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	FORM NAME		SOURCE DOCUMENT
Accounts Payable
CO-17 Rev 10/2010	VENDOR INVOICE FOR GOODS OR SERVICES RENDERED TO STATE OF CONNECTICUT
CO-17 Rev 10/2010	PDF format	WORD format
CO-17RPC Rev 7/15	REQUEST TO REPLENISH PETTY CASH FUND
CO-17RPC Rev 7/15	PDF format	Word format
CO-17RPC/ADV Rev 2003	Record of Outstanding Petty Cash Advances
CO-17RPC/ADV Rev 2003	PDF format	Word format
CO-507 Rev 12/19	Lease and Rent Account Control PDF format		State Accounting Manual - Commitments
CO-512 Rev 4/2006	Claims Authorization Form EXCEL Format		State Accounting Manual - Commitments
CO-780 Rev. 2/2008	Subscription-Order and Remittance Advice EXCEL format
CO-790 Rev 02/2022	Payment Cancellation: The CO-790 has been replaced with an online process in Core-CT		Link to Job Aid for new online CO-790 process: https://www.core-ct.state.ct.us/financials/ap/Default.htm
CO-790S Rev 08/2021	Analysis of Improper Payment/Internal Control Statement
CO-790S Rev 08/2021	PDF Format
CO-802A Rev 2/2008	PERSONAL SERVICE AGREEMENT		PSA Standards and Procedures
CO-802A Rev 2/2008	PDF format	WORD format	PSA Standards and Procedures
CO-860 Rev 12/2019	The CO-860 has been replaced with an online process in Core-CT.		Link to Job Aid for new online CO-860 process (see 'Cancellation' Job Aid): https://www.core-ct.state.ct.us/financials/ap/Default.htm
CO-924 Rev 11/2003	Postal Service Transaction		State Accounting Manual - Expenditures
CO-924 Rev 11/2003	PDF format	HTML format	State Accounting Manual - Expenditures
SP-26NB Rev 4/03	Agency Vendor Form - PDF format on DAS site		Replaces CO-1055 - Vendor Profile Form

Accounts Receivable
N/A	Grant Award Report - WORD97 format
CO-608 Rev 6/2010	INTRA-DEPARTMENT TRANSFER INVOICE
CO-608 Rev 6/2010	PDF format	WORD format
CO-610 Rev 4/91	RECORD OF PENDING RECEIPT		State Accounting Manual - Receipts
CO-671	ADVICE OF BAD CHECKS /ACC. SYSTEM		State Accounting Manual - Receipts
CP-1 Rev 9/97	Notification of Intent to Apply for Federal Assistance or Private Grant Funding - EXCEL format

Employee Reimbursements
CO-17XPA Rev 1/2004	EMPLOYEE VOUCHER- ADDENDUM
CO-17XPA Rev 1/2004	PDF format	Word format
CO-17XP-PR Rev 11/2022	EMPLOYEE PAYROLL REIMBURSEMENTS
CO-17XP-PR Rev 11/2022	PDF format
CO-101 Rev 1/23	Application for Tuition Reimbursement
CO-101 Rev 1/23	PDF format
CO-102 Rev 7/2015	Tuition Priority Log
CO-102 Rev 7/2015	WORD format	PDF format
CO-112 Rev 12/2019	Travel Authorization Request		State Accounting Manual - Commitments
CO-112 Rev 12/2019	PDF format		State Accounting Manual - Commitments
TR-2Form	Tuition Reimbursement Authorization Form (TR-2) - PDF format on DAS site

Fiscal Policy and Statewide Services
Assets and Inventory
CO-58 02/2016	PROPERTY TRANSFER WITHIN AGENCY
CO-59 Rev 5/22	ASSET MANAGEMENT/INVENTORY REPORT/GAAP REPORTING FORM EXCEL format
CO-64 Rev 2/16	INTER-UNIT TRANSFER OF ASSETS
CO-64 Rev 2/16	WORD format
CO-65 7/05	MASS CHANGE OF ASSETS REQUEST FORM - PDF
CO-648B Rev 12/2019	SUMMARY MOTOR VEHICLE REPORT EXCEL format		Property Control Manual Appendix B
CO-853 Rev 12/2019	REPORT OF ADJUSTMENT TO STATE OWNED REAL AND PERSONAL PROPERTY
CO-853 Rev 12/2019	Word format
CO-1079 Rev 2/2016	RECORD OF EQUIPMENT ON LOAN		Property Control Manual - Appendix B
CO-1079 Rev 2/2016	WORD format		Property Control Manual - Appendix B
DPS-29 Rev 2015/01	Sale Declaration Report EXCEL		Property Control Manual
Military
CO-11	Payroll Information Release Form EXCEL
CO-12	REQUEST FOR INFORMATION EMPLOYEES RETURNING TO STATE SERVICE FROM ACTIVE MILITARY SERVICE
	PDF format
CO-13	REQUEST FOR INFORMATION REGARDING STATE EMPLOYEES IN THE RESERVES OF THE ARMED FORCES OF THE UNITED STATES
	PDF format
Purchasing Card
CO-501 Rev 01/2020	P-Card Log Sheet		PURCHASING CARD CARDHOLDER WORK RULES
CO-501 Rev 01/2020	Excel format	PDF format	PURCHASING CARD CARDHOLDER WORK RULES
CO-502 Rev 7/2003	Air Travel Log Sheet		AGENCY PURCHASING CARD COORDINATOR MANUAL
CO-502 Rev 7/2003	PDF format	WORD format	AGENCY PURCHASING CARD COORDINATOR MANUAL
CO-503D	Department Card Purchase Log Sheet - EXCEL format
CO-504D	Department Card User Log Sheet - EXCEL format
Securities for Retainages
CO-747 Rev 12/2019	Application For Substitution of Securities For Retainages WORD format
Trustee Accounts
CO-1052 Rev 12/2019	TRUSTEE ACCOUNT
CO-1052 Rev 12/2019	PDF format
Other
CO-929 Rev 12/2019	BANK ACCOUNT ESTABLISHMENT REQUEST		State Accounting Manual - Receipts
CO-929 Rev 12/2019	PDF format		State Accounting Manual - Receipts
CO-928 Rev 04/2023	ANNUAL PETTY CASH REPORT		State Accounting Manual - Petty Cash
CO-928 Rev 04/2023	PDF format		State Accounting Manual - Petty Cash

Health Benefits
CO-638 Rev 8/2015	NOTICE OF DEATH - STATE EMPLOYEE
CO-638 Rev 8/2015	WORD format	PDF format
CO-744 REV 10/2020	Choice of Health Services After Retirement - PDF format
CO-819 Rev 12/2019	APPLICATION FOR WAIVER OF GROUP LIFE INSURANCE PREMIUM PAYMENTS
CO-819 Rev 12/2019	PDF format
CO-1048NQ Rev 5/2012	NON-QUALIFIED CHILD (FORMER WARD) ENROLLMENT APPLICATION WORD format
CO-1048QR Rev 5/2012	QUALIFIED DEPENDENT (FORMER WARD) ENROLLMENT APPLICATION WORD format
CO-1300 Rev 12/2019	OPEB Enrollment Form - Retiree Health Fund WORD format
CO-1300B rev 12/2019	ENROLLMENT FORM RETIREE HEALTH FUND FOR EMPLOYEES FIRST HIRED ON OR AFTER 7/1/2017 - PDF format
CO-1301 Rev 12/2019	Application for Refund - Retiree Health Contributions PDF format
CO-1302 Rev12/2019	Repayment of Retiree Health Fund For Prior Service Credit - PDF format
CO-1303 Rev 01-2021	Affidavit - WORD format
CO-1304 Rev 12/2019	Exemption Application and Waiver - PDF Format
CO-1305 Rev 1/2021	Rehired Employee's Waiver of Right to Restore Prior Service Credit for Retiree Healthcare Eligibility WORD format
CO-1314 Rev 9/2015	HEP Enrollment Form PDF format
CO-1315 REV 12/2019	Emergency Room Copayment Waiver Request
CO-1315 REV 12/2019	PDF format
CO-1315 REV 05/2019	Emergency Room Copayment Waiver Request - Partnership Plan
CO-1315 REV 05/2019	PDF format
CO-1317 Rev 1/2016	For Doctors: Physician Notification Form PDF format
CO-1318 New 5/2012	Legal Guardianship Notification and Dependency Verification WORD format
CO-1319 New 5/2012	CHANGE IN MARITAL STATUS NOTIFICATION AND CONTINUATION OF COVERAGE REQUEST WORD format
CO-1321 Rev 12/2019	ANNUAL CERTIFICATION QUALIFIED DEPENDENT PDF format
CO-1323 Rev 12/2019	RETIREE HEALTH FUND CONTRIBUTION WORD format
CO-1328 Rev 12/2019	RETIREE HEALTH FUND PAYMENT ADJUSTMENT
CO-1329 Rev 12/2019	Application for Refund Incorrectly Coded Retiree Health Fund Contributions

Payroll
CO-959 Rev 6/2006	VEHICLE USAGE FRINGE BENEFIT COMPUTATION RECORD EXCEL format
CO-960 Rev 6/2006	VEHICLE USAGE FRINGE BENEFIT COMPUTATION RECORD/CENTS PER MILE METHOD EXCEL format
CO-961 Rev 6/2006	VEHICLE USAGE FRINGE BENEFIT COMPUTATION RECORD/LEASE VALUE METHOD EXCEL format
CO-1040 Rev 10/2022	DIRECT DEPOSIT AUTHORIZATION AND INPUT FORM - PDF format
CO-1081 New 10/94	AGENCY MULTI-PURPOSE PAYROLL REPORT
COP-9 Rev 12/2015	WAGE AND DEDUCTION ADJUSTMENT FORM - WORD format - (Link to Core-CT website)

Reporting
N/A	GAAP Closing Package - 2022 - EXCEL format
N/A	GAAP form preparation training - PowerPoint format
N/A	Schedule of Federal Awards (SEFA)
N/A	Instructions for FYE June 30, 2022 - PDF format	SEFA Forms - EXCEL format
CO-826 (non-project coding) Rev - 5/2018	REIMBURSABLE COST RECOVERY REPORT - NONPROJECT (Federal and Other Funds) - EXCEL format
CO-826 (Project coding) REV. 5-2019	REIMBURSABLE COST RECOVERY REPORT - PROJECT (Federal and Other Funds) - EXCEL forma

Miscellaneous
CO-931 Rev 04/2018	Designation of Retirement Plan Election Non-Higher Education Only
CO-999 6/2018	Designation of Retirement Plan Beneficiary Form for Active/Inactive Members

This page was last updated on: March 06, 2023