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Forms for State Agencies and Employees

Form #Form Name and ResourcesFormat

Accounting

AC 22‑SJournal VoucherExcel
AC 909‑SReport of Moneys ReceivedExcel
AC 1286‑SRefund of AppropriationExcel
AC 3286‑AFederal Grant Amendment Information for SFSFillable PDF
AC 3286‑PFederal Grant Pre-Award Information for SFSFillable PDF
AC 3312‑SAR Deposit FormExcel
AC 3329‑SCash Advance Account Confirmation & Reconciliation FormFillable PDF

Contracts

AC 340-S

Contract Encumbrance Request (SFS)

  • Original AC 340 with revisions highlighted and fields defined (PDF)
Excel
Fillable PDF
AC 1782‑SBureau of Contracts Authorized Signature FormFillable PDF
AC 3268‑SSimplified Renewal AgreementWord
AC 3269‑SState of New York Multi-Year AgreementWord
AC 3270‑SCompetitive Grants Procurement Record ChecklistWord
AC 3271‑SNew York State Consultant Services Contractor's Planned EmploymentWord
AC 3272‑SNew York State Consultant Services Contractor's Annual Employment ReportWord
PDF
AC 3273‑SVendor Responsibility ProfileWord
PDF
AC 3276‑SNovation Agreement Template (All Parties)
Novation Agreement Template (No Transferor)		Word
Word
AC 3277‑SContract Certification Form for Quick Contract ProcessingFillable PDF
AC 3278‑SQuick Contract Boilerplate AgreementWord
AC 3279‑SChecklist for Legislative InitiativeWord
AC 3280‑SRequest for Exception to OSC Encumbrance Policy For Programs with Multiple Grant AwardsWord
PDF
AC 3281‑SGovernmental Entity Representation Concerning Compliance with State Finance Law §§139-j and 139-kFillable PDF
AC 3357Online Services Bureau of Contracts Applications Account MaintenanceFillable PDF
AC 3358Online Services Government Account AuthorizationFillable PDF

Payroll

AC 230Report of Check Returned for Refund or ExchangeFillable PDF
AC 873Extra Service Payroll VoucherFillable PDF
AC 934‑PNext of Kin Affidavit for Bureau of State Payroll ServicesFillable PDF
AC 1394Application & Account for Partial Payment of SalaryPrint Only
AC 1476‑PReport of Check ExchangeFillable PDF
AC 1588Dual Employment/Extra Service Approval FormFillable PDF
AC 2674W-2 Correction WorksheetFillable PDF
AC 2714Undeliverable Payroll Check ReportFillable PDF
AC 2772Direct Deposit Form
Guide to Completing AC-2772 Direct Deposit Form		Fillable PDF
AC 2822

Bureau of State Payroll Services Payroll Transaction Authorization Form

(Please see Payroll Bulletin 1420 New Procedures for Electronic Payroll Certification for more information)

Fillable PDF
AC 3173Agency Report of Taxable Value of Personal Use of an Employer-Provided VehicleFillable PDF
AC 3197Request for Direct Deposit Stop/ReversalFillable PDF
AC 3202Payroll Certification FormFillable PDF
AC 3206Prior Year Social Security and Medicare Tax Refund CertificationFillable PDF for NYS
Fillable PDF for CUNY
AC 3216

Personal Privacy Protection Law Release Form

  • Instructions (PDF)
PDF
AC 3217Extra Service Position Data Request FormFillable PDF
AC 3218NYS Position Data Request FormFillable PDF
AC 3219Position Data Request FormFillable PDF
AC 3300‑SCertification for Payment of Pre-Adjudicatory Settlement AgreementsFillable PDF
AC 3340Application by Payee or Agency Representative for Issuance of Replacement CheckFillable PDF

Purchasing and Payments

AC 92Standard VoucherPDF
Word template
AC 130‑S

Purchase Order (Stand-alone)

  • Original AC 130 with revisions highlighted and fields defined (PDF)
  • Terms and Conditions (PDF)
PDF
AC 852‑SBusiness Unit Voucher Authorizer DesignationFillable PDF
AC 902‑S

Purchase Order Change Notice (SFS)

  • Original AC 902 with revisions highlighted and fields defined (PDF)
Fillable PDF
AC 946Tax Exempt CertificateFillable PDF
AC 1171State Aid VoucherPDF
AC 1366‑S

Land Claims Payment Voucher (SFS)

  • Fields numbered and defined (PDF)
Fillable PDF
AC 2397Voucher Charge Continuation with TailFillable PDF
AC 3253‑S

Claim for Payment

  • Instructions for Users (PDF)
  • Fields numbered and defined (PDF)
Fillable PDF 
(with auto-calculate)
AC 3254‑S

PeopleSoft Charge Continuation

  • Instructions for Users (PDF)
  • Fields numbered and defined (PDF)
Fillable PDF
TD- 346Request for Stop Payment, Replacement Check, Photocopy of Check or Forgery AffidavitFillable PDF

Travel

AC 132‑ATravel VoucherForm AC 132-A is now obsolete and has been replaced by form AC 132-S
AC 132‑S

Employee Report of Travel Expenses and Claim for Payment

  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 160‑S

Statement of Automobile Travel

  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 1099‑S

Request/Agreement for Moving Expense Reimbursement

  • Fields numbered and defined (PDF)
Fillable PDF
AC 3256‑S

Statement of State Corporate Travel Card Charges

  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 3257‑S

Claim for Travel Reimbursement by a Non-Employee

  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 3258‑S

Statement of Meals Claimed

  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 3259‑S

Statement of Incidental and Transportation Expenses (previously on AC 148)

  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word 
 

Vendors

AC 3237‑SNew York State Substitute Form W-9Fillable PDF
AC 3261‑SSpecial Use Vendor ID RequestFillable PDF
AC 3266‑SSingle Payment Vendor ID RequestFillable PDF
AC 3267‑SForeign Vendor Registration RequestFillable PDF
AC 3317Customer ID Request FormFillable PDF

Other

AC 934Next of Kin AffidavitPDF
AC 1551Affidavit to Support Claim of Forged EndorsementFillable PDF
AC 3300‑SCertification for Payment of Pre-Adjudicatory Settlement AgreementsFillable PDF
AC 3337Request for Stop Payment, Check Reissue, Check Copy or Forgery Claim for the Comptroller's Refund Account (P and W Checks)Fillable PDF