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Governor Eric J. Holcomb
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Forms

View all state forms using the State Form Catalog.

  • Administrative Services
    Form NameInstructionsForm
    Driver's Checklist  PDF
    DOC
    Incident Report -
    State Form 52359    		 Form
    Request for Internal Access -
    State Form 52120    		 Form
    ISP Bomb Threat -
    State Form 24353    		 Form
    Print Request -
    State Form 44874    		 Form
    Print/Copy Requests General Information and FAQ's   Word
    Credential and Access form -
    State Form 52044    		 Form
    Record Transmittal and Receipt -
    State Form 23628    		 Form
    Release From Liability For Non-State Employee Passenger in State Vehicle -
    State Form 50188    		 Form
    Request for Approval of New/Revised Form -
    State Form 36040    		Instructions
    Forms Coordinator Handbook

    Form

    Request for Records
    State Form 24019    		 

    Form

    Rental Vehicle Use Agreement -
    State Form 53553    		 PDF
    DOC
    Temporary Vehicle Agreement -
    State Form 52297    		 Form
    SF16 - Records Destruction Notification  Form
    SF48883 - State Archives Record Transmittal and Receipt  Form
  • Commissioner's Office
    Form NameInstructions
    Official Letterhead in WordBrand Resources
  • Finance
    Form NameInstructionsForm
    Assessment Criteria Instructions 
    Authorization for Out of State Travel (formerly G-10) -
    State Form 823    		 Form
    Certification for Missing Receipt -
    State Form 42275    		 Form
    Cheat Sheet InstructionsForm
    Employee Statement of Employer Provided Vehicle Use -
    State Form 49632    		 Form
    Indiana Business Preferences Instructions 
    Indiana Economic Impact Form -
    State Form 51778    		 Form
    Requisition/Purchase Order - State Form 37773 Form
    Official Station  Form
    Record of Telephone Price Quotations -
    State Form 43464    		 Form
    Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement for Employees Using the IDOH Fitness Center
    State Form 54729    		 Form
    Report of Collections/Receipts (Due Treasurer of State) -
    State Form 14311    		 Form
    Request for Special Procurement -
    State Form 54650    		 Form
    Surplus Spreadsheet InstructionsForm
    Temporary Employee Request Instructions and Templates  
    Strategic Hiring Request Template for Knowledge Services Positions Forms 
    Job Description for Knowledge Services Requests Template Form 
    Travel Advance -
    State Form 49630    		InstructionsForm
    Travel Status Memo InstructionsForm
    Vendor Information Form
    State Form 53788     		 Form
  • Grants Resource Center
    Form NameForm
    Request to Acquire New Funding - State Form 51757Form
    Grant Award Notification TemplateForm
  • Human Resources
    Form NameForm
    First Report of Injury/Illness -
    State Form 34401 (R10/1-02)    		Form
    Outside Employment Disclosure -
    State Form 53182    		Form
  • Office of Legal Affairs
    Form NameForm
    Agreement for Release of Data Containing Confidential Information
    State Form 52104    		Form
    Request For Approval of Memorandum of Understanding
    State Form 53555    		Form
    Consent To Release Social Security Number -
    State Form 53190    		Form
    Request for Internal Legal Advice -Form
    Request for Approval of Special Agreement -
    State Form 53676    		Form
    Request for Assistance with Contract, Memorandum of Understanding (MOU) or Special Agreement -
    State Form 53559    		Form
    Request for Assistance with Rules Promulgation -
    State Form 52702    		Form

    Data Sharing Agreement template - Internal
    Data Sharing Agreement template - External

    Link

    Find under “Responsible Data Sharing.”

  • Office of Technology and Cybersecurity
    Form NameForm
    Virtual Private Network (VPN) Request-Agreement
    State Form 55278    		Form
    Database Access Form -
    State Form 55859    		Form
    Justification for Purchase of Removable Media Devices
    State Form 55872    		Form
    Personal Device Connection to State E-mail System Agreement -
    State Form 55610    		Form
    Request for Internal HIPAA Advice -
    State Form 51245    		Form
    Receipt of Mobile Device
    State Form 55953    		Form