1319
New 5/2012
N/A CHANGE IN MARITAL STATUS NOTIFICATION AND CONTINUATION OF COVERAGE REQUEST
WORD format
391 Kb  
CO-1321
New 7/2013
N/A ANNUAL CERTIFICATION QUALIFIED DEPENDENT
WORD format
244 Kb  
CO-1323
New 7/2013
N/A RETIREE HEALTH FUND CONTRIBUTION
WORD format
344 Kb  
CO-1328
Rev 9/14
N/A RETIREE HEALTH FUND PAYMENT ADJUSTMENT    
CO-1329
9/14
N/A Application for Refund Incorrectly Coded
Retiree Health Fund Contributions
   
COP-9
Rev 11/2003
N/A WAGE AND DEDUCTION ADJUSTMENT FORM - WORD format - (Link to Core-CT website)    
CP-1
Rev 9/97
N/A Notification of Intent to Apply for Federal Assistance or Private Grant Funding - EXCEL format 89KB  
DPS-29
Rev 5/01
N/A Sale Declaration Report 44 Kb Property Control Manual
SP-26NB
Rev 4/03
  Agency Vendor Form - PDF format on DAS site   Replaces CO-1055 - Vendor Profile Form

TR-2Form
N/A Tuition Reimbursement Authorization Form (TR-2)  
- PDF format on DAS site
   


This page was last updated on: October 14, 2014

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