Forms Online Catalog
PLEASE NOTE: This page is a representation of the Forms Catalog as it existed on 8/21/2009; it is no longer being updated and serves only as a historical back-up. For the most recent version of all available state forms, please return to forms.IN.gov and use the All-Agency Catalog or browse forms for the individual agencies.
For questions about specific forms (how to fill out a form or how to find a form that is missing from the catalog), please contact the agency which owns that form. The Commission on Public Records, which provides a central posting-place for electronic forms, is unable to answer questions regarding the functions of other agencies. For additional information about individual forms, contact the forms coordinator for the agency which owns the form.
For questions about how to use this catalog, or to inform us of a technical problem, please e-mail the Forms Management Division.
TO SEARCH THIS CATALOG: From the toolbar in the Edit menu, select "Find". When the Find search box appears, enter a keyword or form number. The first search result will display with the keyword or number highlighted, at the top of the page. Click "Find next" until the desired form is highlighted.
For forms labeled "PDF", the free Adobe Acrobat Reader software is required to view and in some cases complete a form. Forms in other formats (MS Word, MS Excel, etc.) are indicated where appropriate.
To open a form once you have chosen it, click on the linked State Form Number (such as 01365.pdf).
NOTE: Forms marked Read-Only cannot be filled-in by computer. They must be printed out to be used.
All-Agency, All-Formats Catalog
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| IV-D Applicant Information | Dept. of Child Services - Child Support Bureau | 51802.pdf |
| 2009-10 Application for Remission of Fees for a Child of a Disabled Indiana Veteran or a POW / MIA | Dept. of Veteran's Affairs | 20234.pdf |
| 2009-2010 Remission of Fees Application for Indiana Purple Heart Veterans | Dept. of Veteran's Affairs | 53705.pdf |
| 302 Emergency Planning Notification (Read-Only) | Dept. of Environmental Management | 52016.pdf |
| 311 Reporting (Read-Only) | Dept. of Environmental Management | 52017.pdf |
| 319-A, Agriculture Cost-Share – Clean Water Act Section 319 Cost-Share Program | Dept. of Environmental Management | 50065.pdf |
| 319-A, Agriculture Cost-Share – Clean Water Act Section 319 Cost-Share Program | Dept. of Environmental Management | 50065.doc |
| 319-U, Urban Cost-Share – Clean Water Act Section 319 Cost-Share Program | Dept. of Environmental Management | 50063.pdf |
| 319-U, Urban Cost-Share – Clean Water Act Section 319 Cost-Share Program | Dept. of Environmental Management | 50063.doc |
| 450B Attachment for the Aged and Disabled Waiver, the Medically Fragile Children Waiver, the TBI Waiver, and the AL and AFC Waiver | Family & Social Service Admin. - Division of Disability and Rehabilitation | 48115.pdf |
| 450B / PASARR2A Physician Certification for Long-Term Care Services | Family and Social Service Administration - Division of Disability and Rehabilitation | 38143.pdf |
| 6 Month (Or Other Planned) IFSP Review Cover Sheet | Family and Social Services Administration - DFR | 51840.pdf |
| Abandoned Tank Community Assistance Program | Dept. of Environmental Management | 49493.pdf |
| ABS-1 Application for Absentee Ballot | Election Division | 42106.pdf |
| ABS-1 Solicitud para Emitir un Voto en Ausencia | Election Division | 53369.pdf |
| ABS-2 Application for Absentee Ballot by Mail Only | Election Division | 47090.pdf |
| ABS-2 Solicitud de Voto en Ausencia por Correo Solamente | Election Division | 53368.pdf |
| ABS-11 Uniformed Services Voter Registration Certification (Read-Only) | Election Division | 51261.pdf |
| ABS-11 Uniformed Services Voter Registration Certification | Election Division | 51261.doc |
| ABS-13 Affidavit for Late Voter Registration by Absent Uniformed Services Voter for the Primary & General Election | Election Division | 51263.pdf |
| ABS-18 Notice to Absentee Voter to Supply Additional Documentation | Election Division | 51631.pdf |
| ABS-20 Affidavit of County Election Board or Absentee Voter Board Member Challenging Absentee Ballot Application | Election Division | 52410.pdf |
| Accountancy Application | Professional Licensing Agency | 49209.pdf |
| Active Member Data Change (Read-Only) | Teachers' Retirement Fund | 43567.pdf |
| Adjacent Landowner/Occupant Affidavit (Read-Only) | Dept. of Environmental Management | 51872.pdf |
| Adjacent Landowner/Occupant Affidavit | Dept. of Environmental Management | 51872.doc |
| Adjacent Property Owners Listing - Form N4(Read-Only) | DNR, Division of Water | 52086.pdf |
| Administrative Staff IDRS User Agreement | Dept. of Health | 53755.pdf |
| Admittance for Indiana Funeral Director Examination (Read-Only) | Professional Licensing Agency | 33289.pdf |
| Adoption History Registration Program Birth Parent Nonrelease Form (Read-Only) | Dept. of Health | 46392.pdf |
| Adoption Subsidy Agreement (Read-Only) | Dept. of Child Services - Child Welfare | |
| Adult Viral Hepatitis Prevention Training Registration | Dept. of Health | 53699.pdf |
| Advance Notification of Transfer of Ownership Request for NPDES Permit | Dept. of Environmental Management | 53919.pdf |
| Advance Notification of Transfer of Ownership Request for NPDES Permit | Dept. of Environmental Management | 53919.doc |
| Advice of Change | Dept. of Administration, Procurement Division | 00828.pdf |
| Advice of Change | Dept. of Administration, Procurement Division | 00828.xls |
| AEF-01 Alternate Emission Factor Request (Read-Only) | Dept. of Environmental Management | 51860.pdf |
| AEF-01 Alternate Emission Factor Request | Dept. of Environmental Management | 51860.doc |
| AES-01 Air Emission Statement Certification | Dept. of Environmental Management | 52052.pdf |
| AES-01 Air Emission Statement Certification | Dept. of Environmental Management | 52052.doc |
| AES-02 General Facility Information | Dept. of Environmental Management | 52053.pdf |
| AES-02 General Facility Information | Dept. of Environmental Management | 52053.doc |
| AES-03 Stack Information | Dept. of Environmental Management | 52054.pdf |
| AES-03 Stack Information | Dept. of Environmental Management | 52054.doc |
| AES-04 Abatement Equipment | Dept. of Environmental Management | 52055.pdf |
| AES-04 Abatement Equipment | Dept. of Environmental Management | 52055.doc |
| AES-05 Group/Process/Emissions Information | Dept. of Environmental Management | 52056.pdf |
| AES-05 Group/Process/Emissions Information | Dept. of Environmental Management | 52056.doc |
| AES-06 Voluntary Hazardous Air Pollutant Reporting (Read-Only) | Dept. of Environmental Management | 52057.pdf |
| AES-06 Voluntary Hazardous Air Pollutant Reporting | Dept. of Environmental Management | 52057.doc |
| Affidavit (Read-Only) | Bureau of Motor Vehicles | 37964.pdf |
| Affidavit (Read-Only) | Bureau of Motor Vehicles | 49555.pdf |
| Affidavit - Certificate of Use | Professional Licensing Agency | 47401.pdf |
| Affidavit - Hold Harmless (Read-Only) | Bureau of Motor Vehicles | 14302.pdf |
| Affidavit -- One and the Same Person (Read-Only) | Bureau of Motor Vehicles | 13637.pdf |
| Affidavit - Dealer | Secretary of State - Dealer Division | 46633.pdf |
| Affidavit Completion of Two Hundred Fifty Hours of Barber Instruction | Professional Licensing Agency | 47266.pdf |
| Affidavit for Change of Name | Dept. of Education | 47870.pdf |
| Affidavit for Inspection -- Antique Vehicle (Read-Only) | Bureau of Motor Vehicles | 37935.pdf |
| Affidavit for Lost or Not Received Warrant (Read-Only) | Auditor of State | 42850.pdf |
| Affidavit for Military Exemption from Excise Tax (Read-Only) | Bureau of Motor Vehicles | 46402.pdf |
| Affidavit For Replacement of Food Stamp Benefits (Read-Only) | Family and Social Services Administration/DFR | 40988.pdf |
| Affidavit for Transfer of Certification of Title for a Vehicle/Watercraft Without Administration | Bureau of Motor Vehicles | 18733.pdf |
| Affidavit for Use by Financial Institutions for Warrant Replacement (Read-Only) | Auditor of State | 50712.pdf |
| Affidavit for Use by Financial Institutions for Warrant Replacement | Auditor of State | 50712.doc |
| Affidavit of Applicant for Disability Benefit | Teachers' Retirement Fund | 21703.pdf |
| Affidavit of Completion of Additional Hours of Instruction | Professional Licensing Agency | 51774.pdf |
| Affidavit of Completion of Administrator-in-Training Program | Professional Licensing Agency | 52640.pdf |
| Affidavit of Completion of One Hundred (100) Hours of Manicuring Instruction (Read-Only) | Professional Licensing Agency | 51770.pdf |
| Affidavit of Completion of One Hundred Fifty (150) Hours of Instructor Training (Read-Only) | Professional Licensing Agency | 51771.pdf |
| Affidavit of Current Insurance "SR-50" (Read-Only) | Bureau of Motor Vehicles | 48483.pdf |
| Affidavit of Date of Birth - Beneficiary | Public Employees Retirement Fund | |
| Affidavit of Date of Birth - Member | Public Employees Retirement Fund | 49290.pdf |
| Affidavit of Date of Birth - Survivor | Public Employees Retirement Fund | 52636.pdf |
| Affidavit of Destroyed or Removed Property (Form 135) | Dept. of Local Government Finance | 51536.pdf |
| Affidavit of Distributee for Death Benefit of Deceased Member (Read-Only) | Teacher's Retirement Fund | 17294.pdf |
| Affidavit of Experience - Dietician Intern Training Program | Professional Licensing Agency | 47587.pdf |
| Affidavit of Experience - Pharmacist Intern Training Program | Professional Licensing Agency | 26877.pdf |
| Affidavit of Gross Retail and Use Tax (Read-Only) | Bureau of Motor Vehicles | 41806.pdf |
| Affidavit of Ownership for Motor Vehicle | Bureau of Motor Vehicles | 23037.pdf |
| Affidavit of Ownership-Trailer (Read-Only) | Bureau of Motor Vehicles | 43753.pdf |
| Affidavit of Police Officer, Physical Inspection of an Indiana Resident's Watercraft (Read-Only) | Bureau of Motor Vehicles | 39530.pdf |
| Affidavit of Restoration for a Salvage Motor Vehicle (Read-Only) | Bureau of Motor Vehicles | 44606.pdf |
| Affidavit of Revocation Financial Responsibility (Read-Only) | Bureau of Motor Vehicles | 45425.pdf |
| Affidavit of Supervision - Student Hearing Aid Dealer Certificate | Professional Licensing Agency | 50791.pdf |
| Affidavit of Work Experience (Read-Only) | Professional Licensing Agency | 45993.pdf |
| Affidavit: Applicant Notification to Adjoining Property Owners/Occupants | Dept. of Environmental Management | 49785.pdf |
| Agent's Registration | DNR, Forestry Division | 50312.pdf |
| Agreement for Release of Vital Statistics Data Tapes Containing Confidential Information | Dept. of Health | 44384.pdf |
| Agreement of Financial Liability (Read-Only) | Bureau of Motor Vehicles | 39531.pdf |
| Agreement to Compensation of Employee and Employer | Worker's Compensation Board | 01043.pdf |
| Agreement to Compensation of Employee and Employer | Worker's Compensation Board | 01043.doc |
| Air Permit Application Cover Sheet | Dept. of Environmental Management | 50639.pdf |
| Air Permit Application Cover Sheet | Dept. of Environmental Management | 50639.doc |
| Air Permit Application - Forms Checklist | Dept. of Environmental Management | 51607.pdf |
| Air Permit Application - Forms Checklist | Dept. of Environmental Management | 51607.doc |
| Airport Development Zone Business Personal Property Tax Credit (Form ADZ-1) | Dept. of Local Government Finance | 46560.pdf |
| Airport Firefighter Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53523.pdf |
| Alzheimer's / Dementia Special Care Unit | Family and Social Service Admin. - Division of Disability and Rehabilitation | 48896.pdf |
| Amendment to Irrevocable Letter of Credit (LC-2) (Read-Only) | DNR - Div. of Reclamation | 50622.pdf |
| Annual Birthing Center Report | Dept. of Health | 52236.pdf |
| Annual IFSP Checklist | Family & Social Service Admin. / DFR | 51919.pdf |
| Annually Assessed Mobile Home Assessor's Book (Form 29 MH) | Dept. of Local Government Finance | 49865.doc |
| Annual Manifest Summary Report - OS (Read-Only) | Dept. of Environmental Management | 52717.pdf |
| Annual Manifest Summary Report - OS | Dept. of Environmental Management | 52717.doc |
| Annual Manifest Summary Report - WG (Read-Only) | Dept. of Environmental Management | 52718.pdf |
| Annual Manifest Summary Report - WG | Dept. of Environmental Management | 52718.doc |
| Annual Nonprofit Hospital Community Benefit Statement (Read-Only) | Dept. of Health | 50654.pdf |
| Annual Report - Concentrated Animal Feeding Operations (Read-Only) | Dept. of Environmental Management | 52510.pdf |
| Annual Report - Concentrated Animal Feeding Operations | Dept. of Environmental Management | 52510.doc |
| Annual Report of Comprehensive Long Term Care Facility (Read-Only) | Dept. of Health | 50834.pdf |
| Annual Report for Turtle Possession Permit (Read-Only) | Dept. of Natural Resources - Division of Fish & Wildlife | 54042.pdf |
| Annual Report of Departmental Data | Law Enforcement Academy | 46241.pdf |
| Annual Report of Funeral Trust Funds | Professional Licensing Agency | 45266.pdf |
| Annual Report on Training Status | Law Enforcement Academy | 46177.pdf |
| Annual Report Pursuant to IC 30-2-13 | Professional Licensing Agency | 45279.pdf |
| Annual Report - Railroad Property (UD Form 32) (Read-Only) | Dept. of Local Government Finance | 31289.pdf |
| Annual Report Regarding Foster Family Home | Dept. of Child Services - Child Welfare | 53213.pdf |
| Annual Report (UD Form 45) (Read-Only) | Dept. of Local Government Finance | 40408.pdf |
| Annual Tire Summary: Waste Tire Storage Site/Waste Tire Processing Operation | Dept. of Environmental Management | 52716.pdf |
| Annual Waste Tire Report: Waste Tire Transporter | Dept. of Environmental Management | 53898.pdf |
| Annual Watershed Land Treatment Project Application | Dept. of Natural Resources - Division of Fish & Wildlife | 50315.doc |
| Aplicacion Y Referido DDARS (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 47131.pdf |
| Applicant Background Record Checklist | State Personnel Department | 53390.pdf |
| Applicant Background Record Checklist | State Personnel Department | 53390.doc |
| Applicant Disclosure and Release for Consumer and Investigative Consumer Reports | State Personnel Department | 51334.pdf |
| Applicant Disclosure and Release for Consumer and Investigative Consumer Reports | State Personnel Department | 51334.doc |
| Applicant Job Search Referral (Read-Only) | FSSA - Division of Family Resources | 48190.pdf |
| Applicant Job Search Rights and Responsibilities (Read-Only) | FSSA - Division of Family Resources | 48191.pdf |
| Application & Approval for Admission (Read-Only) | Dept. of Health | 52397.pdf |
| Application and Claim for Funds to Defray Burial Costs - Medicaid Aged, Blind and Disabled Recipients | Family and Social Service Administration | 35937.pdf |
| Application & Notice of Service Cessation & Relinquishment of Provider of Last Resort Obligations within the State of Indiana | Utility Regulatory Commission | 52714.pdf |
| Application by an Indiana Bank Holding Company (Read-Only) | Dept. of Financial Institutions | 48001.pdf |
| Application Checklist for Asbestos Contractor | Dept. of Environmental Management | 52571.doc |
| Application Checksheet for Lead Contractor | Dept. of Health | 50745.pdf |
| Application for Absentee Ballot By Mail | Election Division | 47090.pdf |
| Application For Acceptance of Real Estate College Course Credits (Read-Only) | Professional Licensing Agency | 50669.pdf |
| Application For Accountancy Firm Permit | Professional Licensing Agency | 46609.pdf |
| Application For Activation Of An Inactive CPA/PA/AP License | Professional Licensing Agency | 48541.pdf |
| Application for a Certificate of Franchise Authority to Provide Video Service in the State of Indiana | Utility Regulatory Commission | 52712.pdf |
| Application for a Certificate of Territorial Authority for Communications Service Providers | Utility Regulatory Commission | 52648.pdf |
| Application for Address Confidentiality Program | Attorney General's Office | 53664.doc |
| Application for Adjustment of Claim For Provider Fee | Workers' Compensation Board | 18487.pdf |
| Application for Absentee Ballot By Mail | Election Division | 47090.pdf |
| Application for Activation of a Cosmetology Professional License | Professional Licensing Agency | 49638.pdf |
| Application for Activation of a Land Surveyor - Certificate of Registration (Read-Only) | Professional Licensing Agency | 51185.pdf |
| Application for Adjustment of Claim (Read-Only) | Worker's Compensation Board | 29109.pdf |
| Application For Admission of a Foreign Corporation | Dept. of Financial Institutions | 18572.pdf |
| Application for Affidavit to Transfer to Real Estate | Bureau of Motor Vehicles | 51408.pdf |
| Application For Agent's Permit | Commission on Proprietary Education | 39286.pdf |
| Application For Agent's Renewal Permit | Commission on Proprietary Education | 41429.pdf |
| Application for a License to Operate a Private Secure Facility | Dept. of Child Services - Child Welfare | 45159.pdf |
| Application for a License to Practice Dentistry or Dental Hygiene | Professional Licensing Agency | 42127.pdf |
| Application for a License to Practice Medicine/Osteopathic Medicine in Indiana | Professional Licensing Agency | 29495.pdf |
| Application for a License to Practice Veterinary Medicine (Read-Only) | Professional Licensing Agency | 44614.pdf |
| Application for a Limited License to Participate in a Postgraduate Training Program for Podiatric Medicine | Professional Licensing Agency | 50318.pdf |
| Application for a Limited Temporary Permit to Practice Chiropractic | Professional Licensing Agency | 51116.pdf |
| Application for Amended Certificate of Authority (Foreign Corporation) | Secretary of State - Business Services Division | 39034.pdf |
| Application for Amended Certificate of Authority (Foreign Limited Liability Company) (Read-Only) | Secretary of State - Business Services Division | 49462.pdf |
| Application for Amusement Entertainment Permit | Dept. of Homeland Security | 42235.pdf |
| Application for an Historical Marker | Historical Bureau | 45937.pdf |
| Application for an Importation Permit (Read-Only) | DNR - Fish and Wildlife | |
| Application for an Incidental Boundary Revision to a Previously Approved Permit (Read-Only) | DNR - Div. of Reclamation | 50617.pdf |
| Application for Annual Permit to Operate Amusement Device | Dept. of Homeland Security | 00323.pdf |
| Application for a Non-Renewable Limited Scope Temporary Medical License | Professional Licensing Agency | 26138.pdf |
| Application for a permit (R-100) (Read-Only) | DNR - Div. of Reclamation | 02192.pdf |
| Application for Apiary Registration (Read-Only) | DNR - Div. of Entomology and Plant Pathology | 47075.pdf |
| Application for Approval of an Individual or Organization to Provide Continuing Education Courses for Dentists and Dental Hygienists (Read-Only) | Professional Licensing Agency | 50327.pdf |
| Application for Approval of a Study Club to Provide Continuing Education Courses (Read-Only) | Professional Licensing Agency | 50326.pdf |
| Application For Approval of Auctioneer Prelicensing Course Provider Or Continuing Education Course Sponsor | Professional Licensing Agency | 47919.pdf |
| Application For Approval Of Continuing Education Courses for Psychologists | Professional Licensing Agency | 50257.pdf |
| Application For Approval Of Continuing Education Programs For Chiropractors (Read-Only) | Professional Licensing Agency | 50713.pdf |
| Application for Approval of Continuing Education Programs for Optometrist (Read-Only) | Professional Licensing Agency | 50714.pdf |
| Application For Approval Of Continuing Education Programs For Podiatric Medicine (Read-Only) | Professional Licensing Agency | 50690.pdf |
| Application For Approval Of Continuing Education Programs For Respiratory Care Practitioners (Read-Only) | Professional Licensing Agency | 50323.pdf |
| Application for Approval of Continuing Education Programs for Veterinarians and Veterinary Technicians (Read-Only) | Professional Licensing Agency | 51115.pdf |
| Application For Approval of Cosmetology Educator For Continuing Education (Read-Only) | Professional Licensing Agency | 47837.pdf |
| Application for Approval of Land Surveyor Continuing Education Provider | Professional Licensing Agency | 49990.pdf |
| Application for Approval of Loan Broker Academic Instruction Course | Secretary of State - Securities Division | 53272.pdf |
| Application for Approval of Plumbing Apprentice School | Professional Licensing Agency | 49995.pdf |
| Application For Approval of Professional Supervision For Continuing Education Credit for Psychologists | Professional Licensing Agency | 50256.pdf |
| Application For Approval of Real Estate Appraiser Continuing Education Course Provider (Read-Only) | Professional Licensing Agency | 45665.pdf |
| Application for Approval of Real Estate Appraiser School or Course (Read-Only) | Professional Licensing Agency | 45666.pdf |
| Application for Approval of Real Estate Continuing Education Course Sponsor | Professional Licensing Agency | 46182.pdf |
| Application for Approval of Real Estate Salesperson/Broker's Course | Professional Licensing Agency | 36071.pdf |
| Application For Approval of Real Estate School Site (Read-Only) | Professional Licensing Agency | 42252.pdf |
| Application For Approval of the Qualified Medication Aide Course (Read-Only) | Dept. of Health | 51118.pdf |
| Application for Approval of Training for Continuing Education - Drinking Water (Read-Only) | Dept. of Environmental Management | 45675.pdf |
| Application for Approval of Training for Wastewater Operator/Apprentice Continuing Education Credit | Dept. of Environmental Management | 51138.pdf |
| Application for Approval to Conduct Coal Exploration Activities (Read-Only) | DNR - Div. of Reclamation | 50616.pdf |
| Application for Approval to Provide Category I Continuing Education for LSW / LCSW / LMFT / LMHC | Professional Licensing Agency | 50841.pdf |
| Application for Approval to Provide Category I Continuing Education for Psychologists | Professional Licensing Agency | 50328.pdf |
| Application for Approval to Use Water Treatment Additives | Dept. of Environmental Management | 50000.pdf |
| Application for Approval to Utilize Electronic Daily Dispensing System | Professional Licensing Agency | 51060.pdf |
| Application for Architect Corporation License | Professional Licensing Agency | 44867.pdf |
| Application for Architect Examination (Read-Only) | Professional Licensing Agency | 45691.pdf |
| Application for Architect Registration (Read-Only) | Professional Licensing Agency | 01576.pdf |
| Application for Asbestos Contractor License | Dept. of Environmental Management | 52575.doc |
| Application for Asbestos Training Course - Provider Approval | Dept. of Environmental Management | 48741.doc |
| Application for a Shooting Preserve License | DNR - Fish and Wildlife | 21937.pdf |
| Application for Assigned Hull Identification Number (Read-Only) | Bureau of Motor Vehicles | 43725.pdf |
| Application for Assistance - Part 3 - Client Certification and Assignment (Read-Only) | FSSA - Division of Family Resources | 47991.pdf |
| Application for a Student Hearing Aid Dealer Certificate | Professional Licensing Agency | 50686.pdf |
| Application for a Temporary Medical Permit (For Postgraduate Training or Teaching) | Professional Licensing Agency | 17598.pdf |
| Application for Athletic Trainers License | Professional Licensing Agency | 46715.pdf |
| Application for Auctioneer License Activation | Professional Licensing Agency | 48911.pdf |
| Application for Auction House/Company License | Professional Licensing Agency | 18476.pdf |
| Application for Authorization to Discharge Dredged or Fill Material to Isolated Wetlands and/or Waters of the State | Dept. of Environmental Management | 51821.pdf |
| Application for a Wastewater Management Business Permit & Vehicle License (Read-Only) | Dept. of Environmental Management | 50399.doc |
| Application for a Wastewater Management Land Application Site Permit (Read-Only) | Dept. of Environmental Management | 50403.doc |
| Application for a Wastewater Management Storage / Treatment Facility Permit (Read-Only) | Dept. of Environmental Management | 50402.doc |
| Application for Bait Dealers License | Dept. of Natural Resources - Division of Fish & Wildlife (Read-Only) | 03071.pdf |
| Application For Barber Instructor License by Recipocity | Professional Licensing Agency | 51773.pdf |
| Application For Barber Professional Temporary Permit | Professional Licensing Agency | 51772.pdf |
| Application for Barber School License | Professional Licensing Agency | 44671.pdf |
| Application for Barber Shop License | Professional Licensing Agency | 26770.pdf |
| Application for Benefits from Violent Crimes Compensation Fund | Criminal Justice Institute | 23776.pdf |
| Application For Biodiesel Credit Certification (Read-Only) | Economic Development Corporation | 52301.pdf |
| Application for Blind or Disabled Person's Deduction from Assessed Valuation | Dept. of Local Government Finance | 43710.pdf |
| Application for Blue River Permit (Read-Only) | DNR, Outdoor Recreation | 37733.pdf |
| Application for Blue River Permit | Dept. of Natural Resources - Division of Outdoor Recreation | 37733.doc |
| Application for Boxer License or Renewal of License | Professional Licensing Agency | 45727.pdf |
| Application for Bulk, Milk Hauler / Sampler Permit | Board of Animal Health | 01242.pdf |
| Application for Burial, Indiana Veterans Memorial Cemetary (Read-Only) | Dept. of Veteran's Affairs | 48554.pdf |
| Application for Cemetery Registration | Professional Licensing Agency | 47332.pdf |
| Application for Certificate of Authority | Professional Licensing Agency | 48961.pdf |
| Application for Certificate of Authority of a Foreign Corporation | Secretary of State - Business Services Division | 38784.pdf |
| Application for Certificate of Authority of a Foreign Limited Liability Company | Secretary of State - Business Services Division | 49464.pdf |
| Application for Certificate of Authority of a Foreign NonProfit Organization (Read-Only) | Secretary of State - Business Services Division | 37035.pdf |
| Application for Certificate of Title (Read-Only) | Bureau of Motor Vehicles | 44049.pdf |
| Application for Certificate of Withdrawal of a Foreign Corporation (Read-Only) | Secretary of State - Business Services Division | 39077.pdf |
| Application for Certificate of Withdrawal of a Foreign Limited Liability Corporation | Secretary of State - Business Services Division | 49461.pdf |
| Application for Certification (Read-Only) | Dept. of Administration-Minority Business | 46250.pdf |
| Application for Certification as a Massage Therapist | Professional Licensing Agency | 53748.pdf |
| Application for Certification as a Massage Therapist by Grandfathering | Professional Licensing Agency | 53749.pdf |
| Application for Certification as an Acupuncture Detox Specialist | Professional Licensing Agency | 50711.pdf |
| Application for Certification as an Occupational Therapist or Occupational Therapy Assistant | Professional Licensing Agency | 43826.pdf |
| Application for Certification as a Pharmacy Technician (CPT) | Professional Licensing Agency | 51635.pdf |
| Application for Certification as a Physician Assistant | Professional Licensing Agency | 09237.pdf |
| Application for Certification as a Respiratory Care Practitioner | Professional Licensing Agency | 43825.pdf |
| Application for Certification as a Volunteer Outdoor Education Instructor | Dept. of Natural Resources - Division of Fish & Wildlife | 38445.pdf |
| Application for Certification of Engineering Intern (Read-Only) | Professional Licensing Agency | 09101.pdf |
| Application for Certification of Land Surveyor-in-Training | Professional Licensing Agency | 49328.pdf |
| Application For Certification or Licensure | Family and Social Service Admin. - DMHA | 48161.pdf |
| Application for Certification to Practice Hypnotism | Professional Licensing Agency | 48168.pdf |
| Application for Change of Beneficiary – Active Member (Annuity Savings Account or Rollover Account) | Public Employees Retirement Fund | 01856.pdf |
| Application for Change of Beneficiary – Active Member (Employee Contribution Account) – State Excise Police, Gaming Agent, Gaming Control Officer & Conservation Enforcement Officers’ Retirement Plan | Public Employees Retirement Fund | 53962.pdf |
| Application for Change or Addition of Supervising Physician for Physician Assistants | Professional Licensing Agency | 42907.pdf |
| Application for Charter Boat Operator's License (Read-Only) | DNR - Fish and Wildlife | 25298.pdf |
| Application for Child Abuse Research (Read-Only) | Dept. of Child Services - Child Welfare | 00116.pdf |
| Application for Chiropractic Graduate Students | Professional Licensing Agency | 53462.pdf |
| Application for Chiropractic License | Professional Licensing Agency | 05174.pdf |
| Application for Cigarette Importer or Manufacturer's License | Alcohol and Tobacco Commission | 52632.pdf |
| Application For Collection Agency License | Secretary of State - Securities Division | 40495.pdf |
| Application for Commercial Fishing License on Ohio River (Read-Only) | DNR - Fish and Wildlife | 23742.pdf |
| Application for Construction Permit (Read-Only) | Dept. of Health | 50098.pdf |
| Application for Construction Permit for an Acute Care Facility (Read-Only) | Dept. of Health | 50097.pdf |
| Application for Construction Permit For Child Care Facility (Read-Only) | Dept. of Health | 49454.pdf |
| Application for Construction Permit For Long-Term Care Facilities (Read-Only) | Dept. of Health | 49453.pdf |
| Application for Construction Permit for Private Mental Health Institutions (Read-Only) | Dept. of Health | 52047.pdf |
| Application for Construction Permit For Public Water System | Dept. of Environmental Management | 35058.pdf |
| Application for Construction Permit For School Facilities (Read-Only) | Dept. of Health | 50231.pdf |
| Application for Corporate Plumbing Contractor License | Professional Licensing Agency | 11812.pdf |
| Application for Cosmetology Continuing Education Instructor | Professional Licensing Agency | 49529.pdf |
| Application For Cosmetology Instructor By Reciprocity | Professional Licensing Agency | 46041.pdf |
| Application for Cosmetology License by Reciprocity | Professional Licensing Agency | 43493.pdf |
| Application for Cosmetology Professional Temporary Permit (Read-Only) | Professional Licensing Agency | 51120.pdf |
| Application for Cosmetology Salon License | Professional Licensing Agency | 38924.pdf |
| Application For Cosmetology School License | Professional Licensing Agency | 45654.pdf |
| Application for Dealer Business License | Secretary of State - Dealer Division | 13215.pdf |
| Application for Dealer Plates & Additional Dealer Plates | Secretary of State - Dealer Division | 12798.pdf |
| Application for Dealer Plates (Read-Only) | Bureau of Motor Vehicles | 23350.pdf |
| Application for Dealer Vehicle Identification Inspection | Secretary of State - Dealer Division | 45702.pdf |
| Application for Deduction from Assessed Valuation - Maritime Opportunity District (Form MOD-1) | Dept. of Local Government Finance | 42963.pdf |
| Application for Deduction from Assessed Valuation of Rehabilitated Property (Form 322A) | Dept. of Local Government Finance | 49567.pdf |
| Application for Deduction from Assessed Valuation of Structures in Economic Revitalization Areas (ERA) (Form 322 / RE) This form is subject to change by the legislature. | Dept. of Local Government Finance | 18379.pdf |
| Application for Deduction from Assessed Valuation Personal Property Investment Deduction (Form PPID-1) | Dept. of Local Government Finance | 52502.pdf |
| Application for Deduction from Assessed Valuation / Real Property Investment Deduction (Form RPID-1) | Dept. of Local Government Finance | 52504.pdf |
| Application for Deduction from Assessed Valuation - Real Property Vacant Building Deduction (Form 322 / VBD) | Dept. of Local Government Finance | 53179.pdf |
| Application For Delayed High School Diploma (Read-Only) | Dept. of Veterans' Affairs | 50900.pdf |
| Application For Direct Deposit | Teachers' Retirement Fund | 47144.pdf |
| Application for Disability Benefits - 1977 Police Officers’ & Firefighters’ Pension & Disability Fund | Public Employees' Retirement Fund | 10564.pdf |
| Application for Disability Parking Placard or Disability Plate (Read-Only) | Bureau of Motor Vehicles | 42070.pdf |
| Application for Disposal Plant License (Read-Only) | Board of Animal Health | 48563.pdf |
| Application for Distribution of Contributions | Public Employees' Retirement Fund | 00940.pdf |
| Application For Dog Training Ground Permit (Read-Only) | DNR - Fish and Wildlife | 45231.pdf |
| Application for Duplicate Asbestos License | Dept. of Environmental Management | 48740.doc |
| Application for Duplicate Lead License | Dept. of Health | 50746.pdf |
| Application for Duplicate License (Read-Only) | DNR, Fish and Wildlife | 42480.pdf |
| Application for Duplicate of Indiana Teaching Administration or School Services License Only | Dept. of Education | 46701.pdf |
| Application for Duplicate or Replacement License Plate (Read-Only) | Bureau of Motor Vehicles | 37135.pdf |
| Application For Electrology Salon (Read-Only) | Professional Licensing Agency | 45241.pdf |
| Application for Elevator Contractor License - Individual | Dept. of Homeland Security | 52334.pdf |
| Application for Elevator Mechanic License | Dept. of Homeland Security | 52472.pdf |
| Application for Emergency Medical Technician | Dept. of Homeland Security | 00555.pdf |
| Application for Emergency Permit | Dept. of Education | 46698.pdf |
| Application for Employee Permit (Read-Only) | Alcohol and Tobacco Commission | 00043.pdf |
| Application for Employment (Bureau of Motor Vehicles Commission) (Read-Only) | Bureau of Motor Vehicles | 46230.pdf |
| Application for Endorsement as a Health Service Provider in Psychology (HSPP) | Professional Licensing Agency | 20231.pdf |
| Application For Esthetic Salon License (Read-Only) | Professional Licensing Agency | 45242.pdf |
| Application For Ethanol Credit Certification (Read-Only) | Economic Development Corporation | 52302.pdf |
| Application for Examination for Auctioneer Licence, License By Reciprocity, or Temporary Permit | Professional Licensing Agency | 18479.pdf |
| Application for Examination for Barber Instructor Registration | Professional Licensing Agency | 45303.pdf |
| Application for Examination for Cosmetologist, Manicurist, Esthetician, or Electrology License | Professional Licensing Agency | 15969.pdf |
| Application for Examination for Beauty Culture Instructor License | Professional Licensing Agency | 45245.pdf |
| Application for Examination for Esthetician or Electrologist (Read-Only) | Professional Licensing Agency | 45244.pdf |
| Application for Expanding Markets for Indiana Livestock Producers (Section 2) (Read-Only) | Office of the Commissioner of Agriculture | 50425.pdf |
| Application for Extension of Time to File Indiana EZB-R | Economic Development Corporation | 50468.pdf |
| Application for Falconry License (Read-Only) | DNR, Fish and Wildlife | 27021.pdf |
| Application for Federal Excess Personal Property | DNR, Forestry Division | 50311.pdf |
| Application for Federal Professional Qualifications Documentation for Archaeology (Read-Only) | DNR--Division of Historic Preservation and Archaeology | 52779.pdf |
| Application for Federal Professional Qualifications Documentation for Architectural History (Read-Only) | DNR--Division of Historic Preservation and Archaeology | 52781.pdf |
| Application for Federal Professional Qualifications Documentation for Architecture (Read-Only) | DNR--Division of Historic Preservation and Archaeology | 52780.pdf |
| Application for Federal Professional Qualifications Documentation for Historic Architecture (Read-Only) | DNR--Division of Historic Preservation and Archaeology | 53138.pdf |
| Application for Federal Professional Qualifications Documentation for History (Read-Only) | DNR--Division of Historic Preservation and Archaeology | 52782.pdf |
| Application for Field Trial / Hunt Permit (Read-Only) | DNR, Fish and Wildlife | 27022.pdf |
| Application for Firefighter Certification (Read-Only) | Dept. of Homeland Security | 46662.doc |
| Application for Fireworks Stand Retail Sales Permit (Read-Only) | Dept. of Homeland Security | 11622.pdf |
| Application for Fish Hauler’s & Supplier’s Permit (Read-Only) | Dept. of Natural Resources - Division of Fish & Wildlife | 31360.pdf |
| Application for Fishing Tournament on Public Waters (Read-Only) | DNR - Division of Law Enforcement | 52398.pdf |
| Application for Fish Stocking Permit (Read-Only) | DNR, Fish and Wildlife | 47056.pdf |
| Application for Foster Family Home License (Read-Only) | Dept. of Child Services - Child Welfare | 10100.pdf |
| Application For Funeral Director Examination | Professional Licensing Agency | 45267.pdf |
| Application For Funeral Director Intern License | Professional Licensing Agency | 28138.pdf |
| Application for Funeral Director License by Reciprocity | Professional Licensing Agency | 45265.pdf |
| Application For Funeral Home Branch License | Professional Licensing Agency | 48444.pdf |
| Application for Funeral Home License | Professional Licensing Agency | 45268.pdf |
| Application For Funeral Home Restoration (Read-Only) | Professional Licensing Agency | 45269.pdf |
| Application for Fur Buyer's License (Read-Only) | DNR - Fish and Wildlife | 03070.pdf |
| Application for Game Breeder's License (Read-Only) | DNR, Fish and Wildlife | 03069.pdf |
| Application for Guaranteed Auto Protection (GAP) Program | Dept. of Financial Institutions | 51819.pdf |
| Application for Grave Memorial Removal (IC 14-21-2) - (Read-Only) | DNR, Division of Historic Preservation and Archaeology | 52492.xls |
| Application for Grave Memorial Removal (IC 14-21-2) (Read-Only) | DNR--Division of Historic Preservation and Archaeology | 52492.pdf |
| Application for Historic Rehabilitation Tax Credit Certification (Read-Only) | DNR--Division of Historic Preservation and Archaeology | 51300.pdf |
| Application for Hoosier Healthwise for Children and Pregnant Women (Read-Only) | FSSA - Division of Family Resources | 43202.pdf |
| Application for Indiana Aquaculture Permit (Read-Only) | DNR - Fish and Wildlife | 47058.pdf |
| Application for Indiana Controlled Substances Registration (CSR) for Practitioners | Professional Licensing Agency | 34617.pdf |
| Application for Indiana Controlled Substances Registration for Non-Practitioners | Professional Licensing Agency | 52616.pdf |
| Application for Indiana Dietitian Certification | Professional Licensing Agency | 47586.pdf |
| Application for Indiana Intern Training and Experience Record | Professional Licensing Agency | 44738.pdf |
| Application for Indiana Substitute Teaching Permit | Dept. of Education | 46700.pdf |
| Application for Indiana Teaching, Administration, or School Services License | Dept. of Education | 09331.pdf |
| Application for Individual Asbestos License | Dept. of Environmental Management | 43786.doc |
| Application for Individual Lead License | Dept. of Health | 49240.pdf |
| Application for Individual Lead License | Dept. of Health | 49240.doc |
| Application for Industrial Wastewater Pretreatment (IWP) Permit | Dept. of Environmental Management | 50271.pdf |
| Application for Industrial Wastewater Treatment Construction Permit per 327 IAC 3 | Dept. of Environmental Management | 53161.doc |
| Application for Inspection of Moisture Testing Equipment | Dept. of Agriculture | 00516.pdf |
| Application for Installation or Alteration Permit | Dept. of Homeland Security | 38299.pdf |
| Application For Instructor Approval (Read-Only) | Professional Licensing Agency | 43492.pdf |
| Application for Insulin and Township Claim (Read-Only) | Dept. of Health | 00687.pdf |
| Application for Interim Plates | Secretary of State - Dealer Division | 22465.pdf |
| Application for Irrevocable Voluntary Withdrawal to Purchase Service Credit from Another Governmental Retirement Plan | Public Employees' Retirement Fund | 53972.pdf |
| Application for Journeyman Plumber or Plumbing Contractor Examination for Licensing | Professional Licensing Agency | 40602.pdf |
| Application for Landscape Architect Examination (Read-Only) | Professional Licensing Agency | 50153.pdf |
| Application for Landscape Architect Registration (Read-Only) | Professional Licensing Agency | 43741.pdf |
| Application for Lead-Based Training Course - Provider Approval | Dept. of Health | 50747.pdf |
| Application for Lead-Based Training Course - Provider Approval | Dept. of Health | 50747.doc |
| Application for Lead Contractor License | Dept. of Health | 48739.pdf |
| Application for Lead Contractor License | Dept. of Health | 48739.doc |
| Application for Library Education Unit (LEU) Trainer Provider (Read-Only) | Indiana State Library | 53621.pdf |
| Application for Library Education Unit (LEU) Trainer Provider | Indiana State Library | 53621.xls |
| Application for License Activation (Read-Only) | Professional Licensing Agency | 47330.pdf |
| Application for License Approval to Operate a Hospice Program (pursuant to IC 16-25-3) (Read-Only) | Dept. of Health | 43813.pdf |
| Application for License or Renewal of License for Trainer, Manager, Matchmaker, or Second | Professional Licensing Agency | 45729.pdf |
| Application for License or Renewal of License: Referee, Judge, Timekeeper | Professional Licensing Agency | 45728.pdf |
| Application for License to Operate a Birthing Center | Dept. of Health | 52235.pdf |
| Application for License to Operate a Blood Center | Dept. of Health | 49621.pdf |
| Application for License to Operate a Health Facility | Dept. of Health | 08200.pdf |
| Application for License to Operate a Health Facility | Dept. of Health | 08200.doc |
| Application for License to Operate a Home Health Agency (pursuant to IC 16-27 and 410 IAC 17) (Read-Only) | Dept. of Health | 04008.doc |
| Application for License to Operate a Hospital Pursuant to IC 16-21-2 | Dept. of Health | 44885.pdf |
| Application for License to Operate an Abortion Clinic | Dept. of Health | 52233.pdf |
| Application for License to Operate an Ambulatory Outpatient Surgical Center | Dept. of Health | 09340.pdf |
| Application for License to Operate a Personal Services Agency | Dept. of Health | 53391.pdf |
| Application for License to Practice Speech-Language Pathology or Audiology | Professional Licensing Agency | 37911.pdf |
| Application for License to Probe for Grave Memorial Restoration Projects in a Cemetery | DNR--Division of Historic Preservation and Archaeology | 53862.pdf |
| Application for Licensure as a Barber | Professional Licensing Agency | 01877.pdf |
| Application for Licensure as a Clinical Social Worker (LCSW) | Professional Licensing Agency | 50325.pdf |
| Application for Licensure as a Health Facility Administrator | Professional Licensing Agency | 42075.pdf |
| Application for Licensure as a Home Inspector | Professional Licensing Agency | 53175.pdf |
| Application for Licensure as a Home Medical Equipment Service Provider | Professional Licensing Agency | 52525.pdf |
| Application for Licensure as a Marriage & Family Therapist Associate (LMFTA) | Professional Licensing Agency | 53737.pdf |
| Application for Licensure as a Manufactured Home Installer | Professional Licensing Agency | 53858.pdf |
| Application for Licensure as a Marriage and Family Therapist (LMFT) | Professional Licensing Agency | 50710.pdf |
| Application for Licensure as a Mental Health Counselor (LMHC) | Professional Licensing Agency | 50319.pdf |
| Application For Licensure As An Acupuncturist/Professional Acupuncturist | Professional Licensing Agency | 50694.pdf |
| Application for Licensure as a Physical Therapist or Physical Therapist's Assistant | Professional Licensing Agency | 09111.pdf |
| Application for Licensure as a Private Investigator Firm | Professional Licensing Agency | 53325.pdf |
| Application for Licensure as a Real Estate Salesperson or Broker | Professional Licensing Agency | 44176.pdf |
| Application for Licensure as a Residential Care Administrator | Professional Licensing Agency | 53787.pdf |
| Application for Licensure as a Security Guard Agency | Professional Licensing Agency | 53326.pdf |
| Application for Licensure as a Social Worker (LSW) | Professional Licensing Agency | 50324.pdf |
| Application for Licensure as a Wholesale Drug Distributor | Professional Licensing Agency | 47228.pdf |
| Application for Licensure by Endorsement as a Nurse | Professional Licensing Agency | 50027.pdf |
| Application for Licensure by Examination for Graduates of Foreign Nursing Schools (Read-Only) | Professional Licensing Agency | 50023.pdf |
| Application for Licensure by Examination for Graduates of U.S. Nursing Schools | Professional Licensing Agency | 50024.pdf |
| Application for Licensure to Practice Psychology in Indiana | Professional Licensing Agency | 27522.pdf |
| Application for Limited License to Practice Nurse-Midwifery | Professional Licensing Agency | 50026.pdf |
| Application for Listing as a Qualified Inspector for Drug Lab Cleanup (Read-Only) | Dept. of Environmental Management | 53316.pdf |
| Application for Listing as a Qualified Inspector for Drug Lab Cleanup | Dept. of Environmental Management | 53316.doc |
| Application for Livestock Brand Registration | Board of Animal Health | 00550.pdf |
| Application for Livestock Dealer License | Board of Animal Health | 18496.pdf |
| Application for Livestock Industry Promotion (Section 1) (Read-Only) | Office of the Commissioner of Agriculture | 50424.pdf |
| Application for Loan License | Dept. of Financial Institutions | 18542.pdf |
| Application for Long-Term Care Services (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 45943.pdf |
| Application For Long Term Care Services - Mental Health Hospitalised Waiver (Read-Only) | Family and Social Service Admin. - DMHA | 51550.pdf |
| Application for Manufactured Home Installer Licensing / Continuing Education Course Provider | Professional Licensing Agency | 53617.pdf |
| Application for Marriage License(Read-Only) | Dept. of Health | 53394.doc |
| Application for Media Production Expenditure Tax Credit | Economic Development Corporation | 53651.pdf |
| Application for Membership in the 1977 Police Officers' & Firefighters' Pension & Disability Fund | Public Employees' Retirement Fund | 04928.pdf |
| Application for Military Family Relief Fund (MFRF) | Dept. of Veteran's Affairs | 53880.pdf |
| Application for Model Residence Deduction | Dept. of Local Government Finance | 53812.pdf |
| Application for Model Residence Deduction for 2008 Assessment Date | Dept. of Local Government Finance | 53947.pdf |
| Application for New Commercial Driver Training Instructor (Read-Only) | Bureau of Motor Vehicles | 50515.pdf |
| Application For New or Transfer Permit (Read-Only) | Alcohol and Tobacco Commission | 51189.pdf |
| Application for New Pawnbroking Location | Dept. of Financial Institutions | 50290.pdf |
| Application for Non-Renewable Limited Scope Temporary Psychology Permit | Professional Licensing Agency | 53738.pdf |
| Application for Nursery Dealer's License (Read-Only) | DNR - Division of Entomolgy and Plant Pathology | 42898.pdf |
| Application for Optometric Legend Drug Certificate | Professional Licensing Agency | 45276.pdf |
| Application for Optometry License | Professional Licensing Agency | 00007.pdf |
| Application for or Renewal of Registration as an Apprentice Plumber (Read-Only) | Professional Licensing Agency | 02557.pdf |
| Application for Participation in the Deferred Retirement Option Plan (DROP) – 1977 Police Officers’ & Firefighters’ Pension & Disability Fund | Public Employees' Retirement Fund | 51145.pdf |
| Application for Participation in the Deferred Retirement Option Plan (DROP) – State Excise Police, Gaming Agent, Gaming Control Officer & | Public Employees' Retirement Fund | 53688.pdf |
| Application for Pawnbroking License | Dept. of Financial Institutions | 50292.pdf |
| Application for Permit for Fishing Tournaments on Designated Public Waters | DNR, Fish and Wildlife | 41644.pdf |
| Application For Permit For Nonresident Broker To Act As An Indiana Principal Broker (Read-Only) | Professional Licensing Agency | 43363.pdf |
| Application For Permit - Supervised Public Display of Fireworks | Dept. of Homeland Security | 01617.pdf |
| Application for Permit to Administer Anesthesia and Sedation (Read-Only) | Professional Licensing Agency | 46159.pdf |
| Application for Permit to Discharge Storm Water Discharges Associated with Industrial Activity (NPDES Application 2F | Dept. of Environmental Management | 53895.pdf |
| Application for Permit to Disinter, Remove, and Reinter Human Remains | Dept. of Health | 38697.doc |
| Application for Permit to Handle Milk or Milk Products | Board of Animal Health | 36560.pdf |
| Application For Permit To Hold Particular Boxing or Sparring Match or Exhibition (Read-Only) | Professional Licensing Agency | 13255.pdf |
| Application For Permit To Move Or Release Plant Pests And Pathogens, Weeds, & Beneficial Organisms (Read-Only) | DNR - Division of Entomolgy and Plant Pathology | 51859.pdf |
| Application for Permit to Operate Maintain, Open or Establish a Pharmacy in the State of Indiana | Professional Licensing Agency | 30410.pdf |
| Application for Pharmacist Intern Registration | Professional Licensing Agency | 12567.pdf |
| Application for Pharmacist's License | Professional Licensing Agency | 36028.pdf |
| Application for Physician License or Renewal of License for Boxing Matches | Professional Licensing Agency | 45723.pdf |
| Application For Plan Review (Read-Only) | State Dept. of Health | 50033.pdf |
| Application for Plumbing Contractor Examination for Licensing (Read-Only) | Professional Licensing Agency | 22806.pdf |
| Application for Podiatry License | Professional Licensing Agency | 27521.pdf |
| Application for Position Change or Replacement Badge (Read-Only) | Gaming Commission | 53543.pdf |
| Application for Preceptor | Professional Licensing Agency | 49845.pdf |
| Application for Prescriptive Authority as an Advanced Practice Nurse | Professional Licensing Agency | 50025.pdf |
| Application for Prescriptive Authority for a Physician Assistant | Professional Licensing Agency | 53314.pdf |
| Application For Promoter's License To Hold Boxing or Sparring Matches or Exhibitions | Professional Licensing Agency | 45726.pdf |
| Application for Property Tax Exemption | Dept. of Local Government Finance | 09284.pdf |
| Application for Provisional License | Professional Licensing Agency | 52569.pdf |
| Application for Provisional Wastewater Treatment Plant Operator Certification (Read-Only) | Dept. of Environmental Management | 51494.pdf |
| Application for Public Library Certificate(Read-Only) | Indiana State Library | 26859.pdf |
| Application for Public Library Certificate | Indiana State Library | 26859.xls |
| Application for Radiology License or Permit | State Dept. of Health | 27068.pdf |
| Application for Radon Tester/Mitigator Certification (Read-Only) | Dept. of Health | 45703.pdf |
| Application for Reactivation of Appraiser License | Professional Licensing Agency | 46467.pdf |
| Application For Real Estate Appraiser Certification | Professional Licensing Agency | 45016.pdf |
| Application for Real Estate Appraiser Continuing Education Course | Professional Licensing Agency | 53496.pdf |
| Application for Real Estate Appraiser Permit for Temporary Practice (Read-Only) | Professional Licensing Agency | 45664.pdf |
| Application for Real Estate Continuing Education Instructor | Professional Licensing Agency | 49490.pdf |
| Application for Real Estate License as a Corporation | Professional Licensing Agency | 00932.pdf |
| Application For Real Estate License As A Limited Liability Company (Read-Only) | Professional Licensing Agency | 46591.pdf |
| Application for Real Estate License as Partnership or D/B/A | Professional Licensing Agency | 00934.pdf |
| Application for Real Estate Trainee Appraiser Examination/Licensure (Read-Only) | Professional Licensing Agency | 46355.pdf |
| Application for Reassignment of Real Estate License | Professional Licensing Agency | 47478.pdf |
| Application for Recertification Based on Previous Certification | Dept. of Homeland Security | 53522.pdf |
| Application For Recognition As A Sponsor of Continuing Education | Professional Licensing Agency | 18558.pdf |
| Application for Recreational Events on Public Waters (Read-Only) | DNR - Division of Law Enforcement | 15832.pdf |
| Application for Recreational Structure on Public Waters (Read-Only) | DNR - Division of Law Enforcement | 15831.pdf |
| Application for Reduced Fee Hunting and Fishing License for Disabled Veterans (Read-Only) | DNR -- Dept. of Fish and Wildlife | 50833.pdf |
| Application for Registered Unlicensed Child Care Ministries | Dept. of Homeland Security | 53844.pdf |
| Application for Registration as an Environmental Health Specialist | Professional Licensing Agency | 46158.pdf |
| Application for Registration as a Non-Resident Pharmacy in the State of Indiana | Professional Licensing Agency | 50248.pdf |
| Application for Registration as a Speech-Language Pathology Aide | Professional Licensing Agency | 50322.pdf |
| Application for Registration as a Veterinary Technician | Professional Licensing Agency | 49703.pdf |
| Application for Registration as Speech-Language Pathology Support Personnel | Professional Licensing Agency | 53764.pdf |
| Application for Registration for Real Estate Professional Corporation (Read-Only) | Professional Licensing Agency | 47914.pdf |
| Application for Registration for Speech-Language Pathology and Audiology Clinical Fellowship Year | Professional Licensing Agency | 50320.pdf |
| Application For Registration For Accounting Professional Corporation | Professional Licensing Agency | 10555.pdf |
| Application For Registration For Professional Corporation (Read-Only) | Professional Licensing Agency | 50792.pdf |
| Application for Registration of a Mobile Dental Facility (Read-Only) | Professional Licensing Agency | 50923.pdf |
| Application for Registration of Indiana Owned Quarter Horse - 2004 (Read-Only) | Horse Racing Commission | 49941.pdf |
| Application for Registration of Off-Road Vehicle or Snowmobile (Read-Only) | DNR, Outdoor Recreation | 00390.pdf |
| Application for Registration of Trademark/Service Mark (Read-Only) | Secretary of State - Trademarks | 04430.pdf |
| Application for Registration to Operate an Out of State Mobile Health Care Entity | Dept. of Health | 53398.pdf |
| Application for Registration to Practice as a Land Surveyor (Read-Only) | Professional Licensing Agency | 09436.pdf |
| Application for Registration to Practice Engineering (Read-Only) | Professional Licensing Agency | 46454.pdf |
| Application for Registration Under the Professional Corporation Act | Professional Licensing Agency | 50160.pdf |
| Application for Regulated Explosive Use - Blaster License (Read-Only) | Dept. of Homeland Security | 52488.pdf |
| Application for Regulated Explosive Use - Operator License (Read-Only) | Dept. of Homeland Security | 52489.pdf |
| Application for Reinstatement | Secretary of State - Business Services Division | 04160.pdf |
| Application For Renewal Of Alcoholic Beverage Permit (Read-Only) | Alcohol and Tobacco Commission | 00047.pdf |
| Application For Renewal Of A Student Hearing Aid Dealer Certificate | Professional Licensing Agency | 50688.pdf |
| Application For Renewal Of Health Facility License (Read-Only) | State Dept. of Health | 01714.pdf |
| Application for Repeat Examination for Psychology | Professional Licensing Agency | 53327.pdf |
| Application for Renewal of Reservation of Exclusive Use of a Corporate Name (Read-Only) | Secretary of State - Business Services Division | 26237.pdf |
| Application for Renewal of Trademark/Service Mark (Read-Only) | Secretary of State - Trademarks | 02927.pdf |
| Application for Renewal of Underground Storage Tank Certification | Dept. of Homeland Security | 53150.pdf |
| Application for Repeat Examination for Health Facility Administrators / Residential Care Administrators | Professional Licensing Agency | 52564.pdf |
| Application for Repeat Examination for Hypnotist Certification (Read-Only) | Professional Licensing Agency | 52565.pdf |
| Application For Repeat Examination For Pharmacist License | Professional Licensing Agency | 51636.pdf |
| Application for Repeat Examination for Physical Therapists & Physical Therapist's Assistants | Professional Licensing Agency | 52563.pdf |
| Application for Reservation of Exclusive Use of Corporate Name (Read-Only) | Secretary of State - Business Services Division | 26233.pdf |
| Application for Residential Historic Rehabilitation Credit | DNR, Division of Historic Preservation and Archaeology | 50743.xls |
| Application for Residential Historic Rehabilitation Credit (Read-Only) | DNR, Division of Historic Preservation and Archaeology | 50743.pdf |
| Application for Restricted Agricultural Commercial Driver's License (Read-Only) | Bureau of Motor Vehicles | 48440.pdf |
| Application for Retired Member Change of Beneficiary/Survivor Beneficiary and/or Retirement Option (Read-Only) | Teachers' Retirement Fund | 49518.pdf |
| Application for Retired Member Change of Beneficiary/Survivor Beneficiary and/or Retirement Option | Teachers' Retirement Fund | 49518.doc |
| Application for Retirement Benefits | Public Employees' Retirement Fund | 45343.pdf |
| Application for Retirement Benefits – Indiana Judges’ Retirement System | Public Employees' Retirement Fund | 07096.pdf |
| Application for Retirement Benefits - Part I | Teachers' Retirement Fund | 23226.pdf |
| Application for Retirement Benefits - Part II | Teachers' Retirement Fund | 53486.pdf |
| Application for Retirement Benefits - Prosecuting Attorneys’ Retirement Fund | Public Employees' Retirement Fund | 52696.pdf |
| Application for Retirement Benefits – State Excise Police, Gaming Agent, Gaming Control Officer & Conservation Enforcement Officers’ Retirement Plan | Public Employees' Retirement Fund | 24728.pdf |
| Application For Review by Full Board | Worker's Compensation Board | 1042.pdf |
| Application for Revised or Duplicate Notary Commission (Read-Only) | Secretary of State - Notary | 28801.pdf |
| Application for Rollover Account | Public Employees' Retirement Fund | 51003.pdf |
| Application for Rollover Account Withdrawal (Read-Only) | Teachers' Retirement Fund | 52413.pdf |
| Application for Route / Truck Permit | Board of Animal Health | 50907.pdf |
| Application for Salon License | Professional Licensing Agency | 45243.pdf |
| Application for Salvage Motor Vehicle Business License | Secretary of State - Dealer Division | 40248.pdf |
| Application for Sanitary Sewer Construction Permit per 327 IAC 3 | Dept. of Environmental Management | 53159.doc |
| Application for Scientific Purposes License | Dept. of Natural Resources - Division of Fish & Wildlife | 21945.pdf |
| Application for Search and Certified Copy of Birth Record (Read-Only) | Dept. of Health | 49607.pdf |
| Application for Search and Certified Copy of Death Record (Read-Only) | Dept. of Health | 49606.pdf |
| Application for Second Injury Fund Benefits (Read-Only) | Workers' Compensation Board | 51247.pdf |
| Application for Section 205 Nonpoint Source Management Program Grant | Dept. of Environmental Management | 53970.pdf |
| Application for Self-Bonding (Read-Only) | DNR - Div. of Reclamation | 51895.pdf |
| Application for Senior Citizen Property Tax Benefits | Dept. of Local Government Finance | 43708.pdf |
| Application for Shipping Bees and Elements of Beekeeping into Indiana (Read-Only) | DNR- Entomology and Plant Pathology | 49599.pdf |
| Application for Small Loan License | Dept. of Financial Institutions | 49789.pdf |
| Application for Special Identification Number for Motor Vehicle, House, Car, and Other Self-Assembled Motor Vehicles (Read-Only) | Bureau of Motor Vehicles | 12907.pdf |
| Application For Special Permit For Hunter With Disabilities (Read-Only) | DNR - Fish & Wildlife | 10691.pdf |
| Application for Special Purpose Educational Permit (Read-Only) | DNR - Fish & Wildlife | 51815.pdf |
| Application for Special Purpose Salvage Permit (Read-Only) | DNR - Fish & Wildlife | 51801.pdf |
| Application for Sponsorship as a Continuing Education Provider for Health Facility Administrators (Read-Only) | Professional Licensing Agency | 52568.pdf |
| Application for Student Permit to Practice Respiratory Care (Read-Only) | Professional Licensing Agency | 50819.pdf |
| Application for Surviving Dependent Benefit (Read-Only) | Teachers' Retirement Fund | 44512.pdf |
| Application for Surviving Spouse Benefit (Read-Only) | Teachers' Retirement Fund | 44511.pdf |
| Application for Surviving Spouse Pension Benefit (Read-Only) | Teachers' Retirement Fund | 44510.pdf |
| Application for Surviving Spouse Pension Benefit (Read-Only) | Teachers' Retirement Fund | 44510.doc |
| Application for Survivor Benefits - 1977 Police Officers’ & Firefighters’ Pension & Disability Fund | Public Employees' Retirement Fund | 07045.pdf |
| Application for Survivor Benefits - Judges’ Retirement System | Public Employees' Retirement Fund | 07095.pdf |
| Application for Survivor Benefits - Legislators’ Defined Benefit Plan | Public Employees' Retirement Fund | 53671.pdf |
| Application for Survivor Benefits - Prosecuting Attorneys’ Retirement Fund | Public Employees' Retirement Fund | 53670.pdf |
| Application for Survivor Benefits – State Excise Police, Gaming Agent, Gaming Control Officer & Conservation Enforcement Officers’ Retirement Plan | Public Employees' Retirement Fund | 53663.pdf |
| Application for Tanning Facility License | Professional Licensing Agency | 47393.pdf |
| Application for Tax Deduction for Disabled Veterans, WWI Veterans and Surviving Spouses of Certain Veterans | Dept. of Local Government Finance | 12662.pdf |
| Application for Taxidermist License (Read-Only) | DNR - Fish & Wildlife | 03230.pdf |
| Application For Temporary Plumbing Contractor's License (Read-Only) | Professional Licensing Agency | 45819.pdf |
| Application For The Hearing Aid Dealer Examination | Professional Licensing Agency | 50685.pdf |
| Application for the North American Veterinary Licensure Examination (NALVE) | Professional Licensing Agency | 50020.pdf |
| Application For the Residential Care Assistance Program (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 37113.pdf |
| Application for Title IV-D Child Support Services | Dept. of Child Services - Child Support Bureau | 34882.pdf |
| Application For Tobacco Sales Certificate (Read-Only) | Alcohol and Tobacco Commission | 51357.pdf |
| Application for Training Acceleration Grant (Read-Only) | Dept. of Workforce Development | 52728.pdf |
| Application for Transfer of Supervision - Speech-Language Pathology and Audiology Clinical Fellowship Year (Read-Only) | Professional Licensing Agency | 50321.pdf |
| Application for Transition to Teaching Permit (Read-Only) | Dept. of Education | 52649.pdf |
| Application for Transport Operator Plates | Bureau of Motor Vehicles | 37028.pdf |
| Application for Underground Storage Tank Certification | Dept. of Homeland Security | 53148.pdf |
| Application for Undue Hardship Waiver (Read-Only) | Family and Social Service Administration | 48259.pdf |
| Application for Variance | Dept. of Homeland Security | 44400.pdf |
| Application for Voluntary Withdrawal | Teachers' Retirement Fund | 18521.pdf |
| Application for Volunteer Fire Assistance | DNR, Forestry Division | 50310.pdf |
| Application for Wage Claim | Dept. of Labor | 02069.pdf |
| Application for Waiver of Auctioneer Continuing Education | Professional Licensing Agency | 50947.pdf |
| Application for Waiver of Continuing Education | Professional Licensing Agency | 48359.pdf |
| Application for Waiver of Cosmetology Professional Continuing Education (Read-Only) | Professional Licensing Agency | 51331.pdf |
| Application for Waiver of one (1) Year Real Estate Experience Requirement (Read-Only) | Professional Licensing Agency | 50668.pdf |
| Application for Waste Tire Processing Operation Registration (Read-Only) | Dept. of Environmental Management | 47221.pdf |
| Application for Waste Tire Storage Site Registration (Read-Only) | Dept. of Environmental Management | 47222.pdf |
| Application for Wastewater Treatment Plant Apprentice to Request Certification | Dept. of Environmental Management | 53785.pdf |
| Application for Wastewater Treatment Plant Construction Permit per 327 IAC 3 | Dept. of Environmental Management | 53160.doc |
| Application for Wastewater Treatment Plant Operator Certification Examination (Read-Only) | Dept. of Environmental Management | 47289.pdf |
| Application for Wastewater Treatment Plant Operator Certification Examination | Dept. of Environmental Management | 47289.xls |
| Application for Wastewater Treatment Plant Operator Certification Examination - Short Form for Apprenticeship Only (Read-Only) | Dept. of Environmental Management | 53583.pdf |
| Application for Wastewater Treatment Plant Operator Certification Examination - Short Form for Apprenticeship Only | Dept. of Environmental Management | 53583.xls |
| Application for Wastewater Treatment Plant Operator Certification By Reciprocity (Read-Only) | Dept. of Environmental Management | 47290.pdf |
| Application for Wastewater Treatment Plant Operator Certification By Reciprocity (Read-Only) | Dept. of Environmental Management | 47290.xls |
| Application for Watercraft Dealer License | Secretary of State - Dealer Division | 47584.pdf |
| Application for Watercraft Dealer Plates/Registrations | Secretary of State - Dealer Division | 43724.pdf |
| Application for Water Well Drilling License (Read-Only) | DNR, Division of Water | 00417.pdf |
| Application for Wetland Adjustment to Land Assessed Using the Agricultural Soil Productivity Method | Dept. of Local Government Finance | 46885.pdf |
| Application for Withdrawal from the Fund Due to Death of Member (Read-Only) | Teacher's Retirement Fund | 04717.pdf |
| Application for Wild Animal Rehabilitation Permit (Read-Only) | DNR - Fish & Wildlife | 27020.pdf |
| Application for Withdrawal from the Fund Due to Death of Member (Read-Only) | Teachers' Retirement Fund | 04717.doc |
| Application for Voluntary Certificate of Recognition | FSSA - Div. of Family Resources | 49443.pdf |
| Application Information for Flood Control Revolving Fund Loan (Read-Only) | DNR-Division of Water | 50352.pdf |
| Application Information for Flood Control Revolving Fund Loan - Rural Water Supply Program IC 14-28-11 (Read-Only) | DNR-Division of Water | 50353.pdf |
| Application - Senior Farmers' Market Nutrition Program (Read-Only) | Dept. of Health | 53250.pdf |
| Application to Classify Land as Cemetery Land | DNR- Division of Historic Preservation and Archaeology | 50948.xls |
| Application to Classify Land As Cemetery Land (Read-Only) | DNR - Division of Historic Preservation and Archaeology | 50948.pdf |
| Application to Convert Pursuant to IC 28-1-21.6, IC 28-1-21.7, IC 28-1-21.8, IC 28-1-21.9 or IC 28-1-33(Read-Only) | Dept. of Financial Institutions | 50276.pdf |
| Application to Convert Pursuant to IC 28-1-21.6, IC 28-1-21.7, IC 28-1-21.8, IC 28-1-21.9 or IC 28-1-33(Read-Only) | Dept. of Financial Institutions | 50276.doc |
| Application: To Establish a Branch Office or Offices / To Relocate a Branch Office / To Relocate a Main Office / For a Mobile Branch | Dept. of Financial Institutions | 49349.pdf |
| Application to Participate (Retiree Flexible Spending Program) (Read-Only) | State Personnel | 50673.pdf |
| Application to Organize a Credit Union (Read-Only) | Dept. of Financial Institutions | 17720.pdf |
| Application to Organize a State Chartered Financial Institution | Dept. of Financial Institutions | 50943.pdf |
| Application to Start or Stop Payment of Retirement Benefits to a Revocable Trust | Public Employees Retirement Fund | 50928.pdf |
| Appointment of Indiana Auctioneer Commission as Agent of Auctioneer to Accept Service of Process or Pleading | Professional Licensing Agency | 44147.pdf |
| Appointment of Real Estate Commission of State of Indiana as Agent of Broker or Salesman to Accept Service of Process or Pleading | Professional Licensing Agency | 47415.pdf |
| Approval for Conference/ Training/ Travel | Family and Social Services Admin. | 45116.pdf |
| Approval for Self-Bonding (Read-Only) | DNR - Div. of Reclamation | 51893.pdf |
| Architect / Landscape Architect Verification of Employment | Professional Licensing Agency | 44668.pdf |
| Architect Training and Experience Report (IDP) | Professional Licensing Agency | 49699.pdf |
| Arrearage Calculation Worksheet | Dept. of Child Services - Child Support Bureau | 51799.pdf |
| Articles of Acceptance (Professional Act of 1983 (Read-Only) | Secretary of State - Business Services Division | 13451.pdf |
| Articles of Amendment to the Articles of Incorporation | Secretary of State - Business Services Division | 38333.pdf |
| Articles of Amendment to the Articles of Incorporation (Nonprofit) | Secretary of State - Business Services Division | 04161.pdf |
| Articles of Amendment to the Articles of Organization | Secretary of State - Business Services Division | 49460.pdf |
| Articles of Correction (Read-Only) | Secretary of State - Business Services Division | 26235.pdf |
| Articles of Credit Union Conversion (Read-Only) | Dept. of Financial Institutions | 53429.pdf |
| Articles of Cross-Species Merger, Resulting in the Formation of a Corporation | Secretary of State - Business Services Division | 51584.pdf |
| Articles of Cross-Species Merger, Resulting in the Formation of a Limited Liability Company | Secretary of State - Business Services Division | 51583.pdf |
| Articles of Cross-Species Merger, Resulting in the Formation of a Limited Liability Partnership (Read-Only) | Secretary of State - Business Services Division | 51578.pdf |
| Articles of Cross-Species Merger, Resulting in the Formation of a Limited Partnership | Secretary of State - Business Services Division | 51579.pdf |
| Articles of Dissolution by Director or Incorporators of a NonProfit Corporation (Read-Only) | Secretary of State - Business Services Division | 35228.pdf |
| Articles of Dissolution for a Corporation | Secretary of State - Business Services Division | 34471.pdf |
| Articles of Dissolution of a Domestic NonProfit Corporation (Read-Only) | Secretary of State - Business Services Division | 39080.pdf |
| Articles of Dissolution of a Limited Liability Company | Secretary of State - Business Services Division | 49465.pdf |
| Articles of Dissolution Prior to Issuing Shares or Commencing Business (Read-Only) | Secretary of State - Business Services Division | 39035.pdf |
| Articles of Domestication, Domestication of a Foreign Corporation into an Indiana Corporation | Secretary of State - Business Services Division | 51575.pdf |
| Articles of Domestication, Domestication of an Indiana Corporation into a Foreign Corporation | Secretary of State - Business Services Division | 51581.pdf |
| Articles Of Entity Conversion: Conversion Of A Corporation Into A Limited Liability Company (Read-Only) | Secretary of State - Business Services Division | 51576.pdf |
| Articles Of Entity Conversion: Conversion Of A Corporation Into A Limited Liability Partnership | Secretary of State - Business Services Division | 51574.pdf |
| Articles of Entity Conversion: Conversion of a Corporation into a Limited Partnership | Secretary of State - Business Services Division | 51580.pdf |
| Articles Of Entity Conversion: Conversion Of An Indiana Non-Corporation Business Entity Into An Indiana Limited Liability Company (Read-Only) | Secretary of State - Business Services Division | 51577.pdf |
| Articles Of Entity Conversion: Conversion Of An Indiana Non-Corporation Business Entity Into An Indiana Limited Liability Partnership (Read-Only) | Secretary of State - Business Services Division | 51582.pdf |
| Articles Of Entity Conversion: Conversion Of An Indiana Non-Corporation Business Entity Into An Indiana Limited Partnership (Read-Only) | Secretary of State - Business Services Division | 51573.pdf |
| Articles Of Entity Conversion: Conversion Of A Non-Corporation Business Entity Into An Indiana Corporation (Read-Only) | Secretary of State - Business Services Division | 51571.pdf |
| Articles of Exchange (Read-Only) | Dept. of Financial Institutions | 13762.pdf |
| Articles of Incorporation (Read-Only) | Dept. of Financial Institutions | 48006.pdf |
| Articles of Incorporation | Secretary of State - Business Services Division | 04159.pdf |
| Articles of Incorporation/Nonprofit Corporations | Secretary of State - Business Services Division | 04162.pdf |
| Articles of Merger (Read-Only) | Secretary of State - Business Services Division | 39036.pdf |
| Articles of Merger (Limited Liability) | Secretary of State - Business Services Division | 49463.pdf |
| Articles of Merger NonProfit Corporations (Read-Only) | Secretary of State - Business Services Division | 42199.pdf |
| Articles of Organization | Secretary of State - Business Services Division | 49459.pdf |
| Articles of Registration for a Limited Liability Partnership (LLP) | Secretary of State - Business Services Division | 51572.pdf |
| ASA 5/ASA 6 Post-Retirement Election (Read-Only) | Teachers' Retirement Fund | 50798.pdf |
| ASA 5/ASA 6 Post-Retirement Election | Teachers' Retirement Fund | 50798.doc |
| ASC Utilization Report (Read-Only) | Dept. of Health | 49933.pdf |
| Assessment / Authorization for Family & Children Emergency Services (Read-Only) | Dept. of Child Services - Child Welfare | 47348.pdf |
| Assignment of Trademark/Service Mark (Read-Only) | Secretary of State - Trademarks | 48258.pdf |
| Assistance to Residents in County Homes / Room and Board Assistance Budget and Recommendation (Read-Only) | Family and Social Service Admin. - DDARS | 31759.pdf |
| Attending Physician's Statement (Read-Only) | Dept. of Personnel | 45547.pdf |
| Attending Physician's Statement | State Personnel Department | 45547.doc |
| Attending Physician's Statement (Read-Only) | Teachers' Retirement Fund | 17296.pdf |
| Attending Physician's Statement | Teachers' Retirement Fund | 17296.doc |
| Authorization for Disclosure of Drug and Alcohol Abuse Patient Records | Protection and Advocacy Services | 53988.pdf |
| Authorization for Disclosure of Drug and Alcohol Abuse Patient Records | Protection and Advocacy Services | 53988.doc |
| Authorization for Disclosure of Protected Health Information and Other Information | Protection and Advocacy Services | 40223.pdf |
| Authorization for Disclosure of Protected Health Information and Other Information | Protection and Advocacy Services | 40223.doc |
| Authorization for IPAS to Disclose Protected Health Information and Other Information | Protection and Advocacy Services | 53989.pdf |
| Authorization for IPAS to Disclose Protected Health Information and Other Information | Protection and Advocacy Services | 53989.doc |
| Authorization for Receipt of Electronic Property Tax Statements | Dept. of Local Government Finance | 53954.pdf |
| Authorization / Request for Out of State Travel | Dept. of Administration, Procurement Division | 00823.xls |
| Authorization / Request for Out of State Travel | Dept. of Administration | 00823.pdf |
| Authorization/Request for Paternity Blood Test (Read-Only) | Dept. of Child Services - Child Support Bureau | 07859.pdf |
| Authorization to Release Confidential Information | Public Employees' Retirement Fund | 51806.pdf |
| Authorization to Release Information (Read-Only) | Professional Licensing Agency | 50667.pdf |
| Auto Salvage Recyclers Certification Program – Certification Statement | Dept. of Environmental Management | 53766.pdf |
| Auto Salvage Recyclers Certification Program – Environmental Self-Audit Checklist | Dept. of Environmental Management | 53765.pdf |
| Auto Salvage Recyclers Certification Program – Facility Non-Applicability Statement | Dept. of Environmental Management | 53768.pdf |
| Auto Salvage Recyclers Certification Program – Return-to-Compliance Plan | Dept. of Environmental Management | 53767.pdf |
|
|
|
|
| BCC 0012 - Attestation Statement (Read-Only) | Family and Social Service Admin. - Division of Family Resources | 48629.pdf |
| BCC 0025 - Application for Child Care Home Variance or Waiver (Read-Only) | Family and Social Service Admin. - Division of Family Resources | 48269.pdf |
| BCC 0032 - Checklist for Unlicensed Registered Child Care Ministries Sanitation Survey (Read-Only) | Family and Social Service Admin. - Division of Family Resources | 49441.pdf |
| BCC 0036 - History of Immunizations | Family and Social Service Admin. - Division of Family Resources | 49445.pdf |
| BCC 0037: Health / Food / Sanitation Survey of Group Home Licensed Under 465 IAC 2-12 (2-13) | Family and Social Service Admin. - Division of Family Resources | 49446.pdf |
| BCC 0041: Health / Food / Sanitation Survey of Institution / Private Secure Facility Licensed Under 465 IAC 2-9 (2-10) (2-11) | Family and Social Service Admin. - Division of Family Resources | 49449.pdf |
| BCC 0052 - Written Nutrition / Food Service Program for Child Caring Institutions (2-9-77) and Group Homes (2-12-75) Emergency Shelter Institutions (2-10-76) Group Homes (2-12-74) Shelter Group Homes (2-13-74) Private Secure Facilities (2-11-77) | Family and Social Service Admin. - Division of Family Resources | 46683.pdf |
| BCC 0056 - Health Care Program for Child Caring Institutions & Group Homes & Private Secure Facilities, Child Caring Institutions & Group Homes with Emergency Shelter | Family and Social Service Admin. - Division of Family Resources | 45879.pdf |
| BCC 0079 Licensed Child Care Center / Home Monthly Report as Required by IC 12-17.2.2-1.5 | Family and Social Service Admin. - Division of Family Resources | 50550.pdf |
| BCC 0080 Licensed Child Care Center / Home Consent | Family and Social Service Admin. - Division of Family Resources | 50548.pdf |
| BCC 0091 - Child Care Development Fund (CCDF) Provider Eligibility Standards (PES) Checklist (Read-Only) | FSSA - Division of Family Resources | 51363.pdf |
| BCC 0095 - Application / Decline / Recommendation for Denial for Non-Compliance | FSSA - Division of Family Resources | 51362.pdf |
| BCC 0100 - Proposed Multiple Residences for Child Care Home Design Professional Statement (Read-Only) | FSSA - Division of Family Resources | 51476.pdf |
| BCC 0101 - Child Care Home Certification of Residential Structure (Read-Only) | FSSA - Division of Family Resources | 51477.pdf |
| BCC 0310 - DFR / CCDF Referral (Read-Only) | FSSA - Division of Family Resources | 53132.pdf |
| BCC 0312 - Provider Response Document | FSSA - Division of Family Resources | 53320.pdf |
| BCC 0320 - Review / Assessment for Child Care Centers (Read-Only) | FSSA - Division of Family Resources | 46153.pdf |
| BCC 0330 - Consent to Release Information for Licensed Centers, Licensed Homes, Unlicensed Registered Ministries, and CCDF LLEPs (Read-Only) | FSSA - Division of Family Resources | 53323.pdf |
| BCC 0331 - Child Care Area | FSSA - Division of Family Resources | 53561.pdf |
| BCC 0410 - Child Care: Consent for Release of Information | Family and Social Service Admin. - Division of Family Resources | 53253.pdf |
| BCD 0001 - Indiana's Individualized Family Service Plan to Enhance the Capacity of Families to Meet the Special Needs of their Child | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 46514.pdf |
| BCD 0088 - Prior Approval Request | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 51311.pdf |
| BCD 0005 - Provider Reciprocal Consent to Release and Share Information | FSSA - Division of Family Resources | 47960.pdf |
| BCD 0076, First Steps Part C Eligibility Determination Statement | Family and Social Service Admin -- Division of Disability and Rehabilitative Services | 50054.pdf |
| BCD 0097 - Work Sheet for CCDF Provider Eligibility Standards Staff Records | Family and Social Service Administration | 51340.pdf |
| BCD 0108 General Reciprocal Consent to Release and Share Information | Family and Social Service Admin -- Division of Family Resources | 51675.pdf |
| BCD 0110 - Outcome Review | Family and Social Services Administration -- Division of Family Resources | 51838.pdf |
| BCD 0111 - Request For Authorization / Meeting Minutes (Read-Only) | Family and Social Service Admin -- Division of Family Resources | 51839.pdf |
| BCD 0211 - Ongoing Record | Family and Social Service Admin -- Division of Family Resources | 52001.pdf |
| BCD 0220 - Data Entry Information Request | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 53507.pdf |
| BCD 0805 - Application for Child Care Services (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 46513.pdf |
| BCD 0807 – Initial Contact Checklist | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 53977.pdf |
| BCD 0808 – Quarterly Contact Checklist | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 53975.pdf |
| BCD 0809 – Service Coordinator Visit Checklist | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 53978.pdf |
| BCD – 0810 Third Quarter Checklist | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 53976.pdf |
| Bed Change Request (Read-Only) | Dept. of Health | 52322.pdf |
| Bed Inventory Sheet (Read-Only) | Dept. of Health | 04332.pdf |
| Behavioral/Physical Health Coordination | FSSA - Division of Family Resources | 51856.pdf |
| Benefit Correction Request | State Personnel Department | 52090.pdf |
| Benefit Correction Request | State Personnel Department | 52090.doc |
| Bill of Lading | Dept. of Correction | 47708.pdf |
| Bill of Sale (Read-Only) | Bureau of Motor Vehicles | 44237.pdf |
| Bill of Sale for ORV / Snowmobile (Read-Only) | DNR, Outdoor Recreation | 51779.pdf |
| Bioterrorism Environmental Sample Submission | Dept. of Health | 53169.pdf |
| BOAH Application for Indiana Aquaculture Pre-Entry Permit (Read-Only) | Board of Animal Health | 53488.pdf |
| BOAH Application for Indiana Aquaculture Pre-Entry Permit (Read-Only) | Board of Animal Health | 53488.doc |
| Boating Infrastructure Grant Program Tier I Application (Read-Only) | Dept. of Environmental Management | 53433.pdf |
| Boating Infrastructure Grant Program Tier I Application | Dept. of Environmental Management | 53433.doc |
| Body Type Clarification/Body Type Change Affidavit (Read-Only) | Bureau of Motor Vehicles | 39771.pdf |
| Bond and/or Permit Fee Waiver (Read-Only) | Dept. of Transportation | 35483.pdf |
| Bonding Evaluation Factor Sheet (Read-Only) | DNR - Div. of Reclamation | 20069.pdf |
| Bond Pool Application (Read-Only) | DNR - Div. of Reclamation | 51507.pdf |
| Bond Required of Livestock Market Facilities and Dealers Under IC 15-17-14 | Board of Animal Health | 18496.pdf |
| Boxing Score Card (White Judge) (Read-Only) | Professional Licensing Agency | 50233.pdf |
| BQIS 0009 - Notification of Individual's Death | Family & Social Service Admin. - Division of Disability and Rehabilitative Services | 51685.pdf |
| BQIS 0010 - MRC Release of Information for DDRS | Family & Social Service Admin. - Division of Disability and Rehabilitative Services | 51686.pdf |
| Branch Questionnaire for a Home Health Agency | Dept. of Health | 53209.doc |
| Breed Development Late Closing Events Nomination – Two-Year Olds, Three-Year Olds & Aged (Four-Year Olds & Older) (Read-Only) | Horse Racing Commission | 49806.pdf |
| Budget - Cooperative Agreement Appendix 1-a (Read-Only) | Family and Social Service Administration | 41708.pdf |
| Budget Service Company License Application | Dept. of Financial Institutions | 50291.pdf |
| Business/Farm Account Information (Read-Only) | Board of Animal Health | 52009.pdf |
| Business Tangible Personal Property Assessment Return(Form 103 - Long Form) | Dept. of Local Government Finance | 11405.pdf |
| Business Tangible Personal Property/Depreciable Assets in Pool 5 (Form 103 - P5) | Dept. of Local Government Finance | 52497.pdf |
| Business Tangible Personal Property Return (Form 104) | Dept. of Local Government Finance | 10068.pdf |
| Business Tangible Personal Property Return (Form 103 - Short Form) | Dept. of Local Government Finance | 11274.pdf |
| BVIS 0004 Vending Facility Monthly Report | Family & Social Service Admin. - Division of Disability and Rehabilitative Services | 35326.pdf |
| Bylaws For Credit Unions (Read-Only) | Dept. of Financial Institutions | 18917.pdf |
| Bypass/Overflow Incident Report (Read-Only) | Dept. of Environmental Management | 48373.pdf |
| Bypass/Overflow Incident Report | Dept. of Environmental Management | 48373.doc |
| CAFO/CFO Public Meeting Question & Public Comment Submittal(Read-Only) | Dept. of Environmental Management | 53455.pdf |
| Calculation of Loan Broker Application Fee | Secretary of State - Securities Division | 53304.pdf |
| Calculator for Retirement Benefits (Read-Only) | Teacher's Retirement Fund | 3240.pdf |
| Calculator for Retirement Benefits (Read-Only) | Teachers' Retirement Fund | 03240.doc |
| CAN-1 Candidate Filing Challenge | Election Division | 46437.pdf |
| CAN-2 Declaration of Candidacy for Primary Nomination | Election Division | 46439.pdf |
| CAN-3 Declaration of Intent to be a Write-In Candidate | Election Division | 46438.pdf |
| CAN-7 Request for Presidential Primary Ballot Placement | Election Division | 46431.pdf |
| CAN-9 Legal Notice of Primary Election | Election Division | 46430.pdf |
| CAN-10 Primary Election Candidate Withdrawal | Election Division | 46429.pdf |
| CAN-11 County Certification of Presidential Primary Vote to Indiana Election Division | Election Division | 46428.pdf |
| CAN-12 Indiana Election Division Certification of Presidential Primary Vote | Election Division | 46427.pdf |
| CAN-13 Declaration of Intent to be a Write-in Candidate for a School Board Office Elected at the Primary Election | Election Division | 50671.pdf |
| CAN-16 - Town Office Declaration of Candidacy by a Democratic, Libertarian, or Republican Party Candidate | Election Division | 46422.pdf |
| CAN-17 - Circuit Court Clerk Certification of Town Candidates | Election Division | 46424.pdf |
| CAN-18 - Town Convention Certificate of Nomination | Election Division | 46423.pdf |
| CAN-20 - Consent of Independent or Minor Political Party Candidate Nominated by Petition | Election Division | 46419.pdf |
| CAN-22 - Party Chairman of Libertarian Party Nominees for County & Certain Town Offices & Candidate's Consent to Nomination | Election Division | 49025.pdf |
| CAN-23 - State Party Chairman Certification of Democratic, Libertarian, & Republican Party State Convention Nominee | Election Division | 46418.pdf |
| CAN-24 - General Election Candidate Withdrawal | Election Division | 46416.pdf |
| CAN-25 - Indiana Petition of Nomination & Consent for County Board of Tax & Capital Projects Review | Election Division | 53452.pdf |
| CAN-27 - Certificate of Candidate Selection to Fill an Early Ballot Vacancy for a Federal Office | Election Division | 47012.pdf |
| CAN-28 - Certificate of Candidate Selection to Fill an Early Vacancy for a State Legislative Office | Election Division | 47009.pdf |
| CAN-29 - Certificate of Candidate Selection to Fill an Early Ballot Vacancy for a Local Office | Election Division | 47011.pdf |
| CAN-30 - Call of Political Party Caucus to Fill an Early Ballot Vacancy on the General Election Ballot | Election Division | 47004.pdf |
| CAN-31 - Declaration of Candidacy & Written Consent to Fill a Ballot Vacancy | Election Division | 47005.pdf |
| CAN-34 - Indiana Petition of Nomination & Consent for School Board Office | Election Division | 47008.pdf |
| CAN-35 - Certificate of Candidate Selection to Fill a Late Ballot Vacancy for a Local Office | Election Division | 47010.pdf |
| CAN-37 - Declaration of Candidacy for Precinct Committeeman & State Convention Delegate | Election Division | 47417.pdf |
| CAN-40 - Replacement of Candidate Nominated by Petition | Election Division | 48518.pdf |
| CAN-41 - Allen County/Vanderburgh County Superior Court Judge Declaration of Candidacy | Election Division | 48517.pdf |
| CAN-46 General Election Town Candidate Withdrawal | Election Division | 49041.pdf |
| Career College Student Assurance Fund Quarterly Collection (CCSAF-1) (Read-Only) | Commission on Proprietary Education | 51804.pdf |
| Career College Student Assurance Fund Quarterly Collection (CCSAF-1) | Commission on Proprietary Education | 51804.doc |
| Case Log (Read-Only) | Indiana Protection and Advocacy Services | 40228.doc |
| Case Reports for Funeral Director Intern | Professional Licensing Agency | 11470.pdf |
| Cash Bond (Read-Only) | Dept. of Agriculture | 17284.pdf |
| Casher of Checks Application For License | Dept. of Financial Institutions | 50289.pdf |
| CD-01 Emissions Unit Compliance Status (Read-Only) | Dept. of Environmental Management | 51861.pdf |
| CD-01 Emissions Unit Compliance Status | Dept. of Environmental Management | 51861.doc |
| CD-02 Compliance Plan Requirements Per Applicable Requirement (Read-Only) | Dept. of Environmental Management | 51862.pdf |
| CD-02 Compliance Plan Requirements Per Applicable Requirement | Dept. of Environmental Management | 51862.doc |
| CD-03 Compliance Plan Requirements Per Emissions Unit | Dept. of Environmental Management | 51863.pdf |
| CD-04 Compliance Schedule and Certification (Read-Only) | Dept. of Environmental Management | 51864.pdf |
| CD-04 Compliance Schedule and Certification | Dept. of Environmental Management | 51864.doc |
| CE-01 Control Equipment Summary (Read-Only) | Dept. of Environmental Management | 51904.pdf |
| CE-01 Control Equipment Summary | Dept. of Environmental Management | 51904.doc |
| CE-02 Particulate Control - Baghouse / Fabric Filter (Read-Only) | Dept. of Environmental Management | 51953.pdf |
| CE-02 Particulate Control - Baghouse / Fabric Filter | Dept. of Environmental Management | 51953.doc |
| CE-03: Particulate Control - Cyclone (Read-Only) | Dept. of Environmental Management | 52620.pdf |
| CE-03: Particulate Control - Cyclone | Dept. of Environmental Management | 52620.doc |
| CE-04: Particulate Control - Electrostatic Precipitator (Read-Only) | Dept. of Environmental Management | 52621.pdf |
| CE-04: Particulate Control - Electrostatic Precipitator | Dept. of Environmental Management | 52621.doc |
| CE-05: Particulate Control - Wet Collector / Scrubber / Absorption (Read-Only) | Dept. of Environmental Management | 52622.pdf |
| CE-05: Particulate Control - Wet Collector / Scrubber / Absorption | Dept. of Environmental Management | 52622.doc |
| CE-06: Organics - Flare / Oxidizer / Incinerator (Read-Only) | Dept. of Environmental Management | 52623.pdf |
| CE-06: Organics - Flare / Oxidizer / Incinerator | Dept. of Environmental Management | 52623.doc |
| CE-07: Organics - Adsorber (Read-Only) | Dept. of Environmental Management | 52624.pdf |
| CE-07: Organics - Adsorber | Dept. of Environmental Management | 52624.doc |
| CE-08: Organics - Condenser (Read-Only) | Dept. of Environmental Management | 52625.pdf |
| CE-08: Organics - Condenser | Dept. of Environmental Management | 52625.doc |
| CE-09: Nitrogen Oxides Reduction Technology (Read-Only) | Dept. of Environmental Management | 52626.pdf |
| CE-09: Nitrogen Oxides Reduction Technology | Dept. of Environmental Management | 52626.doc |
| CE-10: Miscellaneous Control Equipment (Read-Only) | Dept. of Environmental Management | 52436.pdf |
| CE-10: Miscellaneous Control Equipment | Dept. of Environmental Management | 52436.doc |
| Cemetery Registry Survey Form (Read-Only) | DNR, Historic Preservation and Archaeology | 50091.pdf |
| Certificate for Refund of County Vehicle Tax (15TR) (Read-Only) | Bureau of Motor Vehicles | 23389.pdf |
| Certificate in Support of Plumbing Experience Qualifications (Read-Only) | Professional Licensing Agency | 50663.pdf |
| Certificate of Appointment to City Board of Health | Dept. of Health | 48136.pdf |
| Certificate of Appointment to County Board of Health | Dept. of Health | 52577.pdf |
| Certificate of Assumed Business Name | Secretary of State - Business Services Division | 30353.pdf |
| Certificate of Compliance (Read-Only) | Bureau of Motor Vehicles | 48469.pdf |
| Certificate of County Auditor of Tax Refund Claims For Which Credit is Taken on Settlement | Auditor of State | 40168.xls |
| Certificate of Eligibility - Disabled Veteran Tax Deduction | Dept. of Veterans' Affairs | 51186.pdf |
| Certificate of Insurance | Dept. of Agriculture | 23447.pdf |
| Certificate of Insurance | Dept. of Agriculture | 23447.doc |
| Certificate of Liability Insurance (Read-Only) | DNR - Div. of Reclamation | 50613.pdf |
| Certificate of Limited Partnership (Read-Only) | Secretary of State - Business Services Division | 51586.pdf |
| Certificate of Payment of Capital Stock (Read-Only) | Dept. of Financial Institutions | 48003.pdf |
| Certificate of Printing Contract Performance | Dept. of Administration-Procurement | 45769.pdf |
| Certificate of Report of Condition and Income for an Indiana Corporate Fiduciary (Read-Only) | Dept. of Financial Institutions | 47999.pdf |
| Certificate of Repossession | Bureau of Motor Vehicles | 39738.pdf |
| Certificate of Vision (Eye Referral) (Read-Only) | Bureau of Motor Vehicles | 22106.pdf |
| Certification by County Assessor (Of Railroad and Public Utility Assessments) (Form 34C) | Dept. of Local Government Finance | 18602.pdf |
| Certification by Driver Education Instructor (Read-Only) | Bureau of Motor Vehicles | 37358.pdf |
| Certification by Employer of Deceased Member (Read-Only) | Teachers' Retirement Fund | 44503.pdf |
| Certification by Employer of Deceased Member | Teachers' Retirement Fund | 44503.doc |
| Certification by Physician for Long-Term Care Services And Physical Examination for PASARR Level II | Family and Social Service Administration | 45278.pdf |
| Certification by Township Assessor (Of Railroad and Public Utility Assessments) (Form 34T) | Dept. of Local Government Finance | 18603.pdf |
| Certification for Missing Receipt (Read-Only) | Auditor of State | 42275.pdf |
| Certification of Disability for Non-Vocational Rehabilitation Programs (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 36918.pdf |
| Certification of Eligibility for Veteran License Plates | Dept. of Veterans' Affairs | 32584.pdf |
| Certification of Proficiency for Limited Radiographer (Read-Only) | Dept. of Health | 53194.pdf |
| Certification of Records | Dept. of Correction | 36084.pdf |
| Certification - Plan of Care for Inpatient Pschiatric Hospital Services / Determination of Medicaid Eligibility (Read-Only) | Family and Social Service Administration | 44697.pdf |
| Certified Nursing Aide Private Care (Read-Only) | Dept. of Health | 52532.pdf |
| Certified Operator in Responsible Charge (CORC) - Request for Information - Operator of Multiple Public Water Systems | Dept. of Environmental Management | 53249.pdf |
| Certified Operator in Responsible Charge (CORC) - Request for Information - Operator of Multiple Public Water Systems | Dept. of Environmental Management | 53249.doc |
| Certified Public Accountant Verification of Experience | Professional Licensing Agency | 53888.pdf |
| CG-8, Annual License Financial Report | Gaming Commission | 45387.pdf |
| CG-9, Single Event License Financial Report | Gaming Commission | 45388.pdf |
| CG-21, Annual License Gross Receipts Report | Gaming Commission | 47835.pdf |
| CG-22, Single Event Annual Gross Receipts Report | Gaming Commission | 47862.pdf |
| CG-AB, Application for Annual Bingo First Time Applicants | Gaming Commission | 45381.pdf |
| CG-AB(R), Application for Annual Bingo Renewal | Gaming Commission | 46573.pdf |
| CG-ACGN, Application for Annual Charity Game Night - First Time Applicants | Gaming Commission | 53647.pdf |
| CG-ACGN(R), Annual Charity Game Night - Renewal Application | Gaming Commission | 53648.pdf |
| CG-ADP, Annual Door Prize Application for First Time Applicants | Gaming Commission | 53628.pdf |
| CG-ADP(R), Annual Door Prize Renewal Application | Gaming Commission | 53629.pdf |
| CG-AGG, Annual Guessing Game Application for First Time Applicants | Gaming Commission | 53660.pdf |
| CG-AGG(R), Annual Guessing Game Renewal Application | Gaming Commission | 53661.pdf |
| CG-AM, License Amendment Request(s) | Gaming Commission | 52682.pdf |
| CG-APT, Application for Annual Pull Tab First Time Applicants | Gaming Commission | 53632.pdf |
| CG-APT(R), Application for Annual Pull Tab Renewal | Gaming Commission | 53633.pdf |
| CG-AR, Application for Annual Raffle - First Time Applicants | Gaming Commission | 53635.pdf |
| CG-AR(R), Application for Annual Raffle - Renewal | Gaming Commission | 53636.pdf |
| CG-AWR, Application for Annual Water Race First Time Applicants | Gaming Commission | 53642.pdf |
| CG-AWR(R), Application for Annual Water Race Renewal | Gaming Commission | 53643.pdf |
| CG-CCA, Candidate's Committee Application | Gaming Commission | 53655.pdf |
| CG-CGN, Application for Charity Game Night License | Gaming Commission | 45383.pdf |
| CG-CO, Current Officers | Gaming Commission | 49873.pdf |
| CG-CR, Calendar Raffle License Application | Gaming Commission | 53638.pdf |
| CG-DA/MA, Application for Distributors, Manufacturers, & Manufacturers / Distributors | Gaming Commission | 45404.pdf |
| CG-DIST, Charitable Contribution Distribution List | Gaming Commission | 48681.pdf |
| CG-DP, Application for Door Prize License | Gaming Commission | 45386.pdf |
| CG-DTL, Charity Gaming Inventory Destruction, Theft, or Loss Form | Gaming Commission | 53650.pdf |
| CG-EN, Exempt Event Notification | Gaming Commission | 51413.pdf |
| CG-FES, Application for Festival License | Gaming Commission | 45385.pdf |
| CG-GG, Guessing Game License Application | Gaming Commission | 53658.pdf |
| CG-INV, Charity Gaming Ending Inventory Statement | Gaming Commission | 48682.pdf |
| CG-LSDS, Licensed Supply Donation Statement | Gaming Commission | 53657.pdf |
| CG-MDQ, Manufacturer/Distributor Quarterly Report (Read-Only) | Gaming Commission | 51414.pdf |
| CG-NPA, Non-Member Participation Approval | Gaming Commission | 53656.pdf |
| CG-NSR, Nightly Summary Report | Gaming Commission | 48683.pdf |
| CG-QA, Qualification Application | Gaming Commission | 45380.pdf |
| CG-RAF, Application for Raffle License | Gaming Commission | 45384.pdf |
| CG-SB, Application for Special Bingo License | Gaming Commission | 45382.pdf |
| CG-SP, Special Permission Request | Gaming Commission | 53641.pdf |
| CG-WR, Application Water Race License | Gaming Commission | 53645.pdf |
| Change in Status and/or Discontinuance of Administrator-in-Training Program | Professional Licensing Agency | 52639.pdf |
| Change in Status of Medicaid Hospice Patient (Read-Only) | Family and Social Service Administration | 48732.pdf |
| Change Order Form | Dept. of Correction | 53891.pdf |
| Change Order Form | Dept. of Correction | 53891.doc |
| Changes To The IFSP | Family and Social Services Administration - DFR | 51841.pdf |
| Checklist for Child Care Centers Health/Foods/Sanitation/Survey | Family and Social Services Administration - DFR | 45880.pdf |
| Chemical Examination of Water | Dept. of Health | 4626.pdf |
| Child Care Center Narrative (Read-Only) | Family and Social Service Admin -- Division of Family Resources | 46410.pdf |
| Child Registration: Indiana Special Needs Adoption Program (SNAP) Picture Book & Website (Read-Only) | Dept. of Child Services - Child Welfare | 11840.pdf |
| Child Support Interoffice Notification | Dept. of Child Services - Child Support Bureau | 37453.pdf |
| Chlorine and Chloramines Residual Reporting (DS) | Dept. of Environmental Management | 53296.pdf |
| Chlorine and Chloramines Residual Reporting (POE) (Read-Only) | Dept. of Environmental Management | 53295.pdf |
| Chronological Narrative (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 46014.pdf |
| Citizen Complaint and State Inspection Request (Read-Only) | DNR - Div. of Reclamation | 50419.pdf |
| Claim for $12,000 Lump Sum Benefit (For Non-Spouse) - 1977 Police Officers’ & Firefighters’ Pension & Disability Fund | Public Employees' Retirement Fund | 53685.pdf |
| Claim for $12,000 Lump Sum Death Benefit (For Spouses Only) – 1977 Police Officers’ & Firefighters’ Pension & Disability Fund | Public Employees' Retirement Fund | 53684.pdf |
| Claim for Annuity Savings Account Distribution Because of Death for an Estate or Beneficiary Other than Spouse | Public Employees' Retirement Fund | 46188.pdf |
| Claim for Annuity Savings Account Distribution Because of Death for a Spouse as Designated Beneficiary | Public Employees' Retirement Fund | 35193.pdf |
| Claim For Assessment - Preadmission Screening and Annual Resident Review (PASARR) (Read-Only) | Family and Social Service Administration | 43878.pdf |
| Claim for Deduction of Assessed Valuation Applicable to Resource Recovery Systems (Form RRS-1) | Dept. of Local Government Finance | 05469.pdf |
| Claim for Distribution of Contributions – 1977 Police Officers’ & Firefighters’ Pension & Disability Fund | Public Employees' Retirement Fund | 00947.pdf |
| Claim for Distribution of Contributions – Judges’ Retirement System | Public Employees' Retirement Fund | 30880.pdf |
| Claim for Distribution of Contributions – Prosecuting Attorneys’ Retirement Fund | Public Employees' Retirement Fund | 44445.pdf |
| Claim for Distribution of Contributions – State Excise Police, Gaming Agent, Gaming Control Officer & Conservation Enforcement Officers’ Retirement Plan | Public Employees' Retirement Fund | 50965.pdf |
| Claim for Exemption of Air or Water Pollution Control Facilities (Form 103-P) | Dept. of Local Government Finance | 24056.pdf |
| Claim for Payment for Mercury Switches from End-of Life Vehicles | Dept. of Environmental Management | 53238.pdf |
| Claim for Payment for Mercury Switches from End-of Life Vehicles | Dept. of Environmental Management | 53238.doc |
| Claim for Public Safety Officer Line of Duty Death Benefit for a Child as Beneficiary | Public Employees Retirement Fund | 51014.pdf |
| Claim for Public Safety Officer Line of Duty Death Benefit for a Spouse as Beneficiary | Public Employees Retirement Fund | 51015.pdf |
| Claim for Refund Due to Death of a Member or Death Settlement (Read-Only) | Teacher's Retirement Fund | 46461.pdf |
| Claim for Refund Due to Death of a Member or Death Settlement (Read-Only) | Teachers' Retirement Fund | 46461.doc |
| Claim - Voucher | Family and Social Service Admin -- Division of Family Resources | 45637.pdf |
| Claim Voucher (Read-Only) | Auditor of State | 11294.pdf |
| Clean Air Indiana Business Challenge – Project Proposal | Dept. of Environmental Management | 53810.pdf |
| Clean Vessel Act Program Grant Application (Read-Only) | Dept. of Environmental Management | 53432.pdf |
| Clean Vessel Act Program Grant Application | Dept. of Environmental Management | 53432.doc |
| Client Attendance Report - IMPACT Service Provider | FSSA - Division of Family Resources | 47826.pdf |
| Client Satisfaction Survey (Read-Only) | Indiana Protection and Advocacy Services | 47879.doc |
| Closure of Manure, Litter, Process Wastewater Storage Structures (Read-Only) | Dept. of Environmental Management | 51913.pdf |
| Closure of Manure, Litter, Process Wastewater Storage Structures | Dept. of Environmental Management | 51913.doc |
| CNA Activity Log (read-only) | Dept. of Health | 53726.doc |
| CNA Information (read-only) | Dept. of Health | 53728.doc |
| CNA Investigation (read-only) | Dept. of Health | 53730.doc |
| CNA Investigation Entrance Conference Checklist (read-only) | Dept. of Health | 53731.doc |
| CNA Investigation / Interview (read-only) | Dept. of Health | 53729.doc |
| CNA Investigation Packet Checklist (read-only) | Dept. of Health | 53735.doc |
| Dept. of Health | 53734.doc | |
| CNA Investigation Summary Worksheet (read-only) | Dept. of Health | 53732.doc |
| CNA Investigation Worksheet (read-only) | Dept. of Health | 53733.doc |
| Collateral Assignment of Certificate of Deposit | DNR, Forestry Division | 50309.pdf |
| Collateral Assignment of Certificate of Deposit (CA-1) (Read-Only) | DNR - Div. of Reclamation | 50625.pdf |
| Collateral Assignment of Deposit Account (DA-1) (Read-Only) | DNR - Div. of Reclamation | 50624.pdf |
| Collection Agency Bond (Read-Only) | Secretary of State - Securities Division | 00873.pdf |
| Comision De Servicios De Rehabilitacion - Cuestionario Sobre La Satisfaccion Del Cliente (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 51479.pdf |
| Commercial Driving Training School - Application for License (Read-Only) | Bureau of Motor Vehicles | 51567.pdf |
| Commercial Driver Training School Instructor - Physical Examination (Read-Only) | Bureau of Motor Vehicles | 53312.pdf |
| Commercial Vessel Tonnage Tax Return (Form CVTT-1) | Dept. of Local Government Finance | 43779.pdf |
| Commission on Rehabilitation Counselor Certification -Verification of Attendance (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 26460.pdf |
| Commission on Rehabilitation Services Customer Satisfaction Survey (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 46098.pdf |
| Commission on Rehabilitation Services - Customer Satisfaction Survey - Large Print Version (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 49823.pdf |
| Commission on Rehabilitation Services - Satisfaction Survey for Customers with Pre-Lingual Deafness (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 49603.pdf |
| Community Vocational/Habilitation Survey | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 51680.pdf |
| Community Work Experience Program Job Request | Family and Social Service Admin. - DFR | 46518.pdf |
| Compliance With Statement of Benefits - Personal Property (Form CF-1 /PP) | Dept. of Local Government Finance | 51765.pdf |
| Compliance with Statement of Benefits - Real Estate Improvements (Form CF-1 / Real Property) | Dept. of Local Government Finance | 51766.pdf |
| Compliance with Statement of Benefits - Utility Distributable Property (CF - 1 / UD) (Read-Only) | Dept. of Local Government Finance | 52448.pdf |
| Computer Use Agreement (Read-Only) | Indiana Protection and Advocacy Services | 52105.doc |
| Condition Report | Commission on Public Records | 49116.pdf |
| Confidential Financial and Biographical Report (Read-Only) | Dept. of Financial Institutions | 50275.pdf |
| Confidential Print and Mail Services Submission of Confidential Information | Dept. of Administration - Central Printing / Pitney Bowes | 53623.doc |
| Confidential Report of Communicable Diseases (Read-Only) | Dept. of Health | 43823.pdf |
| Confidentiality Agreement (Read-Only) | Dept. of Child Services - Child Welfare | 52736.pdf |
| Confidential Report of Blindness or Visual Impairment | Family and Social Services Admin - Division of Disability and Rehabilitative Services | 48126.pdf |
| Confined Animal Feeding Operation Approval Renewal (Read-Only) | Dept. of Environmental Management | 51318.pdf |
| Confined Animal Feeding Operation Facility Change Notification (Read-Only) | Dept. of Environmental Management | 50209.pdf |
| Confined Animal Feeding Operation Pre-construction Notification (Read-Only) | Dept. of Environmental Management | 50210.pdf |
| Confined Animal Feeding Operation Request for Approval Transfer (Read-Only) | Dept. of Environmental Management | 49832.pdf |
| Confined Animal Feeding Operation Request for Approval Voidance (Read-Only) | Dept. of Environmental Management | 49827.pdf |
| Confined Feeding Facility Approval Application (Read-Only) | Dept. of Environmental Management | 48436.pdf |
| Confined Feeding Operation Completed Construction Affidavit(Read-Only) | Dept. of Environmental Management | 51255.pdf |
| Confined Feeding Operation Manure Management Plan Update (Read-Only) | Dept. of Environmental Management | 49924.pdf |
| Consent For Disclosure of Information (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 42224.pdf |
| Consent for Release of Information Under the Trade Act of 1974, Amended 1981 (Read-Only) | Dept. of Workforce Development | 47287.pdf |
| Conservation Officer 28-Day Activity Report (Read-Only) | DNR - Division of Law Enforcement | 47227.pdf |
| Consent to Release Criminal History Information for Substitute Care Homes (Read-Only) | Dept. of Child Services - Child Welfare | 49996.pdf |
| Consent to Release Social Security Number | Dept. of Child Services - Child Welfare | 53254.pdf |
| Consent to Transfer (Read-Only) | Alcohol and Tobacco Commission | 49930.pdf |
| Consignment Agreement | Secretary of State - Dealer Division | 53608.pdf |
| Construction Completion Affidavit (Read-Only) | Dept. of Environmental Management | 51912.pdf |
| Construction Completion Affidavit | Dept. of Environmental Management | 51912.doc |
| Construction Inspection Report | Dept. of Environmental Management | 53907.doc |
| Construction Notification (Read-Only) | Dept. of Environmental Management | 51911.pdf |
| Construction Notification | Dept. of Environmental Management | 51911.doc |
| Consultant Pharmacist for Health Facilities (Read-Only) | Professional Licensing Agency | 51059.pdf |
| Continuing Education Units For The Indiana Interpreter Certificate (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 50944.pdf |
| Contractor's Bid For Public Work (Read-Only) | Board of Accounts | 52414.pdf |
| Contractor's Bid For Public Work | State Board of Accounts | 52414.doc |
| Contractor's Statement of Experience and Financial Condition (Form CR-1) | Dept. of Transportation | 48048.pdf |
| Corporation Or Educational Institution Elevator Contractor License Application (Read-Only) | Dept. of Homeland Security | 52473.pdf |
| Corporation Or Educational Institution Elevator Contractor License Renewal Application (Read-Only) | Dept. of Homeland Security | 52474.pdf |
| Corrective Action Plan Form SWF-18 (Read-Only) | Dept. of Environmental Management | 50394.pdf |
| Cosmetology Continuing Education Educator Request For Approval Of Additional Courses/Instructors (Read-Only) | Professional Licensing Agency | 50662.pdf |
| Cosmetology Salon Sanitary Rules (Read-Only) | Professional Licensing Agency | 51122.pdf |
| Cosmetology School Sanitary Rules (Read-Only) | Professional Licensing Agency | 51124.pdf |
| County Option Dog Tax (Read-Only) | Dept. of Local Government Finance | 52694.pdf |
| County Treasurer’s Certificate of Tax Collections – Section 1 | Auditor of State | 39821.xls |
| County Verification of Business Location | Alcohol and Tobacco Commission | 44184.pdf |
| Covenants for Traffic Signals & Fence Removals – Authority Affidavit | Dept. of Transportation | 53680.pdf |
| Cover Letter For FI 0014 and FI 0065 | Family & Social Service Admin -- DFR | 49769.pdf |
| Credential and Access Request | Dept. of Administration, Operations | 52044.pdf |
| Credit Card Charge Request (Read-Only) | Dept. of Homeland Security | 53426.pdf |
| Credit Card Charge Request Form (Read-Only) | Dept. of Homeland Security | 52371.pdf |
| Credit Card Charge Request - General | Dept. of Homeland Security | 53518.pdf |
| Credit Union Resolutions Adopted by the Board of Directors (Read-Only) | Dept. of Financial Institutions | 50295.pdf |
| Cremation Authority Registration / Annual Report | Professional Licensing Agency | 50144.pdf |
| CS 0023 Application for OPIOID Treatment Program (OTP) Approval | Family and Social Service Admin. - DMHA | 52685.pdf |
| CS 0024 - Required Documentation for Applicants for Approval as New OPIOID Treatment Programs | Family and Social Service Admin. - DMHA | 52686.pdf |
| CS 0027 - Documentation of Direct Services Providers | Family and Social Service Admin. - DMHA | 52810.pdf |
| CS 0201 - Documentation of Mental Health Services for Compliance with 42 USC 300x-2(c) | Family and Social Service Admin. - DMHA | 53593.pdf |
| CS 0202 - Statement of Understanding of Rule 440 IAC 4.3 | Family and Social Service Admin. - DMHA | 53594.pdf |
| CSB 0010 Employer Online Payment System Website Setup Information | Dept. of Child Services - Child Support Bureau | 51796.pdf |
| CSB 0013 Employer Remittance (Read-Only) | Dept. of Child Services - Child Support Bureau | 51923.pdf |
| CSHCS Enrollment Packet (Read-Only) | Dept. of Health | 49006.pdf |
| CSP-01: Initial Nox Allowance Reservation Request | Dept. of Environmental Management | 53181.doc |
| CW 0001 Record of Training (Read-Only) | Dept. of Child Services - Child Welfare | 46455.pdf |
| CW 0002S Notificación de Revision Periodica del Caso (Read-Only) | Dept. of Child Services - Child Welfare | 52814.pdf |
| CW 0003S Notificación de la Audiencia para Terminar la Relacion Padre-Niño (Read-Only) | Dept. of Child Services - Child Welfare | 53376.pdf |
| CW 0007S Nota de la Revision por Parte del Equipo Proteccion del Niño (Read-Only) | Dept. of Child Services - Child Welfare | 53375.pdf |
| CW 0010S La Consideración de Derechos Legales en Custodia de la Toma de/Completar Una Petición a Nombre de un Niño Alegado para ser un Niño Necesitando de Servicios (Read-Only) | Dept. of Child Services - Child Welfare | 49902.pdf |
| CW 0011S Aviso con Respecto a la Negación o Propuesta Acción para Suspender Asistencia de Adopción (Read-Only) | Dept. of Child Services - Child Welfare | 53378.pdf |
| CW 0015 - Substitute Care Agreement (Read-Only) | Dept. of Child Services - Child Welfare | 47344.pdf |
| CW 0019S - Asistencia de Emergencia - Notificacion de Accion / Emergency Assistance - Notice of Action | Dept. of Child Services - Child Welfare | 53418.pdf |
| CW 0022S Notificacion de Accion(Read-Only) | Dept. of Child Services - Child Welfare | 53423.pdf |
| CW 0023S Reporte de Cambio de Estatus en Niño/Familia (Read-Only) | Dept. of Child Services - Child Welfare | 53416.pdf |
| CW 0024 Notice of Availability of Completed Reports and Information: Investigation of Allegations of Child Abuse or Neglect (Read-Only) | Dept. of Child Services - Child Welfare | 48201.pdf |
| CW 0024S Aviso de Disponibilidad de los Informes e Información Completados: Investigación de Presunto Abuso o Negligencia Infantil (Read-Only) | Dept. of Child Services - Child Welfare | 51886.pdf |
| CW 0025 Applicant's Statement of Attestation | Dept. of Child Services - Child Welfare | 46151.pdf |
| CW 0025S Declaración Testimonial Del Aspirante (Applicant's Statement of Attestation) (Read-Only) | Dept. of Child Services - Child Welfare | 53419.pdf |
| CW 0029 Guardianship Assistance Agreement (Read-Only) | Dept. of Child Services - Child Welfare | 49836.pdf |
| CW 0038 - Medical Report for Household Members (Read-Only) | Dept. of Child Services - Child Welfare | 45144.pdf |
| CW 0039 - Medical Report for Primary Caregivers (Read-Only) | Dept. of Child Services - Child Welfare | 45145.pdf |
| CW 0040 - Safety Plan (Read-Only) | Dept. of Child Services - Child Welfare | 51455.pdf |
| CW 0045 - Consent to Release of Mental Health and Addiction Records | Dept. of Child Services - Child Welfare | 51128.pdf |
| CW 0050 - Application for License to Operate a Children's Home or Child Care Institution (Read-Only) | Dept. of Child Services - Child Welfare | 45158.pdf |
| CW 0051: Application for a License to Operate a Private Secure Facility (Read-Only) | Dept. of Child Services - Child Welfare | 45159.pdf |
| CW 0052 - Consent of Parent, Guardian, or Custodian to Interview Child(ren) (Read-Only) | Dept. of Child Services - Child Welfare | 52013.pdf |
| CW 0100E Indiana Interstate Compact on the Placement of Children Financial/Medical Plan - If Child Is Placed Out-Of-State (Read-Only) | Dept. of Child Services - Child Welfare | 49597.pdf |
| CW 0310 Preliminary Report of Alleged Child Abuse or Neglect (Read-Only) | Dept. of Child Services - Child Welfare | 00114.pdf |
| CW 1331 Consent to Adoption (Read-Only) | Dept. of Child Services - Child Welfare | 12582.pdf |
| CW 1425 Application for License to Operate a Child Placing Agency | Dept. of Child Services - Child Welfare | 47106.pdf |
| CW 2110 - Alternative Training Verification | Dept. of Child Services - Child Welfare | 52643.pdf |
| CW 2113 Application for Emancipation Goods and Services (Read-Only) | Dept. of Child Services - Child Welfare | 52690.pdf |
| CW 2114 Chafee Independent Living (IL) Voluntary Services Application and Service Agreement (Read-Only) | Dept. of Child Services - Child Welfare | 52692.pdf |
| CW 2119 - Foster, Adoptive, & Kinship Training (FAKT) Evaluation of Training | Dept. of Child Services - Child Welfare | 52759.pdf |
| CW 2120 - Foster, Adoptive, & Kinship Training (FAKT) Evaluation of Trainee | Dept. of Child Services - Child Welfare | 52760.pdf |
| CW 2125a - Resource Family Preparation Assessment Cover Page | Dept. of Child Services - Child Welfare | 52795.pdf |
| CW 2128 - Request for a Child Protection Services (CPS) History Check (Read-Only) | Dept. of Child Services - Child Welfare | 52802.pdf |
| CW 2129 - Notice to Parent, Guardian, or Custodian of Interview with Child (Read-Only) | Dept. of Child Services - Child Welfare | 53130.pdf |
| CW 2131 - Child Protection Services Intake Summary | Dept. of Child Services - Child Welfare | 52778.pdf |
| CW 2132 Application for Foster Family Home License: Notice of Automatic System Withdrawal (Read-Only) | Dept. of Child Services - Child Welfare | 53140.pdf |
| CW 2133 Corrective Action Plan Notification: Probation (Read-Only) | Dept. of Child Services - Child Welfare | 53171.pdf |
| CW 2310 - Initial Licensure Requirements Sheet for Foster Family Homes (Read-Only) | Dept. of Child Services - Child Welfare | 53153.pdf |
| CW 2311 - Annual Review Requirements Sheet for Foster Family Homes (Read-Only) | Dept. of Child Services - Child Welfare | 53154.pdf |
| CW 2312 - Relicensure Requirements Sheet for Foster Family Homes (Read-Only) | Dept. of Child Services - Child Welfare | 53155.pdf |
| CW 2321 - Status Report for Completing Foster Family Home Annual Review (Read-Only) | Dept. of Child Services - Child Welfare | 53230.pdf |
| CW 2324 - Notice of Substantiation of Report of Child Abuse or Neglect(Read-Only) | Dept. of Child Services - Child Welfare | 53252.pdf |
| CW 3112 - Visitation Check List | Dept. of Child Services - Child Welfare | 53557.pdf |
| CW 3316 - Direct Vendor Payment Authorization and Certification (Read-Only) | Dept. of Child Services - Child Welfare | 47701.pdf |
| CW 3340 - Voluntary Withdrawal of Application for Licensure or Relinquishment of Foster Family Home License (Read-Only) | Dept. of Child Services - Child Welfare | 53237.pdf |
| CW 3341 - Referral to Medicaid Foster Care Independence Program (Read-Only) | Dept. of Child Services - Child Welfare | 53241.pdf |
| CW 3345 - Independent Living Program: Case Plan for Use by Probation Officer (Read-Only) | Dept. of Child Services - Child Welfare | 53245.pdf |
| CW 3347 - Independent Living Program: Discharge Summary (Read-Only) | Dept. of Child Services - Child Welfare | 53247.pdf |
| CW 3415 - Foster Care / Adoption Information | Dept. of Child Services - Child Welfare | 53184.pdf |
| CW 3416 - Paving the Way to a Decision(Read-Only) | Dept. of Child Services - Child Welfare | 53185.pdf |
| CW 3417 - Foster Family Home Physical Environment Checklist (Read-Only) | Dept. of Child Services - Child Welfare | 53186.pdf |
| CW 3418 - Status Report on Application for Foster Family Home Relicensure (Read-Only) | Dept. of Child Services - Child Welfare | 53187.pdf |
| CW 3425 - Family Support / Community Services Plan (Read-Only) | Dept. of Child Services - Child Welfare | 53243.pdf |
| CW 3517 - Child Behavioral / Health Challenges Checklist (Read-Only) | Dept. of Child Services - Child Welfare | 53199.pdf |
| CW 3610 - Application for Criminal History Background Check (Read-Only) | Dept. of Child Services - Child Welfare | 53259.pdf |
| CW 3611 - Registration for Access to Obtain Name-Based Criminal History Checks(Read-Only) | Dept. of Child Services - Child Welfare | 53324.pdf |
| CW 3618 - Initial Inquiry Regarding Foster Family Home Licensure (Read-Only) | Dept. of Child Services - Child Welfare | 53204.pdf |
| CW 3619 Follow-up Action for Name-Based Check (Read-Only) | Dept. of Child Services - Child Welfare | 53424.pdf |
| Dairy Farm Application for Permit to Sell Raw Milk for Pasteurization (Read-Only) | Board of Animal Health | 38018.pdf |
| DCS 0090 - Ledger of Disbursements and Receipts (Read-Only) | Dept. of Child Services | 37232.pdf |
| DCS 0326 Individual Record - Allowance for Child / Payable from County Welfare Funds by Order of the Court(Read-Only) | Dept. of Child Services - Child Welfare | 30192.pdf |
| DCS 0327 Claim for Support of Children – Payable from Family & Children Funds | Dept. of Child Services - Child Welfare | 28808.pdf |
| DCS 1103 - DCS Transferred Equipment and/or Furniture | Dept. of Child Services | 53619.doc |
| DCS 1105 - Accounts Payable Voucher | Dept. of Child Services | 53786.pdf |
| DDARS Referral and Application (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 10057.pdf |
| Dealer Complaint | Secretary of State - Dealer Division | 53607.pdf |
| Death Report (Read-Only) | Teachers' Retirement Fund | 50790.pdf |
| Death Report (Read-Only) | Teachers' Retirement Fund | 50790.doc |
| Definition of Specialized Services for PAS/ARR (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 46921.pdf |
| Determination of Medicaid Disability - Social Summary for Progress Report | Family and Social Service Administration | 51725.pdf |
| DHHS 0003 Deaf and Hard of Hearing Services Interpreter Service Program (ISP) / Social Services Block Grant (SSBG) Application and Services Registration (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 49452.pdf |
| DHHS 0004, Indiana Interpreter Certificate Application | Family and Social Service Admin. -- Division of Disability and Rehabilitative Services | 49978.pdf |
| DHHS 0008, Indiana Educational Interpreter Certificate Application | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 50945.pdf |
| DHHS 0015, Indiana Educational Interpreter Certificate Application for Renewal | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 52614.pdf |
| DHHS 0016, Indiana Interpreter Certificate Application for Renewal | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 52615.pdf |
| DHHS 0017 Application for Replacement of Indiana Interpreter Certificate or Identification Card | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 52613.pdf |
| DHHS CEU Sponsorship Approval | Family and Social Service Administration -- Division of Disability and Rehabilitative Services | 51381.pdf |
| Direct Deposit Authorization | Dept. of Child Services - Child Support Bureau | 51519.pdf |
| Disability Computation (Read-Only) | Teachers' Retirement Fund | 10358.pdf |
| Disclosure and Payment of Prepaid Contracts Sold | Professional Licensing Agency | 49629.pdf |
| Disclosure For Housing With Services Establishments | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 49028.pdf |
| DNR Tree Seedling Order (Read-Only) | Dept. of Natural Resources - Div. of Forestry | 46766.pdf |
| Documentation of Child Transfer to Another Count | FSSA - Division of Family Resources | 52000.pdf |
| Drycleaner Notification | Dept. of Environmental Management | 48625.doc |
| Drycleaner Notification of Compliance Status | Dept. of Environmental Management | 53430.doc |
| Duplicate Handgun License Request and/or Notification of Name or Address Change | Indiana State Police | 53228.pdf |
| Duplicate Title Affidavit (Read-Only) | Bureau of Motor Vehicles | 22620.pdf |
| DWD 1510 – Waiver of Trade Adjustment Assistance Training Requirement Under the Trade Act of 1974, Amended 1981(Read-Only) | Dept. of Workforce Development | 42923.pdf |
| DWD Form 9 Voluntary Election to Become an Employer under the Indiana Employment and Training Services Act | Dept. of Workforce Development | 48767.pdf |
| DWD Form 10 Application for Termination of Coverage (Read-Only) | Dept. of Workforce Development | 00076.pdf |
| DWD Form 11R Voluntary Election to Extend the Application of the Indiana Employment and Training Services Act Excluded by IC 1971, 22-4-8-2 (j) (3) (A) (i) (ii) | Dept. of Workforce Development | 48766.pdf |
| EC-01 Emission Credit Registry - Generation of Emission Credits (Read-Only) | Dept. of Environmental Management | 51783.pdf |
| EC-01 Emission Credit Registry - Generation of Emission Credits | Dept. of Environmental Management | 51783.doc |
| EC-02 Emission Credit Registry - Transfer of Emission Credits (Read-Only) | Dept. of Environmental Management | 51784.pdf |
| EC-02 Emission Credit Registry - Transfer of Emission Credits | Dept. of Environmental Management | 51784.doc |
| EC-03 Emission Credit Registry - Use of Emission Credits (Read-Only) | Dept. of Environmental Management | 51785.pdf |
| EC-03 Emission Credit Registry - Use of Emission Credits | Dept. of Environmental Management | 51785.doc |
| EC-04 Emission Credit Registry - Emission Credits Request (Read-Only) | Dept. of Environmental Management | 51906.pdf |
| EC-04 Emission Credit Registry - Emission Credits Request | Dept. of Environmental Management | 51906.doc |
| EE-01: Clean Energy Credit Program - Initial Nox Allowance Request (Read-Only) | Dept. of Environmental Management | 52719.pdf |
| EE-01: Clean Energy Credit Program - Initial Nox Allowance Request | Dept. of Environmental Management | 52719.doc |
| EE-02: Clean Energy Credit Program - Notification of Actual Results (Read-Only) | Dept. of Environmental Management | 52720.pdf |
| EE-02: Clean Energy Credit Program - Notification of Actual Results | Dept. of Environmental Management | 52720.doc |
| EE-03: Clean Energy Credit Program - Nox Allowance Reapplication (Read-Only) | Dept. of Environmental Management | 52721.pdf |
| EE-03: Clean Energy Credit Program - Nox Allowance Reapplication | Dept. of Environmental Management | 52721.doc |
| Election for Payees of Nonperiodic Payments (W-4P) (Read-Only) | Teachers' Retirement Fund | 07993.pdf |
| Election to Begin Receiving Benefits (For Elected Officials Age 55 with 20 Years of Service) | Public Employees Retirement Fund | 49287.pdf |
| Election to Begin Receiving Benefits (For members are 70 with 20 years of service) | Public Employees Retirement Fund | |
| Election to Continue or Discontinue Receiving Benefits | Public Employees Retirement Fund | |
| Election to Pay Tax or to Become Liable for Payment in Lieu of Contributions (Read-Only) | Dept. of Workforce Development | 24321.pdf |
| Electrical Grounding & Bonding for Amusement Devices (Read-Only) | Dept. of Homeland Security | 52376.pdf |
| Electrology Salon Sanitary Rules (Read-Only) | Professional Licensing Agency | 51123.pdf |
| Electronic Data Interchange (EDI) Trading Partner Profile - Clearinghouse | Dept. of Health | 51441.pdf |
| Electronic Data Interchange (EDI) Trading Partner Profile - Provider | Dept. of Health | 51401.pdf |
| Elevator Contractor License for an Individual: Renewal Application (Read-Only) | Dept. of Homeland Security | 52380.pdf |
| Elevator Inspector License Renewal Application (Read-Only) | Dept. of Homeland Security | 52471.pdf |
| Elevator Mechanic License Renewal Application (Read-Only) | Dept. of Homeland Security | 52377.pdf |
| Elevator Mechanic Temp. License Application (Read-Only) | Dept. of Homeland Security | 52379.pdf |
| Elevator Mechanic Temp. Renewal License Application (Read-Only) | Dept. of Homeland Security | 52378.pdf |
| Elevator Inspector License Application (Read-Only) | Dept. of Homeland Security | 52342.pdf |
| Emergency Medical Intermediate Application for Reciprocity | Dept. of Homeland Security | 52463.pdf |
| Emergency Medical Technician Application for Reciprocity | Dept. of Homeland Security | 52362.pdf |
| Emergency Medical Technician Basic-Advanced Application for Reciprocity | Dept. of Homeland Security | 52462.pdf |
| Employability Plan (Read-Only) | FSSA - Division of Family Resources | 46205.pdf |
| Employee Attendance Report (A-4) | State Personnel Department | 14304.xls |
| Employee Attendance Report (A-4) | Dept. of Personnel | 14304.pdf |
| Employee Attendance Report (A-4A) | Dept. of Correction | 48781.pdf |
| Employee Benefits Application (Read-Only) | Dept. of Personnel | 53389.pdf |
| Employee Compensatory Time Worksheet | Dept. of Personnel | 42386.pdf |
| Employee Performance Appraisal Comments Sheet | Dept. of Personnel | 05723.pdf |
| Employee Performance Appraisal Comments Sheet | State Personnel Department | 05723.doc |
| Employee Records - SLO Facilities (Read-Only) | Dept. of Health | 53877.doc |
| Employee's Authorization for Release of Medical Information (Read-Only) | Dept. of Personnel | 50107.pdf |
| Employee's Authorization for Release of Medical Information | State Personnel Department | 50107.doc |
| Employee's Claim Statement (Read-Only) | Dept. of Personnel | 45544.pdf |
| Employee's Claim Statement | State Personnel Department | 45544.doc |
| Employee Waiver of Examination by Personal Physician | Workers' Compensation Board | 53913.pdf |
| Employee Work Profile and Performance Appraisal Report (Read-Only) | Dept. of Personnel | 52403.pdf |
| Employee Work Profile and Performance Appraisal Report | State Personnel Department | 52403.doc |
| Employer Contact Information (Read-Only) | Teachers' Retirement Fund | 53142.pdf |
| Employer Contact Information | Teachers' Retirement Fund | 53142.doc |
| Employer Request for Address Change/Correction | Dept. of Workforce Development | 48812.pdf |
| Employer Statement of Employer Provided Vehicle Use (Annual Lease Value Method to be used with the Allowable Personal Use Policy) (Read-Only) | Board of Accounts | 49631.pdf |
| Employer Statement of Employer Provided Vehicle Use (Daily Commuting and Cents Per Mile Methods) (Read-Only) | Board of Accounts | 49632.pdf |
| Employer Certification of Creditable Service & Authorized Leave | Public Employees Retirement Fund | 03422.pdf |
| Employer Certification of School Service | Public Employees Retirement Fund | 47718.pdf |
| Employer's Contribution Adjustment Report (Read-Only) | Dept. of Workforce Development | 44954.pdf |
| Employer’s Report of a 45-Year Rule Employee | Public Employees Retirement Fund | 52514.pdf |
| Employer's Report of Claim (Read-Only) | Dept. of Personnel | 45548.pdf |
| Employer's Report of Claim | State Personnel Department | 45548.doc |
| Employer’s Report of Separation from Employment | Public Employees Retirement Fund | 51563.pdf |
| Employer Report of Wages and Contributions | Public Employees Retirement Fund | 52425.pdf |
| Employment Certificate | Dept. of Labor | 00898.pdf |
| Employment Questionnaire (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 04677.pdf |
| EMT-Intermediate Continuing Education Report | Dept. of Homeland Security | 51249.pdf |
| Enrollment for a School or Charter School as a New Employer (Read-Only) | Teachers' Retirement Fund | 53268.pdf |
| Enrollment for a School or Charter School as a New Employer (Read-Only) | Teachers' Retirement Fund | 53268.doc |
| Enrollment Form For New Members (Read-Only) | Teachers' Retirement Fund | 37680.pdf |
| Enrollment Form For New Members | Teachers' Retirement Fund | 37680.doc |
| Enrollment for New Members Employed by a Charter School (Read-Only) | Teachers' Retirement Fund | 53269.pdf |
| Enrollment for New Members Employed by a Charter School (Read-Only) | Teachers' Retirement Fund | 53269.doc |
| Enteric Bacteriology | Dept. of Health | 13057.pdf |
| Enteric Reference Culture | Dept. of Health | 25601.pdf |
| Enterprise Zone Business Personal Property Tax Credit (Form EZ-1) | Dept. of Local Government Finance | 13620.pdf |
| Enterprise Zone Business Registration (EZB-R) | Economic Development Corporation | 50469.pdf |
| Enterprise Zone Investment Deduction Application (Form EZ-2) | Dept. of Local Government Finance | 52501.pdf |
| Environmental Disclosure for Transfer of Real Property | Dept. of Environmental Management | 52653.pdf |
| Environmental Disclosure for Transfer of Real Property | Dept. of Environmental Management | 52653.doc |
| Equipment - Cooperative Agreement - Appendix I.C. (Read-Only) | Family and Social Service Administration | 24223.pdf |
| Equipment List For New Additions To Era Deduction Personal Property In Economic Revitalization Area (Form 103-EL) | Dept. of Local Government Finance | 52515.pdf |
| Equipment Schedule (Read-Only) | Family and Social Service Administration | 47391.pdf |
| Esthetic Salon Sanitary Rules (Read-Only) | Professional Licensing Agency | 51332.pdf |
| Estimate Information (Read-Only) | Teachers' Retirement Fund | 34864.pdf |
| Estimate Information | Teachers' Retirement Fund | 34864.doc |
| ETA 81 - Initial Application for Disaster Unemployment Assistance | Dept. of Workforce Development | 53667.pdf |
| ETA 81A - Supplemental Application for Disaster Unemployment Assistance | Dept. of Workforce Development | 53668.pdf |
| ETA 83 - Weekly Request for Assistance (Disaster Relief Act of 1974) | Dept. of Workforce Development | 53669.pdf |
| ETA 855 – Request for Determination of Entitlement to Trade Readjustment Allowance Under the Trade Act of 1974, Amended 1981(Read-Only) | Dept. of Workforce Development | 03680.pdf |
| ETA 860 – Request for Relocation Allowances Under the Trade Act of 1974, Amended 1981 (Read-Only) | Dept. of Workforce Development | 43117.pdf |
| Evaluation of Field Mentor by Supervisor of Trainee | Dept. of Child Services - Child Welfare | 53205.pdf |
| Evaluation of Training (Read-Only) | State Personnel Department | 45910.doc |
| Executive Document Summary NOTE: The above is now a link to the online application form (through Peoplesoft) on the IDOA website. |
Dept. of Administration | 41221 |
| Excess Liability Trust Fund Application (Read-Only) | Dept. of Environmental Management | 47139.pdf |
| Facilities Use Request | Law Enforcement Academy | 49152.pdf |
| Facility Facts Record | Family and Social Service Admin. - DMHA | 48160.pdf |
| Facility Specific Operator (FSO) Application for Water Treatment Plant & Water Distribution System Operator Certification (Read-Only) | Dept. of Environmental Management | 53210.pdf |
| Facility Specific Operator (FSO) Application for Water Treatment Plant & Water Distribution System Operator Certification | Dept. of Environmental Management | 53210.doc |
| Falconry Notification and Acquisition Request (Read-Only) | DNR, Fish and Wildlife | 21935.pdf |
| Family Information Update | Family & Social Service Admin. / DFR | 51358.pdf |
| Farmer's Tangible Personal Property Assessment Return (Form 102) | Dept. of Local Government Finance | 50006.pdf |
| Fax/Incident Report (Read-Only) | Dept. of Health | 50761.pdf |
| FED-01: Summary of Federal Requirements – NSPS & NESHAP | Dept. of Environmental Management | 53512.pdf |
| FED-01: Summary of Federal Requirements – NSPS & NESHAP | Dept. of Environmental Management | 53512.doc |
| Federal and Indiana State Income Tax Withholding for Monthly Benefit (Read-Only) | Teachers' Retirement Fund | 53465.pdf |
| Federal and Indiana State Income Tax Withholding for Monthly Benefit | Teachers' Retirement Fund | 53465.doc |
| Federal Excess Personal Property (FEPP) Addendum | DNR, Forestry Division | 50307.pdf |
| FESOP Renewal Permit Application | Dept. of Environmental Management | 50083.pdf |
| FI 0006C - Statement of Medical Condition for the Food Stamp and Temporary Assistance for Needy Families Programs | Family and Social Service Admin -- Division of Family Resources | 31662.pdf |
| FI 0009 - Notice Regarding Rights and Responsibilities | Family and Social Service Admin -- Division of Family Resources | 47990.pdf |
| FI 0009S - Aviso Relacionado con los Derechos y las Responsabilidades (Read-Only) | Family and Social Service Admin -- Division of Family Resources | 48398.pdf |
| FI 0010S Acuerdo de Responsibilidad Personal (read-only) | Family and Social Service Administration | 47971.pdf |
| FI 0019 - Request for Information from Indiana Dept. of Revenue | FSSA - Division of Family Resources | 34970.pdf |
| FI 0033 - EBT Daily Log For Card Issuance | FSSA - Division of Family Resources | 50158.pdf |
| FI 0113, Complaint Call / Report of Fraud | FSSA - Division of Family Resources | 54013.pdf |
| FI 0425B Case disposition Regarding Exemption from Cooperation in Child Support and/or Medical Support Enforcement | FSSA - Division of Family Resources | 23858.pdf |
| FI 2009 Medical Assignment Good Cause Notice (Read-Only) | Family and Social Service Admin -- Division of Family Resources | 06905.pdf |
| FI 2033 Application for Medicare Savings Program (QMB, SLMB, QI) | FSSA - Division of Family Resources | 49228.pdf |
| FI 2236S - Exención del Derecho a una Audiencia Administrativa de Descalificación | FSSA - Division of Family Resources | 51935.pdf |
| FI 2400 Application for Assistance - Part I - Food Stamps, Cash Assistance, Health Coverage (Read-Only) | FSSA - Division of Family Resources | 30465.pdf |
| FI 2400S Solicitud para Asistencia / Cupones para Alimentos, Asistencia Financiera, Cobertura de Salud (Read-Only) | FSSA - Division of Family Resources | 48399.pdf |
| FI 2420 Report of Change | FSSA - Division of Family Resources | 44151.pdf |
| FI 2511 - Consent for Release of Information | FSSA - Division of Family Resources | 53207.pdf |
| FI 2511S - Consentimiento para Revelar of Información | FSSA - Division of Family Resources | 53318.pdf |
| FI HCI 0001 - Application for Hospital Care For The Indigent | FSSA - Division of Family Resources | 27097.pdf |
| Field Tile Monitoring At Land Application Sites (Personal Document) (Read-Only) | Dept. of Environmental Management | 51910.pdf |
| Field Tile Monitoring At Land Application Sites (Personal Document) | Dept. of Environmental Management | 51910.doc |
| Final Description and Elevation of Bench Marks (Crawfordsville District) | Dept. of Transportation | 03031.pdf |
| Final Description and Elevation of Bench Marks (Fort Wayne District) | Dept. of Transportation | 52784.pdf |
| Final Description and Elevation of Bench Marks (Greenfield District) | Dept. of Transportation | 52785.pdf |
| Final Description and Elevation of Bench Marks (LaPorte District) | Dept. of Transportation | 52786.pdf |
| Final Description and Elevation of Bench Marks (Seymour District) | Dept. of Transportation | 52787.pdf |
| Final Description and Elevation of Bench Marks (Vincennes District) | Dept. of Transportation | 52788.pdf |
| Final Report for Organic Projects - Indiana Recycling Grant Program (Read-Only) | Dept. of Environmental Management | 51984.pdf |
| Final Report for Organic Projects - Indiana Recycling Grant Program | Dept. of Environmental Management | 51984.doc |
| Final Report for Pollution Prevention Grant Program (Read-Only) | Dept. of Environmental Management | 53587.pdf |
| Final Report for Pollution Prevention Grant Program | Dept. of Environmental Management | 53587.doc |
| Final Report for Recycling Projects - Indiana Recycling Grant Program (Read-Only) | Dept. of Environmental Management | 51985.pdf |
| Final Report for Recycling Projects - Indiana Recycling Grant Program | Dept. of Environmental Management | 51985.doc |
| Financial Aid Communications (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitative Services | 41378.pdf |
| Financial Disclosure Statement (Read-Only) | Inspector General - Ethics Commission | 40876.pdf |
| Financial Profile | Dept. of Agriculture | 01349.pdf |
| Financial Report of Boxing Promoter | Professional Licensing Agency | 09903.pdf |
| Financial Report Submission Sheet | Commission on Proprietary Education | 39285.pdf |
| Financial Statement | Dept. of Child Services - Child Support Bureau | 51798.pdf |
| Firefighter I / II Practical Skills Exam | Dept. of Homeland Security | 52664.pdf |
| Fire Instructor II / III Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53524.pdf |
| Fire Investigator Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53525.pdf |
| Fire Officer I Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53526.pdf |
| Fire Officer II Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53527.pdf |
| Fire Officer III Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53528.pdf |
| Fireworks Injury Reporting (Read-Only) | Dept. of Health | 51497.pdf |
| First Order for License Agent (Read-Only) | DNR, Fish and Wildlife | 46278.pdf |
| First Report of Employee Injury/Illness (Read-Only) | Worker's Compensation Board | 34401.pdf |
| First Responder Application for Reciprocity | Dept. of Homeland Security | 52464.pdf |
| First Steps 30 Month Notice to Local Education Agency (LEA) | Family and Social Service Admin -- Division of Family Resources | 51673.pdf |
| First Steps Cost Participation Co-Payment (Read-Only) | Family and Social Service Admin -- Division of Family Resources | 51361.pdf |
| First Steps Cost Participation Financial Deduction Worksheet (Read-Only) | Family and Social Service Admin -- Division of Family Resources | 51359.pdf |
| First Steps Documentation of Team Discussion | Family and Social Service Admin -- Division of Family Resources | 51928.pdf |
| First Steps Early Intervention System Documentation Of Receipt Of Rights / Consent To Proceed / Permission To Assess (Read-Only) | Family and Social Service Admin -- Division of Family Resources | 51842.pdf |
| First Steps Private Medical Insurance Consent (Read-Only) | FSSA - Division of Family Resources | 51308.pdf |
| First Steps Transitional Meeting Minutes | Family and Social Service Admin -- Division of Family Resources | 51674.pdf |
| Fish Destination Report (Read-Only) | Board of Animal Health | 53489.pdf |
| Fish Destination Report (Read-Only) | Board of Animal Health | 53489.xls |
| Fixed Asset Inventory | Auditor of State | 39598.pdf |
| FM 0411 Claim for Reimbursement_Expenditures - Approved District Plans - Title | Family and Social Service Administration | 45529.pdf |
| FM 0412 Certification to the Dept. of Child Services_Expenditures - Approved District Plans - Title | Family and Social Service Administration | 45530.pdf |
| Forest Legacy Application & Application Instructions (Read-Only) | DNR, Forestry Division | 50306.pdf |
| Forest Stewardship Challenge Grant Program -- Year 2002 | DNR, Forestry Division | 50782.pdf |
| Forgery Affidavit (Read-Only) | Teacher's Retirement Fund | 52660.pdf |
| Form 11 C/I - Notice of Assessment of Land and Structures | Dept. of Local Government Finance | 45650.pdf |
| Form 11 R/A - Notice of Assessment of Land and Structures | Dept. of Local Government Finance | 21366.pdf |
| Form 14 – Township Report to County Assessor | Dept. of Local Government Finance | 21368.pdf |
| Form 105 – Settlement Sheet | Auditor of State | 01332.xls |
| Form 113 - Notice of Assessment by Assessing Official | Dept. of Local Government Finance | 46725.pdf |
| Form 113 / PP - Notice of Assessment / Change (By an Assessing Official) | Dept. of Local Government Finance | 21521.pdf |
| Form 130 – Petition for Review of Assessment by Local Assessing Official – Property Tax Assessment Board of Appeals | Dept. of Local Government Finance | 21513.pdf |
| Form 130–Short – Taxpayer’s Notice to Initiate an Appeal | Dept. of Local Government Finance | 53958.pdf |
| Form 137PF – Petition for Survey and Reassessment Real Property that is Permanently Flooded or Access is Permanently Prevented by Flooding | Dept. of Local Government Finance | 53950.pdf |
| Form 137R - Petition for Survey and Reassessment-Real and Personal Property Partially or Totally Destroyed by Disaster | Dept. of Local Government Finance | 17592.pdf |
| Form 137 TP – Petition for Waiver of Penalties Against a Taxpayer or Taxpayer’s Representative on Real or Personal Property | Dept. of Local Government Finance | 53165.pdf |
| Form FLML B – First Lien Mortgage Lending Surety Bond | Dept. of Financial Institutions | 53690.pdf |
| Form HC10 - Claim for Homestead Property Tax Standard / Supplemental Deduction | Dept. of Local Government Finance | 05473.pdf |
| Form LB 1, Application for License as a Loan Broker | Secretary of State - Securities Division | 38168.pdf |
| Form LB 2, Ultimate Equitable Owner Information | Secretary of State - Securities Division | 53271.pdf |
| Form LB 3, Branch Office Notification | Secretary of State - Securities Division | 53264.pdf |
| Form LB 4, Application for Registration as a Principal Manager or an Originator | Secretary of State - Securities Division | 49718.pdf |
| Form LB 5, Claim of Exemption | Secretary of State - Securities Division | 53265.pdf |
| Fuel Log - Other State Agencies (Read-Only) | Indiana State Police | 44383.pdf |
| Funeral Director Continuing Education Sponsor Request for Approval of Additional Courses | Professional Licensing Agency | 51391.pdf |
| Funeral Director IDRS Confidentiality Agreement | Dept. of Health | 53757.pdf |
| Future Traffic Signal Covenant | Dept. of Transportation | 52788.pdf |
| Gasoline and Oil Report | Dept. of Natural Resources - Div. of Forestry | 02125.pdf |
| Gasoline Transport Inspection 326 IAC 8-4-7 & 8-4-9 | Dept. of Environmental Management | 49363.pdf |
| General Vapor Recovery Inspection 326 IAC 8-4-6, 8-4-7, & 8-4-9 | Dept. of Environmental Management | 49362.pdf |
| Genesis Series Nomination - Three-Year Old Fillies (Read-Only) | Horse Racing Commission | 49805.pdf |
| Ginseng Dealer's No-Activity Verification (Read-Only) | DNR, Division of Nature Preserves | 50416.pdf |
| Good Character Disclosure Statement (Read-Only) | Dept. of Environmental Management | 50400.pdf |
| Good Character Disclosure Statement | Dept. of Environmental Management | 50400.doc |
| Goose Collar Report | DNR -- Division of Fish and Wildlife | 50882.pdf |
| Governor's Environmental Art Challenge Entry (Read-Only) | Dept. of Environmental Management | 51756.pdf |
| Governor's Environmental Art Challenge Entry | Dept. of Environmental Management | 51756.doc |
| Grant Expenditure Report - Indiana Recycling & HHW Grant Programs (Read-Only) | Dept. of Environmental Management | 51986.pdf |
| Grant Expenditure Report - Indiana Recycling & HHW Grant Programs | Dept. of Environmental Management | 51986.doc |
| Grant Expenditure Report - Pollution Prevention Grant Programs (Read-Only) | Dept. of Environmental Management | 53585.pdf |
| Grant Expenditure Report - Pollution Prevention Grant Programs | Dept. of Environmental Management | 53585.doc |
| Green Certification Departure Request | DNR, Forestry Division | 53720.doc |
| GSD-01 General Source Data - Basic Source Level Information (Read-Only) | Dept. of Environmental Management | 50640.pdf |
| GSD-01 General Source Data - Basic Source Level Information | Dept. of Environmental Management | 50640.doc |
| GSD-02 General Source Data - Plant Layout Diagram (Read-Only) | Dept. of Environmental Management | 51605.pdf |
| GSD-02 General Source Data - Plant Layout Diagram | Dept. of Environmental Management | 51605.doc |
| GSD-03 General Source Data - Process Flow Diagram (Read-Only) | Dept. of Environmental Management | 51599.pdf |
| GSD-03 General Source Data - Process Flow Diagram | Dept. of Environmental Management | 51599.doc |
| GSD-04 General Source Data - Stack / Vent Information (Read-Only) | Dept. of Environmental Management | 51606.pdf |
| GSD-04 General Source Data - Stack / Vent Information | Dept. of Environmental Management | 51606.doc |
| GSD-05 General Source Data - Emissions Unit Information (Read-Only) | Dept. of Environmental Management | 51610.pdf |
| GSD-05 General Source Data - Emissions Unit Information | Dept. of Environmental Management | 51610.doc |
| GSD-06 General Source Data - Particulate Emissions Summary (Read-Only) | Dept. of Environmental Management | 51612.pdf |
| GSD-06 General Source Data - Particulate Emissions Summary | Dept. of Environmental Management | 51612.doc |
| GSD-07 General Source Data - Criteria Pollutant Emissions Summary (Read-Only) | Dept. of Environmental Management | 51602.pdf |
| GSD-07 General Source Data - Criteria Pollutant Emissions Summary | Dept. of Environmental Management | 51602.doc |
| GSD-08 General Source Data - Hazardous Air Pollutant Emissions Summary (Read-Only) | Dept. of Environmental Management | 51604.pdf |
| GSD-08 General Source Data - Hazardous Air Pollutant Emissions Summary | Dept. of Environmental Management | 51604.doc |
| GSD-09 General Source Data - Summary of Additional Information (Read-Only) | Dept. of Environmental Management | 51611.pdf |
| GSD-09 General Source Data - Summary of Additional Information | Dept. of Environmental Management | 51611.doc |
| GSD-10 General Source Data - Insignificant Activities (Read-Only) | Dept. of Environmental Management | 51596.pdf |
| GSD-10 General Source Data - Insignificant Activities | Dept. of Environmental Management | 51596.doc |
| GSD-11 General Source Data - Alternative Operating Scenario Summary (Read-Only) | Dept. of Environmental Management | 51601.pdf |
| GSD-11 General Source Data - Alternative Operating Scenario Summary | Dept. of Environmental Management | 51601.doc |
| GSD-12 General Source Data - Affidavit of Nonapplicability (Read-Only) | Dept. of Environmental Management | 51600.pdf |
| GSD-12 General Source Data - Affidavit of Nonapplicability | Dept. of Environmental Management | 51600.doc |
| GSD-13 General Source Data - Affidavit of Applicability (Read-Only) | Dept. of Environmental Management | 51603.pdf |
| GSD-14 General Source Data - Owners and Occupants Notified (Read-Only) | Dept. of Environmental Management | 51609.pdf |
| GSD-15 General Source Data - Government Officials Notified (Read-Only) | Dept. of Environmental Management | 51608.pdf |
|
|
|
|
| Hazardous Waste Biennial Report CC (Read-Only) | Dept. of Environmental Management | 52387.pdf |
| Hazardous Waste Biennial Report CC | Dept. of Environmental Management | 52387.doc |
| Hazardous Waste Biennial Report GM (Read-Only) | Dept. of Environmental Management | 52388.pdf |
| Hazardous Waste Biennial Report GM | Dept. of Environmental Management | 52388.doc |
| Hazardous Waste Biennial Report OI (Read-Only) | Dept. of Environmental Management | 52389.pdf |
| Hazardous Waste Biennial Report OI | Dept. of Environmental Management | 52389.doc |
| Hazardous Waste Biennial Report WM (Read-Only) | Dept. of Environmental Management | 52390.pdf |
| Hazardous Waste Biennial Report WM | Dept. of Environmental Management | 52390.doc |
| Hazardous Waste Biennial Report WR (Read-Only) | Dept. of Environmental Management | 52391.pdf |
| Hazardous Waste Biennial Report WR | Dept. of Environmental Management | 52391.doc |
| Hazardous Waste Facility Permit Fee Transmittal (Read-Only) | Dept. of Environmental Management | 47214.doc |
| Hazardous Waste Generator Tank Survey (Read-Only) | Dept. of Environmental Management | 52386.pdf |
| Hazardous Waste Generator Tank Survey | Dept. of Environmental Management | 52386.doc |
| Hazardous Waste Transfer Facilities Notification (Read-Only) | Dept. of Environmental Management | 52123.pdf |
| Hazardous Waste Transfer Facilities Notification | Dept. of Environmental Management | 52123.doc |
| Healthcare Program for Childcare Centers (Read-Only) | FSSA - Div. of Family Resources | 45877.pdf |
| Health Officials/Pools & Spas/Beaches & Lakes Report | Dept. of Health | 36740.pdf |
| HHW/CESQG Materials Reporting - Indiana HHW Grant Program (Read-Only) | Dept. of Environmental Management | 51989.pdf |
| HHW/CESQG Materials Reporting - Indiana HHW Grant Program | Dept. of Environmental Management | 51989.doc |
| HIP 2514 Authorization for Release of Medical Information - Healthy Indiana Plan (Read-Only) | FSSA - Division of Family Resources | 53405.pdf |
| HIP 2515 Application for Healthy Indiana Plan (Read-Only) | FSSA - Division of Family Resources | 53421.pdf |
| HIP 2515S Aplicación Plan de Salud de Indiana (Read-Only) | FSSA - Division of Family Resources | 53422.pdf |
| HIP 2518 Healthy Indiana Plan - POWER Account Payment Status (Read-Only) | FSSA - Division of Family Resources | 53427.pdf |
| HIP 2519 Report of Change - Healthy Indiana Plan (Read-Only) | FSSA - Division of Family Resources | 53428.pdf |
| HIP 2521 Notice of Action - Healthy Indiana Plan (Read-Only) | FSSA - Division of Family Resources | 53453.pdf |
| HIPAA Complaint | Dept. of Health | 51512.pdf |
| Historic Preservation Fund Acquisition and Development Grant Application Packet | Dept. of Natural Resources - Division of Historic Preservation and Archaeology | 50554.pdf |
| Historic Preservation Fund Archaeological Grant Application Packet | Dept. of Natural Resources - Division of Historic Preservation and Archaeology | 50553.pdf |
| Historic Preservation Fund Architectural and Historical Grant Application Packet | Dept. of Natural Resources - Division of Historic Preservation and Archaeology | 50552.pdf |
| Historic Preservation Fund - Grant Manual Fiscal Year 2009 (Read-Only) | Dept. of Natural Resources - Division of Historic Preservation and Archaeology | 50866.pdf |
| Historic Preservation Fund - Grant Manual Fiscal Year 2009 (Read-Only) | Dept. of Natural Resources - Division of Historic Preservation and Archaeology | 50866.doc |
| Home Health Aide Registry Application (Read-Only) | Dept. of Health | 49560.pdf |
| Home Health Aide Registry Renewal | Dept. of Health | 49561.doc |
| Home Health Report (Read-Only) | Dept. of Health | 51449.pdf |
| Hoosier Homestead Award Application (Read-Only) | Office of the Commissioner of Agriculture | 28547.pdf |
| Hoosier Homestead Award Application | Office of the Commissioner of Agriculture | 28547.wpd |
| Hoosier Homestead Award Certificate Order (Read-Only) | Office of the Commissioner of Agriculture | 49570.pdf |
| Hoosier Homestead Certificate, Sign and Photograph Order Form (Read-Only) | Office of the Commissioner of Agriculture | 49572.pdf |
| Hoosier Newspaper Press Release (Read-Only) | Office of the Commissioner of Agriculture | 50246.pdf |
| Hoosier Homestead Sign Order Form (Read-Only) | Office of the Commissioner of Agriculture | 49571.pdf |
| Hoosier Water Guardian Award Application | Dept. of Environmental Management | 53248.pdf |
| Hospice Authorization Notice For Dually-Eligible Medicare/Medicaid Nursing Facility Residents | Family and Social Service Administration | 51098.pdf |
| Hospice Provider Change Request Between Indiana Hospice Providers | Family and Social Service Administration | 48733.pdf |
| Hospital / CAH Medicare Database Worksheet (Read-Only) | Dept. of Health | 51865.pdf |
| Hospital Fiscal Report (Read-Only) | Dept. of Health | 49520.pdf |
| Hospital IBRS / IDRS Confidentiality Agreement | Dept. of Health | 53756.pdf |
| Hospital Service Report (Read-Only) | Dept. of Health | 49476.pdf |
| Household Hazardous Waste Grant Application - Indiana Household Hazardous Waste Grant Programs (Read-Only) | Dept. of Environmental Management | 51899.pdf |
| Household Hazardous Waste Grant Application - Indiana Household Hazardous Waste Grant Programs | Dept. of Envionmental Management | 51899.doc |
| Household Hazardous Waste Grant Final Report - Indiana HHW Grant Program (Read-Only) | Dept. of Environmental Management | 51991.pdf |
| Household Hazardous Waste Grant Final Report - Indiana HHW Grant Program | Dept. of Environmental Management | 51991.doc |
| Household Hazardous Waste Grant Progress Report - Indiana HHW Grant Program (Read-Only) | Dept. of Environmental Management | 51990.pdf |
| Household Hazardous Waste Grant Progress Report - Indiana HHW Grant Program | Dept. of Environmental Management | 51990.doc |
| Household Hazardous Waste (HHW) Data - Indiana HHW Grant Program (Read-Only) | Dept. of Environmental Management | 52509.pdf |
| How Are We Doing? (VRS 0009) (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 47234.pdf |
| How Are We Doing? (VRS 0015) (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 47204.pdf |
| HVAC-R Contractors' Pledge (Read-Only) | Dept. of Environmental Management | 49682.pdf |
| IC-730 Request for Approval of Subcontractor (Read-Only) | Dept. of Transportation | 04351.pdf |
| IC-730 Request for Approval of Subcontractor | Dept. of Transportation | 04351.xls |
| IDEM Complaint Form | Dept. of Environmental Management | 50014.pdf |
| IDEM Complaint Form | Dept. of Environmental Management | 50014.doc |
| IDEM Earth Day Celebration Speaker Request | Dept. of Environmental Management | 53454.pdf |
| IDEM Earth Day Celebration Speaker Request | Dept. of Environmental Management | 53454.doc |
| IDEM Poster Contest Entry | Dept. of Environmental Management | 53848.pdf |
| IDEM Poster Contest Entry | Dept. of Environmental Management | 53848.doc |
| IDEM Public Service Announcement (PSA) Contest Entry | Dept. of Environmental Management | 53847.pdf |
| IDEM Public Service Announcement (PSA) Contest Entry | Dept. of Environmental Management | 53847.doc |
| Identification of Potentially Affected Parties | Dept. of Environmental Management | 49456.pdf |
| Identification of Potentially Affected Parties (Read-Only) | Dept. of Environmental Management | 49456.doc |
| Identification of Potentially Affected Persons (Read-Only) | Dept. of Environmental Management | 49635.pdf |
| Identification of Potentially Affected Persons | Dept. of Environmental Management | 49635.doc |
| IE/LT1 SWTR Combined Filter Effluent Turbidity | Dept. of Environmental Management | 53294.pdf |
| Immediate Jeopardy Notification (Read-Only) | Dept. of Health | 50814.doc |
| Immunization Data Removal | Dept. of Health | 52308.pdf |
| IMP 0002 Community Work Experience Program Agreement (CWEP) (Read-Only) | FSSA - Division of Family Resources | 46516.pdf |
| IMP 0007 Self-Sufficiency Plan for Impact Client | FSSA - Division of Family Resources | 47194.pdf |
| IMP 0029 - IMPACT Memorandum | FSSA - Division of Family Resources | 48830.pdf |
| IMP 0032 Impact Responsibilities, Sanctions, and Rights / Voluntary Clients and TANF Minors (Read-Only) | FSSA - Division of Family Resources | 49049.pdf |
| IMP 0033 Impact Responsibilities, Sanctions, and Rights / Mandatory Adult Clients (Read-Only) | FSSA - Division of Family Resources | 49029.pdf |
| IMP 2210 Notice of Noncompliance with Impact (Employment and Training) Requirements | FSSA - Division of Family Resources | 25385.pdf |
| IMP 2210S - Aviso De Imcumplimiento Con Los Requisitos De Impact (Empleo Y Capacitación) (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 43041.pdf |
| IMP 2641B, Claim Voucher – Food Stamps | FSSA - Division of Family Resources | 45636.pdf |
| IMPACT Client Agreement (Read-Only) | FSSA - Division of Family Resources | 48419.pdf |
| IMPACT Referral (Read-Only) | FSSA - Division of Family Resources | 46755.pdf |
| IMPACT Report - Family Case Coordinator Monthly Referrals (Read-Only) | FSSA - Division of Family Resources | 47576.pdf |
| IMPACT Vocational or Job Skills Training -- Financial Information (Read-Only) | FSSA - Division of Family Resources | 48418.pdf |
| Incarcerated Youth Offenders (Specter) Grant Application | State Student Assistance Commission | 50525.pdf |
| Incident Report | Family and Social Service Administration - DDARS | 51677.xls |
| Incident Report (Read-Only) | Family & Social Svc. Admin. - Division of Disability and Rehabilitation | 51677.pdf |
| Independent Living Transition Planning Toolkit (Read-Only) | Dept. of Child Services - Child Welfare | 52691.pdf |
| Independent Verification of Assets and Liabilities (Read-Only) | Dept. of Health | 51996.pdf |
| Indiana 5-Star Environmental Recognition Program for Child Care Facilities Application | Dept. of Environmental Management | 49200.pdf |
| Indiana 5-Star Environmental Recognition Program for Metal Finishers -- Information packet and Application | Dept. of Environmental Management | 50214.pdf |
| Indiana Adoption History Registration - Identifying Information Consent (Read-Only) | Dept. of Health | 47896.pdf |
| Indiana Adoption History Registration - Nonidentifying Information Consent (Read-Only) | Dept. of Health | 47897.pdf |
| Indiana Adoption Medical History Registry (Read-Only) | Dept. of Health | 13342.pdf |
| Indiana Adoption Medical History Report (Read-Only) | Dept. of Health | 09966.pdf |
| Indiana Architect Reference (Read-Only) | Professional Licensing Agency | 50535.pdf |
| Indiana Best Management Practices Cost Share Application | DNR, Forestry Division | 50308.pdf |
| Indiana Board of Pharmacy Change of Qualifying Pharmacist (Read-Only) | Professional Licensing Agency | 01572.pdf |
| Indiana Board of Pharmacy Continuing Education (C.E.) Application (Read-Only) | Professional Licensing Agency | 50689.pdf |
| Indiana Board of Pharmacy Inspection Report (Read-Only) | Professional Licensing Agency | 35890.pdf |
| Indiana Brownfields Program Comfort/Site Status Letter Request | Dept. of Environmental Management | 51493.pdf |
| Indiana Brownfields Program Comfort/Site Status Letter Request | Dept. of Environmental Management | 51493.doc |
| Indiana Business Entity Report | Secretary of State - Business Services Division | 48725.pdf |
| Indiana Casino Owner's License Reinvestigation | Gaming Commission | 49985.pdf |
| Indiana Clean Boater Pledge (Read-Only) | Dept. of Environmental Management | 53581.pdf |
| Indiana CLEAN Community Challenge Annual Performance Report | Dept. of Environmental Management | 53116.pdf |
| Indiana CLEAN Community Challenge Annual Performance Report | Dept. of Environmental Management | 53116.doc |
| Indiana CLEAN Community Challenge Program Application | Dept. of Environmental Management | 51826.doc |
| Indiana Clean Marina Pledge (Read-Only) | Dept. of Environmental Management | 53582.pdf |
| Indiana Clean Marina Program Designation Checklist (Read-Only) | Dept. of Environmental Management | 53567.pdf |
| Indiana Clean Yard – Best Management Practices Checklist | Dept. of Environmental Management | 53924.doc |
| Indiana Conservation Field Officer Performance Appraisal Report (Read-Only) | DNR - Division of Law Enforcement | 51568.pdf |
| Indiana Conservation Officer 28-Day Attendance Report (Read-Only) | DNR - Division of Law Enforcement | 37031.pdf |
| Indiana Conservation Officer Performance Appraisal Comment Report (Read-Only) | DNR - Division of Law Enforcement | 51569.pdf |
| Indiana Conservation Staff Performance Appraisal Report (Read-Only) | DNR - Division of Law Enforcement | 51637.pdf |
| Indiana Dept. of Environmental Management Notification of Demolition and Renovation Operations | Dept. of Environmental Management | 44593.pdf |
| Indiana Department of Natural Resources Notification of Ejection from DNR Property | DNR -- Division of State Parks & Reservoirs | 49243.pdf |
| Indiana Disaster Assistance Program | Dept. of Homeland Security | 53313.pdf |
| Indiana Economic Impact - Proposals and Contracts | Dept. of Administration | 51778.xls |
| Indiana Economic Impact - Proposals and Contracts (Read-Only) | Dept. of Administration | 51778.pdf |
| Indiana Environmental Stewardship Program Annual Performance Report | Dept. of Environmental Management | 53475.doc |
| Indiana Environmental Stewardship Program Application (Read-Only) | Dept. of Environmental Management | 52772.pdf |
| Indiana Environmental Stewardship Program Application | Dept. of Environmental Management | 52772.doc |
| Indiana Environmental Stewardship Program Checklist for Potential Regulatory Incentives | Dept. of Environmental Management | 53706.pdf |
| Indiana Environmental Stewardship Program Checklist for Potential Regulatory Incentives | Dept. of Environmental Management | 53706.doc |
| Indiana First Steps Early Intervention System - Exit Summary | Family and Social Service Admin -- Division of Family Resources | 51310.pdf |
| Indiana First Steps Early Intervention System - Family Interview | Family and Social Service Admin -- Division of Family Resources | 51313.pdf |
| Indiana Gambling Game License Application (Read-Only) | Gaming Commission | 53554.pdf |
| Indiana Game Breeder’s License Inventory & Transaction Record (Read-Only) | DNR -- Division of Fish and Wildlife | 50650.pdf |
| Indiana Gaming Commission Complaint Form (Read-Only) | Gaming Commission | 51676.pdf |
| Indiana Gaming Commission Complaint Form | Gaming Commission | 51676.doc |
| Indiana Health Care Professional Recruitment and Retention Fund - Student Loan Repayment Application Primary Care Health Professional Application (Read-Only) | Dept. of Health | 50775.pdf |
| Indiana Initial Refugee Health Assessment (Read-Only) | Dept. of Health | 53700.pdf |
| Indiana Junketeer Certificate of Registration Application | Gaming Commission | 53687.pdf |
| Indiana Junket Operator Certificate of Registration Application | Gaming Commission | 53686.pdf |
| Indiana Landscape Architect Reference (Read-Only) | Professional Licensing Agency | 44670.pdf |
| Indiana Mare Registration (Read-Only) | Horse Racing Commission | 53921.pdf |
| Indiana Nongame Fund Donation (Read-Only) | DNR -- Division of Fish and Wildlife | 50883.pdf |
| Indiana Occupational Therapy Committee Affirmation of Supervision (Read-Only) | Professional Licensing Agency | 52567.pdf |
| Indiana Organic Certification Cost Share Program Application (Read-Only) | Commissioner of Agriculture | 51338.pdf |
| Indiana PAS/PASRR Program Fax Cover Sheet (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 47178.pdf |
| Indiana PASARR/MI Program - CMHC ARR Referral Checklist (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 47184.pdf |
| Indiana PASARR Program - Dementia Assessment Checklist (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 47182.pdf |
| Indiana PASRR Program - Screen For Depression (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 47179.pdf |
| Indiana Pollution Prevention Grant Program Application | Dept. of Environmental Management | 53334.doc |
| Indiana Property Tax Benefits (Read-Only) | Dept. of Local Government Finance | 51781.pdf |
| Indiana Putative Father Registration (Read-Only) | Dept. of Health | 46750.pdf |
| Indiana Real Estate Commission Branch Office Registration | Professional Licensing Agency | 49384.pdf |
| Indiana State Income Tax Withholding for Lump Sum Distribution (Read-Only) | Teachers' Retirement Fund | 53466.pdf |
| Indiana State Income Tax Withholding for Lump Sum Distribution | Teachers' Retirement Fund | 53466.doc |
| Indiana Voter Registration Application | Election Division | 50504.pdf |
| Indiana's Forest Restoration Grant Application | Dept. of Natural Resources -- Div. of Forestry | 51422.pdf |
| Indiana Sired Fair Circuit Nomination (Read-Only) | Horse Racing Commission | 49803.pdf |
| Indiana Sires Stakes Nomination – Two-Year Olds, Three-Year Olds & Aged (Four-Year Olds & Older) (Read-Only) | Horse Racing Commission | 49804.pdf |
| Indiana State Employee Suggestion Program Submission | Dept. of Personnel | 00922.pdf |
| Indiana Tuition Report Form | Commission on Proprietary Education | 49926.pdf |
| Indiana Vehicle Merchandising Bond | Secretary of State - Dealer Division | 53966.pdf |
| Indiana Wellhead Protection Phase II Application (Read-Only) | Dept. of Environmental Management | 53117.pdf |
| Individualized Family Transition Plan | Family and Social Service Admin -- Division of Family Resources | 51672.pdf |
| Individual Request for Land Surveyor Continuing Education Course Approval (Read-Only) | Professional Licensing Agency | 50666.pdf |
| Individual User Agreement(Read-Only) | Dept. of Health | 52303.pdf |
| INDOT Zoning Affidavit (Read-Only) | Dept. of Transportation | 18748.pdf |
| Industrial / Hazardous Waste Generator Inspection Report | Dept. of Environmental Management | 53910.doc |
| Industrial / Hazardous Waste TSD Inspection Report | Dept. of Environmental Management | |
| Industrial Recovery Site Inventory Tax Credit (Form IR-1) | Dept. of Local Government Finance | 28675.pdf |
| Industrial Streamlined Mercury Variance (SMV) Application (Read-Only) | Dept. of Environmental Management | 52111.pdf |
| Industrial Streamlined Mercury Variance (SMV) Application | Dept. of Environmental Management | 52111.doc |
| Influenza Lab Submission (Read-Only) | Dept. of Health | 52419.pdf |
| Info Express / Instructions | Indiana State Library | ill.xls / illinstructions.doc |
| Information Processing Request | Dept. of Correction | 13712.pdf |
| Information / Referral Survey(Read-Only) | Indiana Protection and Advocacy Services | 48752.doc |
| Information Regarding Retiree Change of Beneficiary/Survivor Beneficiary and/or Retirement Option (Read-Only) | Teachers' Retirement Fund | 49512.pdf |
| Information Regarding Retiree Change of Beneficiary/Survivor Beneficiary and/or Retirement Option | Teachers' Retirement Fund | 49512.doc |
| Information Required in an Emergency (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 46213.pdf |
| Information Return of Not Owned Personal Property (Form 103-N) | Dept. of Local Government Finance | 23000.pdf |
| Information Return of Not Owned Locally Assessed Personal Property (Form 1-N) (Read-Only) | Dept. of Local Government Finance | 46062.pdf |
| Information Return of Owned Personal Property (Form 103-O) | Dept. of Local Government Finance | 24057.pdf |
| Informe de Reclamacíon (Read-Only) | Dept. of Administration | 52631.pdf |
| Initial Appointment for IMPACT | FSSA - Division of Family Resources | 48895.pdf |
| Initial Assessment of Employability | FSSA - Division of Family Resources | 44713.pdf |
| Initial Notification Report Under Regulation 40 CFR Part 63, Subpart DDDDDD (Read-Only) | Dept. of Environmental Management | 51956.pdf |
| Inorganic Compounds (IOCs) in Drinking Water | Dept. of Environmental Management | 53285.pdf |
| Insignificant Permit Modification Checklist - Solid Waste Land Disposal Facilities | Dept. of Environmental Management | 53317.doc |
| Inspector I Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53529.pdf |
| Inspector II Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53530.pdf |
| Institutional Surety Bond (Read-Only) | Commission on Proprietary Education | 39284.pdf |
| Institutional Surety Bond | Commission on Proprietary Education | 39284.doc |
| Instructions for Submission of a Disability Claim (Read-Only) | Dept. of Personnel | 50106.pdf |
| Instructions for Submission of a Disability Claim | State Personnel Department | 50106.doc |
| Instructor I Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53531.pdf |
| Intention to Employ/A1 | Dept. of Labor | 00896.pdf |
| Intent to Participate (Retiree Flexible Spending Program) (Read-Only) | State Personnel | 50675.pdf |
| Inter-Departmental Mailing Envelope Reuse Label (Read-Only) | Dept. of Administration | 50196.pdf |
| Interim Performance Appraisal (Read-Only) | Dept. of Personnel | 52404.pdf |
| Interim Performance Appraisal | State Personnel Department | 52404.doc |
| Interim Psychosocial Evaluation | Family and Social Services Admin., Larue D. Carter Memorial Hospital | 13297.pdf |
| Interpreter Service Program | Family and Social Service Admin. - Division of Disability and Rehabilitation | 46812.pdf |
| Interpreter / Translator Agreement to Allow On-Site Review of Organization (Read-Only) | Bureau of Motor Vehicles | 51939.pdf |
| Interpreter / Translator Agreement to Allow Electronic Sound Recording (Read-Only) | Bureau of Motor Vehicles | 51945.pdf |
| Interpreter / Translator Application | Bureau of Motor Vehicles | 51959.doc |
| Inventory Change | Dept. of Environmental Management | 53291.pdf |
| Inventory Valuation for Incentive Reinvestment (Read-Only) | Economic Development Corporation | 52608.pdf |
| Investment Direction | Public Employees' Retirement Fund | 48970.pdf |
| Irrevocable Letter of Credit (LC-1) (Read-Only) | DNR - Div. of Reclamation | 06733.pdf |
| Irrevocable Payroll Deduction Authorization (Read-Only) | Teachers' Retirement Fund | 52595.pdf |
| Irrevocable Payroll Deduction Authorization (Read-Only) | Teachers' Retirement Fund | 52595.doc |
| ISDH Literature Order (Read-Only) | Dept. of Health | 36235.pdf |
| Itemization | Auditor of State | 00105.xls |
| Job Analysis Questionnaire | Dept. of Personnel | 43434.pdf |
| Job Analysis Questionnaire | State Personnel Department | 43434.doc |
| Job Description (Read-Only) | Dept. of Personnel | 52468.pdf |
| Job Description | State Personnel Department | 52468.doc |
| Job Search Verification (Read-Only) | FSSA - Division of Family Resources | 48335.pdf |
| Joint Report by Taxpayer / Assessor to the County Board of Appeals of a Preliminary Informal Meeting (Form 134) | Dept. of Local Government Finance | 53626.pdf |
| Journal Voucher | Auditor of State | 44439.xls |
| Justification For PDF To Be Placed On IDEM Website (Read-Only) | Dept. of Environmental Management | 51749.pdf |
| Justification For PDF To Be Placed On IDEM Website | Dept. of Environmental Management | 51749.doc |
| Justification of Take Home Vehicle Assignment | Dept. of Administration - Motor Pool | 53846.pdf |
| Landowner Notification Attachment | Dept. of Environmental Management | 50401.doc |
| LARE-Watershed Land Treatment Cost-Share Forms NOTE -- this Excel workbook contains State Forms 50268, 50314, 50316, AND 50317 | Dept. of Natural Resources - Division of Fish and Wildlife | LAREforms.xls |
| Law Enforcement Training Roster | Law Enforcement Academy | 46167.pdf |
| Lead & Copper (PbCu) in Drinking Water Reporting | Dept. of Environmental Management | 53289.pdf |
| Legal Notice of General Election | Election Division | 48110.pdf |
| Legal Representation Agreement | Indiana Protection and Advocacy Services | 49072.doc |
| Leave of Absence Verification (Read-Only) | Teachers' Retirement Fund | 24315.pdf |
| Leave of Absence Verification (Read-Only) | Teachers' Retirement Fund | 24315.doc |
| Letter of Intent - Cosmetology School License (Read-Only) | Professional Licensing Agency | 47972.pdf |
| Level II: PASRR / MI Mental Health Assessment | Family and Social Service Admin -- Division of Aging | 47185.pdf |
| Library Service and Technology Act (LSTA) Grant Application | Indiana State Library | 53456.pdf |
| Library Service and Technology Act (LSTA) Grant Application - Schools | Indiana State Library | 53457.pdf |
| License Application | Dept. of Agriculture | 20313.pdf |
| License Application for Combination Owners License (Read-Only) | Horse Racing Commission | 46651.pdf |
| Licensing Staff Inquiry Regarding Foster Family Home (Read-Only) | Dept. of Child Services - Child Welfare | 53214.pdf |
| Licensure as a Real Estate Appraiser Via Reciprocity | Professional Licensing Agency | 51140.pdf |
| Lifetime Replacement Affidavit (Read-Only) | Dept. of Natural Resources - Division of Fish and Wildlife | 31540.pdf |
| Limited Access Fence Removal Covenant | Dept. of Transportation | 53681.pdf |
| Lineage Chart (Genealogy) | State Library | 34036.pdf |
| Licensed Shooting Preserve Annual Report (Read-Only) | Dept. of Natural Resources - Division of Fish & Wildlife | 15003.pdf |
| Livestock Dealer Business Report | Board of Animal Health | 51025.pdf |
| Loan Broker Bond | Secretary of State - Securities Division | 53305.pdf |
| Local Board of Health Membership Roster | Dept. of Health | 48137.pdf |
| Location Information Sheet (Confidential & Non Confidential) (Read-Only) | Dept. of Environmental Management | 52015.pdf |
| Logistics Storage Center Request to Store | Dept. of Health | 49265.doc |
| Long Distance Record | Indiana Protection and Advocacy Services | 40229.xls |
| Long Term Care Referral (Read-Only) | Dept. of Health | 47860.doc |
| LPA Invoice - Voucher | Dept. of Transportation | 52663.xls |
| Lump Sum Distribution Election | Teachers' Retirement Fund | 53931.pdf |
| MACT-01 Pre-Construction Review | Dept. of Environmental Management | 51905.pdf |
| Manicurist Salon Sanitary Rules (Read-Only) | Professional Licensing Agency | 51125.pdf |
| Manufactured Home Consumer Complaint | Dept. of Homeland Security | 52654.pdf |
| Manure Distribution (Read-Only) | Dept. of Environmental Management | 52381.pdf |
| Manure Distribution | Dept. of Environmental Management | 52381.doc |
| Mare Movement for Thoroughbred Mares Aged (Read-Only) | Horse Racing Commission | 53541.pdf |
| Marital Status – 1977 Police Officers’ & Firefighters’ Pension & Disability Fund | Public Employees' Retirement Fund | 53769.pdf |
| Master Job Application (Read-Only) | FSSA - Division of Family Resources | 48245.pdf |
| Medicaid Hospice Discharge | Family and Social Service Administration | 48734.pdf |
| Medicaid Hospice Election | Family and Social Service Administration | 48737.pdf |
| Medicaid Hospice Revocation (Read-Only) | Family and Social Service Administration | 48735.pdf |
| Medicaid Physician Certification | Family and Social Service Administration | 48736.pdf |
| Medical Certification - Public Passenger Chauffeur License (Read-Only) | Bureau of Motor Vehicles | 03337.pdf |
| Membership Record | Public Employees' Retirement Fund | 34413.pdf |
| Membership Record – State Excise Police, Gaming Agent, Gaming Control Officer & Conservation Enforcement Officers’ Retirement Plan | Public Employees' Retirement Fund | 11403.pdf |
| Mercury Reduction And Recycling For Schools Pledge Program: School Pledge (Read-Only) | Dept. of Environmental Management | 51900.pdf |
| Merit Employee Complaint (Read-Only) | Dept. of Personnel | 27916.pdf |
| Merit Employee Complaint (Read-Only) | State Personnel Department | 27916.doc |
| Merit Working Test Appraisal (Read-Only) | Dept. of Personnel | 53740.pdf |
| Merit Working Test Appraisal | State Personnel Department | 53740.doc |
| Microform Transmittal and Receipt - County/Local Office | Commission on Public Records | 49466.pdf |
| Microform Transmittal and Receipt - State Agency | Commission on Public Records | 52408.pdf |
| Military Affidavit (Read-Only) | Bureau of Motor Vehicles | 45147.pdf |
| Mobile Home Permit | Dept. of Local Government Finance | 07878.pdf |
| Modification Request for Training Acceleration Grant (TAG) (Read-Only) | Dept. of Workforce Development | 52731.pdf |
| Money Transmitters License Application | Dept. of Financial Institutions | 48009.pdf |
| Monthly Bromate Reporting | Dept. of Environmental Management | 53290.pdf |
| Monthly Chlorine Dioxide Monitoring (Read-Only) | Dept. of Environmental Management | 53282.pdf |
| Monthly Chlorite Monitoring (Read-Only) | Dept. of Environmental Management | 53283.pdf |
| Monthly Individual Filter Effluent (IFE) Turbidity Monitoring (Read-Only) | Dept. of Environmental Management | 53293.pdf |
| Monthly Monitoring Report (MMR) for Industrial Discharge Permits (Read-Only) | Dept. of Environmental Management | 30530.pdf |
| Monthly Monitoring Report (MMR) for Industrial Discharge Permits | Dept. of Environmental Management | 30530.xls |
| Monthly Reimbursement Claim For Title IV-D Expenditures (Read-Only) | Family and Social Service Administration | 24220.pdf |
| Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant (Expanded) | Dept. of Environmental Management | 10829.xls |
| Monthly Report of Operation Activated Sludge Type Wastewater Treatment Plant - Standard | Dept. of Environmental Management | 53463.xls |
| Monthly Report of Operation Lagoon Type Wastewater Treatment Plant (Read-Only) | Dept. of Environmental Management | 53343.pdf |
| Monthly Report of Operation Lagoon Type Wastewater Treatment Plant | Dept. of Environmental Management | 53343.xls |
| Monthly Report of Operation of Water Treatment Plant (Read-Only) | Dept. of Environmental Management | 34609.pdf |
| Monthly Report of Operation Package Type Wastewater Treatment Plant - Less than 0.05 mgd(Read-Only) | Dept. of Environmental Management | 53344.pdf |
| Monthly Report of Operation Package Type Wastewater Treatment Plant - Less than 0.05 mgd | Dept. of Environmental Management | 53344.xls |
| Monthly Report of Operation Sequencing Batch Reactor Wastewater Treatment Plant | Dept. of Environmental Management | 53339.xls |
| Monthly Report of Operation Trickling Filter or RBC Wastewater Treatment Plant | Dept. of Environmental Management | 53340.xls |
| Monthly Report of Operation Vertical Loop Reactor Wastewater Treatment Plant | Dept. of Environmental Management | 53341.xls |
| Monthly Report of Vending Income (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 29885.pdf |
| Monthly Review of Vending Facility (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | |
| Monthly Total Coliform Reporting | Dept. of Environmental Management | 53297.pdf |
| Monthly Total Organic Carbon Removal Reporting | Dept. of Environmental Management | 53284.pdf |
| Monthly Tuberculosis Follow-Up Report | Dept. of Health | 48092.pdf |
| Monthly Tuberculosis Follow-Up Report | Dept. of Health | 48092.doc |
| Monthly Verified Report - Barber School | Professional Licensing Agency | 47836.pdf |
| Monthly Verified Report- Cosmetology School | Professional Licensing Agency | 43716.pdf |
| Mosquitoborne Encephalitis Case Investigation | Dept. of Health | 51382.pdf |
| Motor Vehicle Business Offsite License Application | Secretary of State - Dealer Division | 43595.pdf |
| Multi-Purpose License Application (Read-Only) | Horse Racing Commission | 46652.pdf |
| Municipal Solid Waste Landfill Air Permit Application GSD-01SW (Read-Only) | Dept. of Environmental Management | 50395.pdf |
| Municipal Solid Waste Landfill Closure Plan (329 IAC 10-22) | Dept. of Environmental Management | 50391.doc |
| Municipal Solid Waste Landfill Closure Plan Form SWF-3 (Read-Only) | Dept. of Environmental Management | 50390.pdf |
| Municipal Solid Waste Landfill Post-Closure Plan | Dept. of Environmental Management | 50388.doc |
| Municipal Streamlined Mercury Variance (SMV) Application (Read-Only) | Dept. of Environmental Management | 52112.pdf |
| Municipal Streamlined Mercury Variance (SMV) Application | Dept. of Environmental Management | 52112.doc |
| Mycobacteriology Test Request (Read-Only) | Dept. of Health | 13701.pdf |
| Mycobacteriology Test Request | Dept. of Health | 13701.doc |
| Mycology Test Request | Dept. of Health | 06983.pdf |
| National Pollutant Discharge Elimination System (NPDES) Permit Application Form 2D | Dept. of Environmental Management | 51957.pdf |
| National Provider Identifier (NPI) Information | State Dept. of Health | 53215.pdf |
| National Provider Identifier (NPI) Information | Dept. of Health | 53215.doc |
| NCATE/COMPACT Recommendation | Dept. of Education | 46699.pdf |
| NCEE Standard Verification-Engineer | Professional Licensing Agency, State Board of Registration for Professional Engineers | 04034.pdf |
| NCEE Standard Verification - Land Surveyor | Professional Licensing Agency | 43715.pdf |
| New Hire Appraisal For Other Than Merit Employees (Read-Only) | Dept. of Personnel | 53741.pdf |
| New Hire Appraisal For Other Than Merit Employees | State Personnel Department | 53741.doc |
| New Hire Nurse Worksheet | Dept. of Personnel | 53516.pdf |
| New System Questionnaire (Read-Only) | Dept. of Environmental Management | 46977.pdf |
| New Well Site Survey (Read-Only) | Dept. of Environmental Management | 50896.pdf |
| New Well Site Survey | Dept. of Environmental Management | 50896.doc |
| Nitrate & Nitrite in Drinking Water | Dept. of Environmental Management | 53281.pdf |
| Nomination Cover Page for Governor's Awards for Environmental Excellence | Dept. of Environmental Management | 51656.pdf |
| Nomination Cover Page for Governor's Awards for Environmental Excellence | Dept. of Environmental Management | 51656.doc |
| Non-Collusion Affidavit | Dept. of Administration | 04391.pdf |
| Non-Collusion Statement (Read-Only) | Dept. of Transportation | 47157.pdf |
| Non-Collusion Statement | Dept. of Transportation | 47157.doc |
| Noncompliance 24-hour Notification Fax Report (Read-Only) | Dept. of Environmental Management | 52415.pdf |
| Noncompliance 24-hour Notification Fax Report | Dept. of Environmental Management | 52415.doc |
| Nonrecurring Adoption Expenses Agreement (Read-Only) | Dept. of Child Services/Child Welfare | 47702.pdf |
| Notary Public Application (Read-Only) | Secretary of State - Notary | 40889.pdf |
| Notice & Order of Denial of Occupational License Application | Gaming Commission | 47368.pdf |
| Notice for Worker's Compensation and Occupational Diseases Coverage | Workers' Compensation Board | 36097.pdf |
| Notice of Action | Family and Social Service Admin. - Division of Disability and Rehabilitation | 46015.pdf |
| Notice Of Action-Home And Community Based Services / Serious Emotional Disturbance Behavior (Read-Only) | Family and Social Service Admin -- Division of Mental Health And Addiction | 51547.pdf |
| Notice of Action on Exemption Application (Form 120) | Dept. of Local Government Finance | 49585.pdf |
| Notice of Assessment of Mobile Home (Form 2) | Dept. of Local Government Finance | 00466.pdf |
| Notice of Assessment Registration | Dept. of Local Government Finance | 00786.pdf |
| Notice of Change of Agency Coordinator | Commission on Public Records | 42035.pdf |
| Notice of Change of Principal Office Address | Secretary of State - Business Services Division | 50656.pdf |
| Notice of Change of Principal/Officer (Read-Only) | Secretary of State - Business Services Division | 50655.pdf |
| Notice of Change of Registered Office or Registered Agent (All Corporations) (Read-Only) | Secretary of State - Business Services Division | 26276.pdf |
| Notice of Change to Existing Certificate(s) on Franchise Authority to Provide Video Service in the State of Indiana | Utility Regulatory Commission | 52713.pdf |
| Notice of Defect in Completion of Assessment Appeal (Form 138) | Indiana Board of Tax Review | 43087.pdf |
| Notice of Denial of Benefits | Workers' Compensation Board | 53914.pdf |
| Notice of Destruction, Local Government Public Records | Commission on Public Records | 44905.pdf |
| Notice of Discontinuance of IMPACT Services | FSSA - Div. of Family Resources | 48462.pdf |
| Notice of Hearing on Petition - Personal Property (By County Property Tax Assessment Board Appeals) (Form 114 PP) | Dept. of Local Government Finance | 21522.pdf |
| Notice of Inability to Determine Liability / Request For Additional Time (Read-Only) | Workers' Compensation Board | 48557.pdf |
| Notice of Intent to Construct a Water Main Extension | Dept. of Environmental Management | 49008.pdf |
| Notice of Intent to Open Buy, Relocate, or Close a School of Barbering | Professional Licensing Agency | 44672.pdf |
| Notice of Intent to Purchase UST and Reinstate Eligibility | Dept. of Environmental Management | 48079.pdf |
| Notice of Placing of Mobile Home Upon Land or Lot | Dept. of Local Government Finance | 23341.pdf |
| Notice of Real Property (By County Property Tax Assessment Board of Appeals) Hearing on Petition (Form 114) | Dept. of Local Government Finance | 49149.pdf |
| Notice of Review by Child Protection Team (Read-Only) | Dept. of Child Services - Child Welfare | 49212.pdf |
| Notice of Review of Current Year's Assessment (Form 111/PP) | Dept. of Local Government Finance | 21519.pdf |
| Notice of Transfer or Discharge (Read-Only) | State Dept. of Health | 49669.pdf |
| Notice of Transfer or Discharge Request For Hearing (Read-Only) | State Dept. of Health | 49831.pdf |
| Notice of Violation & Order to Correct - Fireworks Sold in Class I Structures (Read-Only) | Dept. of Homeland Security | 53487.pdf |
| Notice to Members Considering the Social Security Integration Option 61 | Public Employees' Retirement Fund | 49282.pdf |
| Notice to Records Coordinators | Commission on Public Records | 47167.pdf |
| Notification for the Construction of a Storage Structure for Biosolids / Industrial Waste Product or Pollutant-Bearing Water | Dept. of Environmental Management | 50405.doc |
| Notification for the Land Application of Agricultural Lime Substitute | Dept. of Environmental Management | 50407.doc |
| Notification for the Land Application of Small Quantities of Pollutant-Bearing Water | Dept. of Environmental Management | 53558.doc |
| Notification for Underground Storage Tanks | Dept. of Environmental Management | 45223.doc |
| Notification of Agent Termination | Commission on Proprietary Education | 20561.pdf |
| Notification of Accessible Parking Permit - Request or Change | Dept. of Administration, Operations | 52045.pdf |
| Notification of Blood or Body Fluid Exposure | State Dept. of Health | 51467.pdf |
| Notification of Construction in a Floodway under IC 14-28-1 for Obstruction Removal for River and Stream Maintainance (Read-Only) | DNR Division of Water | 51039.pdf |
| Notification of Creek Rock Removal in a Floodway Under IC 14-28-1 (Read-Only) | Dept. of Natural Resources - Division of Fish and Wildlife | 54018.pdf |
| Notification of Designated Licensed Plumbing Contractor For Licensed Corporate Plumbing Contractor (Read-Only) | Professional Licensing Agency | 44861.pdf |
| Notification of Designated Trustee | Professional Licensing Agency | 48121.pdf |
| Notification of Final Assessment Determination (Form 115) | Dept. of Local Government Finance | 20916.pdf |
| Notification of Ineligibility - Senior Farmers' Market Nutrition Program (Read-Only) | Dept. of Health | 53251.pdf |
| Notification of Lead Abatement Activities | Dept. of Health | 49150.pdf |
| Notification of Lead Abatement Activities (Read-Only) | Dept. of Health | 49150.doc |
| Notification of Record Series Action | Commission on Public Records | 41139.pdf |
| Notification of Removal/Reversal of Immediate Jeopardy (Read-Only) | Dept. of Health | 51701.doc |
| Notification of Surplus State-Owned Property | Dept. of Administration - State Surplus | 13812.pdf |
| NPDES Industrial Permit Information Application Instructions General Information Form | Dept. of Environmental Management | 51952.pdf |
| NPDES General Permit Notice of Intent Submittal Application | Dept. of Environmental Management, Office of Water Management | 49401.pdf |
| Nuisance Wild Animal Control Annual Report (Read-Only) | Dept. of Natural Resources - Division of Fish and Wildlife | 47572.pdf |
| Nurse Aide Registry CNA Renewal (Read-Only) | State Dept. of Health | 49937.pdf |
| OA-01: Summary of Application & Existing Agreements | Dept. of Environmental Management | 53438.pdf |
| OA-01: Summary of Application & Existing Agreements | Dept. of Environmental Management | 53438.doc |
| OA-02: Industrial / Commercial Surface Coating Operations or Graphic Arts Operations | Dept. of Environmental Management | 53439.pdf |
| OA-02: Industrial / Commercial Surface Coating Operations or Graphic Arts Operations | Dept. of Environmental Management | 53439.doc |
| OA-03: Surface Coating or Graphic Arts Operations | Dept. of Environmental Management | 53440.pdf |
| OA-03: Surface Coating or Graphic Arts Operations | Dept. of Environmental Management | 53440.doc |
| OA-04: Woodworking Operations | Dept. of Environmental Management | 53441.pdf |
| OA-04: Woodworking Operations | Dept. of Environmental Management | 53441.doc |
| OA-05: Abrasive Cleaning Operations | Dept. of Environmental Management | 53442.pdf |
| OA-05: Abrasive Cleaning Operations | Dept. of Environmental Management | 53442.doc |
| OA-06: Grain Elevators | Dept. of Environmental Management | 53443.pdf |
| OA-06: Grain Elevators | Dept. of Environmental Management | 53443.doc |
| OA-07: Sand & Gravel Plants | Dept. of Environmental Management | 53444.pdf |
| OA-07: Sand & Gravel Plants | Dept. of Environmental Management | 53444.doc |
| OA-08: Crushed Stone Processing Plants | Dept. of Environmental Management | 53445.pdf |
| OA-08: Crushed Stone Processing Plants | Dept. of Environmental Management | 53445.doc |
| OA-09: Ready-Mix Concrete Batch Plants | Dept. of Environmental Management | 53446.pdf |
| OA-09: Ready-Mix Concrete Batch Plants | Dept. of Environmental Management | 53446.doc |
| OA-10: Coal Mines and Coal Preparation Plants | Dept. of Environmental Management | 53447.pdf |
| OA-10: Coal Mines and Coal Preparation Plants | Dept. of Environmental Management | 53447.doc |
| OA-11: Automobile Refinishing Operations | Dept. of Environmental Management | 53448.pdf |
| OA-11: Automobile Refinishing Operations | Dept. of Environmental Management | 53448.doc |
| OA-12: Degreasing Operations | Dept. of Environmental Management | 53449.pdf |
| OA-12: Degreasing Operations | Dept. of Environmental Management | 53449.doc |
| OA-13: External Combustion Sources | Dept. of Environmental Management | 53450.pdf |
| OA-13: External Combustion Sources | Dept. of Environmental Management | 53450.doc |
| OA-14: Internal Combustion Sources | Dept. of Environmental Management | 53451.pdf |
| OA-14: Internal Combustion Sources | Dept. of Environmental Management | 53451.doc |
| OAQ Federal Rule Incorporation Application FED-03: Compliance Assurance Monitoring (CAM) | Dept. of Environmental Management | 53377.pdf |
| OAQ Federal Rule Incorporation Application FED-03: Compliance Assurance Monitoring (CAM) | Dept. of Environmental Management | 53377.doc |
| OAQ Permit Renewal Application – Air Permit Renewal Checklist (Read-Only) | Dept. of Environmental Management | 51755.pdf |
| OAQ Permit Renewal Application – Air Permit Renewal Checklist | Dept. of Environmental Management | 51755.doc |
| Occupational License Annual Renewal / Information Update (Read-Only) | Gaming Commission | 53544.pdf |
| Occupational License Intake Form (Read-Only) | Gaming Commission | 47367.pdf |
| Occupational License Separation from Service or Suspension (Read-Only) | Gaming Commission | 51891.pdf |
| Odometer Disclosure Statement (Read-Only) | Bureau of Motor Vehicles | 43230.pdf |
| Office of the Public Access Counselor Formal Complaint | Public Access Counselor | 49407.pdf |
| Office Record Card (Read-Only) | Dept. of Labor | 02718r.pdf |
| Official Indiana Animal Bites Report (Read-Only) | Dept. of Health | 14072.pdf |
| Ombudsman Complaint Report (Read-Only) | Dept. of Administration | 51506.pdf |
| Ombudsman Complaint Report | Dept. of Administration | 51506.doc |
| OMPP 0011 - Medicaid Hospice Plan of Care | Family and Social Service Administration | 48731.pdf |
| OMPP 0046 - Request To Access Indiana Health Coverage (Read-Only) | FSSA - Division of Family Resources | 51731.pdf |
| OMPP 0046 - Request To Access Indiana Health Coverage | FSSA - Division of Family and children | 51731.doc |
| OMPP 0047 - Personal Representative Authorization (Read-Only) | FSSA - Division of Family Resources | 51732.pdf |
| OMPP 0047 - Personal Representative Authorization | FSSA - Division of Family and children | 51732.doc |
| OMPP 0048 - Client Member Authorization (Read-Only) | FSSA - Division of Family Resources | 51733.pdf |
| OMPP 0048 - Client Member Authorization | FSSA - Division of Family and children | 51733.doc |
| OMPP 0050 - Report On Complaint Filed (Read-Only) | FSSA - Division of Family Resources | 51735.pdf |
| OMPP 0050 - Report On Complaint Filed | FSSA - Division of Family and children | 51735.doc |
| OMPP 0051 - Revocation of Authorization (Read-Only) | FSSA - Division of Family Resources | 51736.pdf |
| OMPP 0052 - Member Access Request (Read-Only) | FSSA - Division of Family Resources | 51737.pdf |
| OMPP 0053 - Member Accounting Request (Read-Only) | FSSA - Division of Family Resources | 51738.pdf |
| OMPP 0251 Authorization for Examination to Determine Disability for Medical Assistance (Read-Only) | Family and Social Service Administration | 22032.pdf |
| OMPP 0251A - Determination of Medicaid Disability / Authorization for Release of Medical Information | Family and Social Service Administration | 01380.pdf |
| OMPP 0251B Determination of Medicaid Disability Social Summary | Family and Social Service Administration | 01111.pdf |
| OMPP 3512 - Determination of Disability / Authorization for Release of Medical Information | Family and Social Service Administration | 44554.pdf |
| OMPP 450B SA/DE - Nursing Facility Level of Service - State Authorization and Data Entry | Family and Social Service Administration | 49120.pdf |
| Operator Response to Inspection (Food Protection Program) (Read-Only) | Dept. of Health | 50046.pdf |
| Operator Response to Inspection (Read-Only) | Dept. of Health | 50047.pdf |
| Options Statement | Dept. of Personnel | 50108.pdf |
| Options Statement | State Personnel Department | 50108.doc |
| Order for Archaeology Month Materials | DNR, Historic Preservation & Archaeology | 49863.xls |
| Order for Archaeology Month Materials (Read-Only) | DNR, Historic Preservation & Archaeology | 49863.pdf |
| Order for Archaeology Month T-Shirts | DNR, Historic Preservation & Archaeology | 50253.xls |
| Order for Archaeology Month T-Shirts (Read-Only) | DNR, Historic Preservation & Archaeology | 50253.pdf |
| Order for Back Year Stamps | DNR, Fish and Wildlife | 42879.pdf |
| Order for ILEA Multi-Media Training Materials | Law Enforcement Academy | 53373.pdf |
| Order Form (Read-Only) | Dept. of Correction | 44516.pdf |
| Outbreak Serology Request | Dept. of Health | 53761.pdf |
| Outdoor Advertising Sign Permit Application | Dept. of Transportation | 45918.pdf |
| Out of State Credit Union Application to Establish Service Office in Indiana (Read-Only) | Dept. of Financial Institutions | 50285.pdf |
| PAL-01: Actuals Plantwide Applicability Limit (Read-Only) | Dept. of Environmental Management | 52451.pdf |
| PAL-01: Actuals Plantwide Applicability Limit | Dept. of Environmental Management | 52451.doc |
| PAL-02: Revised Plantwide Applicability Limit (Read-Only) | Dept. of Environmental Management | 52452.pdf |
| PAL-02: Revised Plantwide Applicability Limit | Dept. of Environmental Management | 52452.doc |
| PAL-03: Plantwide Applicability Limit Renewal (Read-Only) | Dept. of Environmental Management | 52453.pdf |
| PAL-03: Plantwide Applicability Limit Renewal | Dept. of Environmental Management | 52453.doc |
| PAL-04: Request for Termination of Plantwide Applicability Limit (Read-Only) | Dept. of Environmental Management | 52454.pdf |
| PAL-04: Request for Termination of Plantwide Applicability Limit | Dept. of Environmental Management | 52454.doc |
| Paramedic Application for Reciprocity | Dept. of Homeland Security | 52465.pdf |
| Parasitology | Dept. of Health | 13053.pdf |
| Parent/Guardian Affidavit (Read-Only) | Bureau of Motor Vehicles | 46538.pdf |
| Parent's Notice (Read-Only) | FSSA - Div. of Family Resources | 49444.pdf |
| Part 2 MACT Application / Application For 112(J) Case-By-Case MACT Determination | Dept. of Environmental Management | 51105.pdf |
| Participation Election for School Corporation Employees | Public Employees Retirement Fund | 28105.pdf |
| Partnership Or Limited Partnership Elevator Contractor License Application (Read-Only) | Dept. of Homeland Security | 52475.pdf |
| Partnership Or Limited Partnership Elevator Contractor License Renewal Application (Read-Only) | Dept. of Homeland Security | 52476.pdf |
| PASARR Categorical Determination For Short-Term Nursing Facility Care - Certification By Physician for Long-Term Care Services | Family and Social Service Administration | 45932.pdf |
| PASARR Level I - Identification Evaluation Criteria - Certification by Physician for Long-Term Care Services | Family and Social Service Administration - Division of Disability and Rehabilitation | 45277.pdf |
| P-Card / Travel Card Program Missing Receipt Record | Dept. of Administration - Procurement Division | 53879.pdf |
| PDP 0001 Indiana's Prescription Drug Program for Seniors - Application for Hoosier Rx | Family and Social Service Administration | 49905.pdf |
| PEP 6 Month Progress Report (Read-Only) | Dept. of Environmental Management | 51998.pdf |
| PEP 6 Month Progress Report | Dept. of Environmental Management | 51998.doc |
| PEP Grant Final Evaluation Report - Indiana Recycling Grant Program (Read-Only) | Dept. of Environmental Management | 51999.pdf |
| PEP Grant Final Evaluation Report - Indiana Recycling Grant Program | Dept. of Environmental Management | 51999.doc |
| Perinatal Hepatitis B Screen | Dept. of Health | 45057.pdf |
| Permissions & Image Release Request | DNR, Communications | 53562.pdf |
| Permit Application (Read-Only) | DNR, Division of Water | 42946.pdf |
| Permit Application for the Construction of a Storage Structure for Biosolids / Industrial Waste Product or Pollutant-Bearing Water | Dept. of Environmental Management | 50406.doc |
| Permit Application for the Land Application of Biosolids | Dept. of Environmental Management | 50410.doc |
| Permit Application for the Land Application of Domestic Wastewater | Dept. of Environmental Management | 50409.doc |
| Permit Application for the Land Application of Industrial Process Wastewater | Dept. of Environmental Management | 53584.doc |
| Permit Application for the Land Application of Industrial Waste Products | Dept. of Environmental Management | 53517.doc |
| Permit Application for the Marketing and/or Distribution of Biosolids | Dept. of Environmental Management | 50408.doc |
| Permit Application for the Marketing and/or Distribution of Industrial Waste Products | Dept. of Environmental Management | 53514.doc |
| Permit Application Package (Contains SF 50103 and SF 50104) | Dept. of Environmental Management | 50103.pdf |
| Permit For Special Permits (Read-Only) | Dept. of Natural Resources -- Division of Forestry | 50716.pdf |
| Personal Disclosure Form 1 | Gaming Commission | 46458.pdf |
| Personal Disclosure Form 2 (Read-Only) | Gaming Commission | 46781.pdf |
| Personal Disclosure Form 3 (Read-Only) | Gaming Commission | 46782.pdf |
| Personal History of Commercial Driver Training School - Owner or Manager (Read-Only) | Bureau of Motor Vehicles | 50519.pdf |
| Personal Name Change Affidavit (Read-Only) | Bureau of Motor Vehicles | 27044.pdf |
| Personal Property Assessor's Book (Form 29A) | Dept. of Local Government Finance | 18160.pdf |
| Personal Responsibility Agreement (read-only) | Family and Social Service Administration | 47073.pdf |
| Personal Services Schedule - Cooperative Agreement Appendix 1-b (Read-Only) | Family and Social Service Administration | 41707.pdf |
| Personnel / Payroll Action | State Personnel Department | 45123.xls |
| Personnel / Payroll Action | Dept. of Personnel | 45123.pdf |
| Pertussis DFA and Culture | Dept. of Health | 09356.pdf |
| Petition For Business Reinstatement (Please Refer To IC 4-4-6.1-2.5(E)) (Read-Only) | Economic Development Corporation | 50474.pdf |
| Petition for Correction of an Error (Form 133) | Dept. of Local Government Finance | 12483.pdf |
| Petition for Review of Dept. of Local Government Finance Action (Form 139) | Board of Tax Review | 51104.pdf |
| Petition for Review of Order Making Annual Adjustments to Assessed Valuation | Dept. of Local Government Finance | 53949.pdf |
| Petition for Waiver or Reduction of Property Taxes Against a Brownfield (Read-Only) | Board of Accounts | 52584.pdf |
| Petition to the Indiana Board of Tax Review for Review of Assessment (Form 131) | Board of Tax Review | 42936.pdf |
| Petition to the Indiana Board of Tax Review for Review of Exemption (Form 132) | Board of Tax Review | 21514.pdf |
| Pheasant, Dove, Migratory Gamebird and Military/Refuge Deer Hunt Applications (Read-Only) | DNR, Fish and Wildlife | 52672.pdf |
| Photo Contest Entry | Dept. of Environmental Management | 53311.doc |
| Physical Therapy Committee Affirmation of Supervision (Read-Only) | Professional Licensing Agency | 52566.pdf |
| Physician / Coroner / Health Officer IDRS Confidentiality Agreement | Dept. of Health | 53763.pdf |
| Physician's Health Care Summary - First Steps Early Intervention System - Children's Special Health Care Services | Family and Social Service Administration/DFR | 51929.pdf |
| Physician's/Optometrist's Report on Eye Examination (Read-Only) | Family and Social Service Administration | 12417.pdf |
| Physician's Statement of Disability (Read-Only) | DNR - Fish & Wildlife | 10692.pdf |
| PI-01: Miscellaneous Process (Read-Only) | Dept. of Environmental Management | 52534.pdf |
| PI-01: Miscellaneous Process | Dept. of Environmental Management | 52534.doc |
| PI-02A: Combustion Unit Summary (Read-Only) | Dept. of Environmental Management | 52535.pdf |
| PI-02A: Combustion Unit Summary | Dept. of Environmental Management | 52535.doc |
| PI-02B: Combustion - Boilers, Process Heaters, & Furnaces (Read-Only) | Dept. of Environmental Management | 52536.pdf |
| PI-02B: Combustion - Boilers, Process Heaters, & Furnaces | Dept. of Environmental Management | 52536.doc |
| PI-02C: Combustion - Turbines & Reciprocating Internal Combustion Engines (Read-Only) | Dept. of Environmental Management | 52537.pdf |
| PI-02C: Combustion - Turbines & Reciprocating Internal Combustion Engines | Dept. of Environmental Management | 52537.doc |
| PI-02D: Combustion - Incinerators & Combustors (Read-Only) | Dept. of Environmental Management | 52538.pdf |
| PI-02D: Combustion - Incinerators & Combustors | Dept. of Environmental Management | 52538.doc |
| PI-02E: Combustion - Kilns (Read-Only) | Dept. of Environmental Management | 52539.pdf |
| PI-02E: Combustion - Kilns | Dept. of Environmental Management | 52539.doc |
| PI-02F: Combustion - Fuel Use (Read-Only) | Dept. of Environmental Management | 52540.pdf |
| PI-02F: Combustion - Fuel Use | Dept. of Environmental Management | 52540.doc |
| PI-02G: Combustion - Emission Factors (Read-Only) | Dept. of Environmental Management | 52541.pdf |
| PI-02G: Combustion - Emission Factors | Dept. of Environmental Management | 52541.doc |
| PI-02H: Combustion - Federal Rule Applicability (Read-Only) | Dept. of Environmental Management | 52542.pdf |
| PI-02H: Combustion - Federal Rule Applicability | Dept. of Environmental Management | 52542.doc |
| PI-03: Storage & Handling of Bulk Material (Read-Only) | Dept. of Environmental Management | 52543.pdf |
| PI-03: Storage & Handling of Bulk Material | Dept. of Environmental Management | 52543.doc |
| PI-04: Hot or Cold Mix Asphalt Plants (Read-Only) | Dept. of Environmental Management | 52544.pdf |
| PI-04: Hot or Cold Mix Asphalt Plants | Dept. of Environmental Management | 52544.doc |
| PI-05: Brick & Clay Products (Read-Only) | Dept. of Environmental Management | 52545.pdf |
| PI-05: Brick & Clay Products | Dept. of Environmental Management | 52545.doc |
| PI-06: Electroplating (Read-Only) | Dept. of Environmental Management | 52546.pdf |
| PI-06: Electroplating | Dept. of Environmental Management | 52546.doc |
| PI-07: Welding & Cutting of Metal (Read-Only) | Dept. of Environmental Management | 52547.pdf |
| PI-07: Welding & Cutting of Metal | Dept. of Environmental Management | 52547.doc |
| PI-08: Concrete Batchers (Read-Only) | Dept. of Environmental Management | 52548.pdf |
| PI-08: Concrete Batchers | Dept. of Environmental Management | 52548.doc |
| PI-09: Degreasing Operations (Read-Only) | Dept. of Environmental Management | 52549.pdf |
| PI-09: Degreasing Operations | Dept. of Environmental Management | 52549.doc |
| PI-10: Dry Cleaning Operations (Read-Only) | Dept. of Environmental Management | 52550.pdf |
| PI-10: Dry Cleaning Operations | Dept. of Environmental Management | 52550.doc |
| PI-11: Foundry, Smelting & Die Cast Operations (Read-Only) | Dept. of Environmental Management | 52551.pdf |
| PI-11: Foundry, Smelting & Die Cast Operations | Dept. of Environmental Management | 52551.doc |
| PI-12: Grain Elevators (Read-Only) | Dept. of Environmental Management | 52552.pdf |
| PI-12: Grain Elevators | Dept. of Environmental Management | 52552.doc |
| PI-13: Lime Manufacturing (Read-Only) | Dept. of Environmental Management | 52553.pdf |
| PI-13: Lime Manufacturing | Dept. of Environmental Management | 52553.doc |
| PI-14: Volatile Organic Liquid Storage (Read-Only) | Dept. of Environmental Management | 52554.pdf |
| PI-14: Volatile Organic Liquid Storage | Dept. of Environmental Management | 52554.doc |
| PI-14ALT: Volatile Organic Liquid Compound Storage (Read-Only) | Dept. of Environmental Management | 52555.pdf |
| PI-14ALT: Volatile Organic Liquid Compound Storage | Dept. of Environmental Management | 52555.xls |
| PI-15: Portland Cement Manufacturing (Read-Only) | Dept. of Environmental Management | 52556.pdf |
| PI-15: Portland Cement Manufacturing | Dept. of Environmental Management | 52556.doc |
| PI-16: Reinforced Plastics & Composites (Read-Only) | Dept. of Environmental Management | 52557.pdf |
| PI-16: Reinforced Plastics & Composites | Dept. of Environmental Management | 52557.doc |
| PI-17: Blasting Operations (Read-Only) | Dept. of Environmental Management | 52558.pdf |
| PI-17: Blasting Operations | Dept. of Environmental Management | 52558.doc |
| PI-18: Mineral Processing (Read-Only) | Dept. of Environmental Management | 52559.pdf |
| PI-18: Mineral Processing | Dept. of Environmental Management | 52559.doc |
| PI-19: Surface Coating & Printing Operations (Read-Only) | Dept. of Environmental Management | 52560.pdf |
| PI-19: Surface Coating & Printing Operations | Dept. of Environmental Management | 52560.doc |
| PI-20: Woodworking & Plastic Machining (Read-Only) | Dept. of Environmental Management | 52561.pdf |
| PI-20: Woodworking & Plastic Machining | Dept. of Environmental Management | 52561.doc |
| PI-21: Site Remediation (Read-Only) | Dept. of Environmental Management | 52570.pdf |
| PI-21: Site Remediation | Dept. of Environmental Management | 52570.doc |
| Plan de Autosuficiencia para el Cliente de IMPACT | Family and Social Service Administration/DFR | 53403.pdf |
| Plan for Conversion (Read-Only) | Dept. of Financial Institutions | 18936.pdf |
| Plan of Care (multi) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 45994.pdf |
| Plan Of Care/Cost Comparison Budget Children With Serious Emotional Disturbances (SED) Waiver | Family and Social Service Admin. - Division of Mental Health and Addiction | 51549.pdf |
| Plan of Care / Cost Comparison Budget For the Aged and Disabled Waiver (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 42822.pdf |
| Plan of Care / Cost Comparison Budget for the AL and AFC Waiver (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 50149.pdf |
| Plan of Care / Cost Comparison Budget for the Autism Waiver (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 46020.pdf |
| Plan of Care / Cost Comparison Budget for the Medically Fragile Children Waiver (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 46019.pdf |
| Plan of Care / Cost Comparison Budget for the TBI Waiver (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 49413.pdf |
| Plan of Reclamation (Read-Only) | DNR - Div. of Reclamation | 02191.pdf |
| Plan of Revegetation (R-301) (Read-Only) | DNR - Div. of Reclamation | 02190.pdf |
| Plan Review Questionnaire (Food Protection Program) (Read-Only) | Dept. of Health | 50004.pdf |
| Political Action Committee or Legislative Caucus Committee Statement of Organization (CFA-2) (Read-Only) | Election Division | 28251.pdf |
| Position Date Change Worksheet | Dept. of Personnel | 53665.pdf |
| Post Test Evaluation | Indiana Protection and Advocacy Services | 48963.doc |
| Post-Transition Quality Assurance Checklist (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 51681.pdf |
| Post-Transition Quality Assurance Checklist | FSSA - DDARS | 51681.doc |
| Post-Transition Quality Assurance Checklist - Guidelines (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 51682.pdf |
| Post-Transition Quality Assurance Checklist - Guidelines | FSSA - DDARS | 51682.doc |
| Power of Attorney | Dept. of Local Government Finance | 23261.pdf |
| Power of Attorney for Active Members (Read-Only) | Teachers' Retirement Fund | 49614.pdf |
| Power of Attorney for Active Members (Read-Only) | Teachers' Retirement Fund | 49614.doc |
| Power of Attorney for Retired Members or Recipients (Read-Only) | Teachers' Retirement Fund | 49613.pdf |
| Power of Attorney for Retired Members or Recipients (Read-Only) | Teachers' Retirement Fund | 49613.doc |
| Power of Attorney-State of Indiana (Read-Only) | Bureau of Motor Vehicles | 01940.pdf |
| Practical Skills Examination Driver Operator Aerial (Read-Only) | Dept. of Homeland Security | 52366.doc |
| Practical Skills Examination FOI (Read-Only) | Dept. of Homeland Security | 52367.doc |
| Practical Skills Examination FOII (Read-Only) | Dept. of Homeland Security | 52396.doc |
| Practical Skills Examination FOIII | Dept. of Homeland Security | 52583.doc |
| Practical Skills Examination - Hazardous Materials Technician (Read-Only) | Dept. of Homeland Security | 52427.doc |
| Practical Skills Examination - Hazmat Operations (Read-Only) | Dept. of Homeland Security | 52426.doc |
| Practical Skills Examination - Mandatory Training (Read-Only) | Dept. of Homeland Security | 52445.doc |
| Pre-Application for Training Acceleration Grant Company Information (Read-Only) | Dept. of Workforce Development | 52729.pdf |
| Pre-Application for Training Acceleration Grant Consortium List (Read-Only) | Dept. of Workforce Development | 52730.pdf |
| Precipitation Events at Land Application Sites (Read-Only) | Dept. of Environmental Management | 52382.pdf |
| Precipitation Events at Land Application Sites | Dept. of Environmental Management | 52382.doc |
| Precipitation Events at Land Application Sites | Dept. of Environmental Management | 52382.doc |
| Pre-Conference Review | (Read-Only)Dept. of Administration | 49928.pdf |
| Pre-Conference Review | Dept. of Administration | 49928.doc |
| Pre-Conference Review Event Sheet | Dept. of Administration | 49929.pdf |
| Pre-Conference Review Event Sheet | Dept. of Administration | 49929.doc |
| Preliminary Effluent Limitation Application | Dept. of Environmental Management | 53912.pdf |
| Preliminary Effluent Limitation Application | Dept. of Environmental Management | 53912.doc |
| Preliminary Estimate Request Retiree Change of Beneficiary/Survivor Beneficiary and/or Retirement Option (Read-Only) | Teachers' Retirement Fund | 49513.pdf |
| Preliminary Estimate Request Retiree Change of Beneficiary/Survivor Beneficiary and/or Retirement Option | Teachers' Retirement Fund | 49513.doc |
| Premise Information (Read-Only) | Board of Animal Health | 52010.pdf |
| Pre-Transition Quality Assurance Checklist (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 51683.pdf |
| Pre-Transition Quality Assurance Checklist | FSSA - DDARS | 51683.doc |
| Pre-Transition Quality Assurance Checklist - Guidelines (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 51684.pdf |
| Pre-Transition Quality Assurance Checklist - Guidelines | Family and Social Service Admin. - Division of Disability and Rehabilitation | 51684.doc |
| Primary And Secondary Education Retirement Payment Transmittal (Read-Only) | Teachers' Retirement Fund | 26716.pdf |
| Primary And Secondary Education Retirement Payment Transmittal | Teachers' Retirement Fund | 26716.doc |
| Primary Health Care - Community Health Center - Request for Proposal (Read-Only) | Dept. of Health | 52633.pdf |
| Private Medical Insurance Supplement (Read-Only) | FSSA - Division of Family Resources | 51309.pdf |
| Private Water Supply Report (Read-Only) | Dept. of Health | 36741.pdf |
| PROC 2600, CRESTA (Confirmation of Received Equipment / Services & State Tag Application) | Family and Social Service Administration | 01138.pdf |
| Professional/Consultant Documentation for ICF/MR (Read-Only) | Dept. of Health | 48316.pdf |
| Professional Engineer or Land Surveyor Roster Listing (Read-Only) | Professional Licensing Agency | 36041.pdf |
| Professional Licensing Agency Comment Card (Read-Only) | Professional Licensing Agency | 46716.pdf |
| Profile Information - Hospital Care For The Indigent | Family and Social Service Administration | 42834.pdf |
| Progress Report for Pollution Prevention Grant Program (Read-Only) | Dept. of Environmental Management | 53586.pdf |
| Progress Report for Pollution Prevention Grant Program | Dept. of Environmental Management | 53586.doc |
| Progress Report for Recycling & Organic Projects (Read-Only) | Dept. of Environmental Management | 51997.pdf |
| Progress Report for Recycling & Organic Projects | Dept. of Environmental Management | 51997.doc |
| Proof of Licensing | Dept. of Education | 47871.pdf |
| Property Schedule for Gas and Oil Well Assessment (Form G&O-1) | Dept. of Local Government Finance | 09931.pdf |
| Proposal for Leasing Space | Dept. of Administration | 00203.pdf |
| Provider Agreement | Dept. of Health | 51396.pdf |
| Provider Agreement – Billing Provider Enrollment – Application – Schedule B | Dept. of Health | 51452.pdf |
| Provider Agreement – Billing Provider Enrollment – Application – Schedule C | Dept. of Health | 51453.pdf |
| Provider Agreement – Children’s Special Health Care Services (CSHCS) – Maximum Caseload Addendum | Dept. of Health | 51399.pdf |
| Provider Request for Approval of Additional Land Surveyor Continuing Education Courses/Instructors (Read-Only) | Professional Licensing Agency | 50665.pdf |
| Provider Request for Supplies | Dept. of Health | 53546.pdf |
| Provider Request for Supplies - Marion Co. | Dept. of Health | 53547.pdf |
| Provider Request for Supplies - Vanderburgh Co. | Dept. of Health | 53548.pdf |
| Provider Site Enrollment Agreement (Read-Only) | Dept. of Health | 52306.pdf |
| Provider Standards Agency Survey | Family and Social Service Admin. - Division of Disability and Rehabilitation | 51678.pdf |
| Provider Survey Questionnaire (Read-Only) | Dept. of Health | 53183.doc |
| Provisional Plan Of Care - Children With Serious Emotional Disturbance Medicaid Waiver (Read-Only) | Family and Social Service Admin -- Division of Mental Health and Addiction | 51551.pdf |
| Public Fire & Life Safety II Practical Skills Evaluation Checklist | Dept. of Homeland Security | 53532.pdf |
| Public Notice (to adjacent property owner) (Read-Only) | DNR-Division of Water | 50354.pdf |
| Public Record Copy Request | Commission on Public Records | 01365.pdf |
| Public Water Supply, Application For Water Treatment Plant and Water Distribution System Operator Certification (Read-Only) | Dept. of Environmental Management | 12094.pdf |
| Public Water Supply Drinking Water Operator Continuing Education Credit Report (Read-Only) | Dept. of Environmental Management | 45674.pdf |
| Public Water Supply, Application For Water Treatment Plant and Water Distribution System Operator Certification | Dept. of Environmental Management | 12094.doc |
| Public Water System Report (Read-Only) | Dept. of Health | 39231.pdf |
| Purchase Order - Foster Care (Read-Only) | Dept. of Child Services/Child Welfare | 27116.pdf |
| PYL 2625: Report of Child Protective Overtime (Read-Only) | FSSA - Division of Family Resources | 47507.pdf |
| QA 1000 - Release of Information Mortality Review | Family and Social Service Admin -- Division of Aging | 53267.pdf |
| QMRP Certification for ICF/MR Level of Care Waiver | FSSA (OMPP) | 51036.pdf |
| Qualified Capital Investment Application | Economic Development Corporation | 52340.pdf |
| Qualified Indiana Business Application | Economic Development Corporation | 52341.pdf |
| Qualified Mental Retardation Professional (QMRP) (Read-Only) | Dept. of Health | 48318.pdf |
| Qualified Mental Retardation Professional Designee Training Registration (Read-Only) | Protection and Advocacy Services | 06978.pdf |
| Quarter Horse Embryo Transfer - Foal Registration Application for Foals of ____ (Read-Only) | Horse Racing Commission | 53499.pdf |
| Quarter Horse Embryo Transfer - Mare Registration Application for Foaling Year ____ (Read-Only) | Horse Racing Commission | 53498.pdf |
| Quarter Horse Foal Registration Application for Foals of ___ (Read-Only) | Horse Racing Commission | 49939.pdf |
| Quarter Horse Foal Registration For Foals Prior to 2002 (Read-Only) | Horse Racing Commission | 50012.pdf |
| Quarter Horse Mare Registration Application for Foaling Year ___ (Read-Only) | Horse Racing Commission | 49940.pdf |
| Quarter Horse Stallion Registration Application for Breeding Year ___ (Read-Only) | Horse Racing Commission | 49942.pdf |
| Quarterly Land Application Report (Read-Only) | Dept. of Environmental Management | 50397.pdf |
| Quarterly Report of Contracting With Minority and Women's Business Enterprises (Read-Only) | Dept. of Administration-Minority Business | 45129.pdf |
| Questionnaire on Applicant Reference for Professional Engineers (Read-Only) | Professional Licensing Agency | 15199.pdf |
| Rabies Examination | Dept. of Health | 37763.pdf |
| Real Estate Continuing Education Sponsor - Request for Approval of Significant Change(s) (Read-Only) | Professional Licensing Agency | 50664.pdf |
| Real Property Assessor's Book (Form 29) | Dept. of Local Government Finance | 18158.pdf |
| Real Property Assessor's Book (Form 29) | Dept. of Local Government Finance | 18158.doc |
| Reason For Delay of IFSP | FSSA - Division of Family Resources | 51312.pdf |
| Reassignment of a Vehicle by a Registered Dealer | Bureau of Motor Vehicles | 20070.pdf |
| Recall Audit (read-only) | Dept. of Health | 53505.pdf |
| Recommendation For Foster Family Home Care License or Relative Home Care License | Dept. of Child Services - Child Welfare | 17769.pdf |
| Recommendation of County Office - Assistance to Residents in County Homes - Room and Board Assistance (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 18438.pdf |
| Record of Adoption (Read-Only) | Dept. of Health | 05438.pdf |
| Record of Adoption | Dept. of Health | 05438.doc |
| Record of Appointment of Local Health Officer | Dept. of Health | 48135.pdf |
| Record of a Water Well | DNR, Division of Water | 35680.xls |
| Record of a Water Well (Read-Only) | DNR, Division of Water | 35680.pdf |
| Record of Complaint | Dept. of Financial Institutions | 47127.pdf |
| Record of Financial Eligibility Budget for Hoosier Healthwise | FSSA - Division of Family Resources | 49422.pdf |
| Record of Hearing (Read-Only) | Family and Social Service Administration | 45933.pdf |
| Record of IMPACT Attendance (Read-Only) | FSSA - Division of Family Resources | 44720.pdf |
| Record of IMPACT Attendance - Multiple Activities (Read-Only) | FSSA - Division of Family Resources | 44721.pdf |
| Record of Individual Itinerary | Indiana Protection and Advocacy Services | 45193.doc |
| Record of License Coding - Rules 2002 | Dept. of Education | 49484.pdf |
| Record of License Coding - Rules Prior to 2002 | Dept. of Education | 53358.pdf |
| Record of Marriage (Read-Only) | Dept. of Health | 27553.doc |
| Record of Monthly Time (Read-Only) | Family and Social Service Administration | 45272.pdf |
| Record of Out-Going Mail | Indiana Protection and Advocacy Services | 48750.doc |
| Record of Receipt of Accountable Documents | Dept. of Correction | 45882.pdf |
| Record of Store Closing (Read-Only) | Professional Licensing Agency | 01588.pdf |
| Record of Telephone Price Quotations | Dept. of Administration | 43464.pdf |
| Record of Training | FSSA - Division of Family Resources | 49708.pdf |
| Records Destruction Notification (Read-Only) | Commission on Public Records | 00016.pdf |
| Records Inventory and Analysis Worksheet | Commission on Public Records | 01141.pdf |
| Record Transmittal and Receipt | Commission on Public Records | 23628.pdf |
| Record Transmittal and Receipt | Commission on Public Records | 23628.doc |
| Recycling Grant Application - Indiana Recycling Grant Program | Dept. of Envionmental Management | 51898.doc |
| Re-employed Retiree Membership Record & Employer Certification of Eligibility | Public Employees Retirement Fund | 50868.pdf |
| Reference Bacteriology Culture Identification | Dept. of Health | 35898.pdf |
| Reference for Registration As A Professional Engineer (Read-Only) | Professional Licensing Agency | 02146.pdf |
| Reference Sheet For Registration As Land Surveyor-In-Training (Read-Only) | Professional Licensing Agency | 50794.pdf |
| Reference Statement (Read-Only) | DNR, Division of Water | 42143.pdf |
| Referral for Services for the Blind and Visually Impaired (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 46206.pdf |
| Registered Tire Storage Site Closure Cost Estimate | Dept. of Envionmental Management | 53784.doc |
| Registration Application for a Retail Food Establishment | Dept. of Health | 49677.pdf |
| Registration Application for Manufacturer, Processor, Repackager, or Wholesale Distributor of Food, Drugs, or Cosmetics | Dept. of Health | 13054.pdf |
| Registration for Lead-Based Paint Third-Party Examinations | Dept. of Health | 50748.pdf |
| Registration for the 2009 Indiana Standardbred Stallion Registry | Horse Racing Commission | 50542.pdf |
| Registration of Auctioneer Doing Business As (DBA) | Professional Licensing Agency | 43962.pdf |
| Registration Of A Significant Water Withdrawal Facility (Read-Only) | DNR, Division of Water | 20094.pdf |
| Registration of Foreign Corporation Name (Read-Only) | Secretary of State - Business Services Division | 26234.pdf |
| Registration Return - RPAA Form 1 - Indiana Rental Purchase Agreement Act (Read-Only) | Dept. of Financial Institutions | 26865.pdf |
| Regular Party Committee Statement of Organization (CFA-3) (Read-Only) | Election Division | 46413.pdf |
| Regulated Explosive Use - Blaster or Regulated Explosive Use Operator - License Renewal Application (Read-Only) | Dept. of Homeland Security | 52490.pdf |
| Regulatory Services Informal Dispute Resolution (IDR) Record (Read-Only) | Dept. of Health | 50058.pdf |
| Reimbursement For Travel To/From Approved Providers For 50 Miles Or More Roundtrip (Read-Only) | Dept. of Health | 50254.pdf |
| Release of Employment / Release from Parking Facilities | Dept. of Administration, Facilities Management | 52708.pdf |
| Release of Interest in Indiana License Plate and Excise Tax (Read-Only) | Bureau of Motor Vehicles | 48102.pdf |
| Remediation Follow-up Report on Environmental Investigations (Read-Only) | Dept. of Health | 53519.pdf |
| Remediation Work Plan Completeness Checklist (Read-Only) | Dept. of Environmental Management | 53413.pdf |
| Removal from NPDES CATO Permit Program (Read-Only) | Dept. of Environmental Management | 51914.pdf |
| Removal from NPDES CATO Permit Program | Dept. of Environmental Management | 51914.doc |
| Renewal Application For License Approval To Operate A Hospice(Read-Only) | Dept. of Health | 49883.pdf |
| Renewal Application for License to Operate a Personal Services Agency | Dept. of Health | 53591.pdf |
| Renewal Application for License to Operate a Home Health Agency (pursuant to IC 16-27 and 410 IAC 17) (Read-Only) | Dept. of Health | 48851.doc |
| Renewal of Certificate of Authority & Disclosure & Payment of Prepaid Contracts Sold | Professional Licensing Agency | 51264.pdf |
| Renewal of Registration of Foreign Corporation Name (Read-Only) | Secretary of State - Business Services Division | 50659.pdf |
| Rental Excise Credit Affidavit (Read-Only) | Bureau of Motor Vehicles | 47353.pdf |
| Rental Vehicle Use Agreement | Dept. of Administration (Procurement Division) | 53553.pdf |
| Rental Vehicle Use Agreement | Dept. of Administration (Procurement Division) | 53553.doc |
| Reorder for License Agent (Read-Only) | DNR--Division of Fish and Wildlife | 46279.pdf |
| Replacement of Candidate Nominated By Petition | Election Division | 48518.pdf |
| Report for Seasonal Determination (Read-Only) | Dept. of Workforce Development | 15672.pdf |
| Reporting for Fishing Tournament on Public Waters (Read-Only) | DNR--Division of Fish and Wildlife | 52361.pdf |
| Report of Affected Area (R-200) (Read-Only) | DNR - Div. of Reclamation | 02193.pdf |
| Report of Annual Falconry Permit (Read-Only) | DNR - Division of Fish and Wildlife | 44455.pdf |
| Report of Assessment for Omitted or Undervalued Property Assessment and Assessment Penalties (Form 122) | Dept. of Local Government Finance | 09283.pdf |
| Report of Basic EMT Continuing Education | Dept. of Homeland Security | 52319.pdf |
| Report of Burn Injury Registry (Read-Only) | Dept. of Homeland Security | 45496.pdf |
| Report of Coal Production & Reclamation Fee (Read-Only) | DNR - Div. of Reclamation | 44984.pdf |
| Report of Collections/Receipts (Due Treasurer of State) (Read-Only) | Auditor of State | 14311.pdf |
| Report of Designee (Read-Only) | Bureau of Motor Vehicles | 47464.pdf |
| Report of Employee Attendance for Professional Engineers and Land Surveyors Exam (Read-Only) | Professional Licensing Agency | 04067.pdf |
| Report of EMT Basic-Advanced Continuing Education | Dept. of Homeland Security | 44737.pdf |
| Report of EMT - Paramedic Continuing Education | Dept. of Homeland Security | 18220.pdf |
| Report of Grading - Maps (R-300) (Read-Only) | DNR - Div. of Reclamation | 20065.pdf |
| Report of Hearing and Ear Assessment (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 35055.pdf |
| Report of Inactivation | Dept. of Workforce Development | 46800.pdf |
| Report of Incident / Injury | Family and Social Service Admin. - Division of Mental Health and Addiction | 46009.pdf |
| Report of Indiana Operator's Boat Accident (Read-Only) | DNR - Division of Law Enforcement | 42528.pdf |
| Report of Injury/Complaint of Injury | Professional Licensing Agency | 47400.pdf |
| Report of In-Kind / Cash Match Contributions | Dept. of Environmental Management | 50066.pdf |
| Report of Intern Periodic Assessment (Read-Only) | Professional Licensing Agency | 44669.pdf |
| Report of Job Placement -IMPACT Service Provider (Read-Only) | FSSA - Division of Family Resources | 47579.pdf |
| Report of License Sales (Read-Only) | DNR, Fish and Wildlife | 01047.pdf |
| Report of Local Travel for Official Travel in Personal Car | Family and Social Services Admin. | 23151.pdf |
| Report of Overtime | Family and Social Service Administration | 47506.xls |
| Report of Partial Delivery (Read-Only) | Auditor of State | 12537.pdf |
| Report of Personal Services Expenditure (Read-Only) | Family and Social Service Administration | 24221.pdf |
| Report of Railcar Tax (DLGF RC-1) (Read-Only) | Dept. of Local Government Finance | 46373.pdf |
| Report of Receipts | DNR, Fish and Wildlife | 41644.pdf |
| Report of Receipts and Expenditures of a Political Committee (Read-Only) | Election Division | 04606.pdf |
| Report of Repayment - Expenditures - Approved District Plans - Title | Family and Social Service Administration | 45531.pdf |
| Report of Serious Occurrence (Read-Only) | Protection and Advocacy Services | 52384.pdf |
| Report of Serious Occurrence | Indiana Protection and Advocacy Services | 52384.doc |
| Report of Tanning Facility Inspection | Professional Licensing Agency | 47626.pdf |
| Report of Temporary Total Disability (TTD) / Temporary Partial Disability (TPD) Termination / Reduction | Worker's Compensation Board | 38911.pdf |
| Report of Temporary Total Disability (TTD) / Temporary Partial Disability (TPD) Termination / Reduction | Worker's Compensation Board | 38911.doc |
| Report of Tests for Elevator, Dumbwaiters, Escalators, Platform Lift, Stairway Chairlifts, People Movers and Special Purpose Elevators (Read-Only) | Dept. of Homeland Security | 34599.pdf |
| Report of Tests for Elevator, Dumbwaiters, Escalators, Platform Lift, Stairway Chairlifts, People Movers and Special Purpose Elevators | Dept. of Homeland Security | 34599.doc |
| Report of Training | Dept. of Homeland Security | 44848.pdf |
| Report of Transfer - Complete Sale (Read-Only) | Dept. of Workforce Development | 46799.pdf |
| Report of Transfer - Partial Sale (Read-Only) | Dept. of Workforce Development | 23299.pdf |
| Report of Treatment for Latent TB Infection (Read-Only) | Dept. of Health | 49894.pdf |
| Report of Tuberculosis (Read-Only) | Dept. of Health | 14058.pdf |
| Report of Unsold Licenses Returned | DNR, Fish and Wildlife | 37697.pdf |
| Report of Vegetation (R-302) (Read-Only) | DNR - Div. of Reclamation | 20063.pdf |
| Report Of Vehicle Mileage And Costs | Dept. of Administration | 13696.xls |
| Report of Vehicle Mileage and Costs (Read-Only) | Dept. of Administration | 13696.pdf |
| Report of Vendor Performance (Read-Only) | Dept. of Administration, Procurement Division | 21322.pdf |
| Report of Weekly Program Activity | Dept. of Labor | 47968.xls |
| Report on Contractor's Performance | Dept. of Transportation | 19896.pdf |
| Report to County Auditor of Added Assessments and Assessment Penalties (Form 122A) | Dept. of Local Government Finance | 22691.pdf |
| Report to Dept. of Local Government Finance by County Assessor (Form 15) | Dept. of Local Government Finance | 34608.pdf |
| Report to Determine Status | Dept. of Workforce Development | 02837.pdf |
| Request and Authorization for Release of Student Records | Commission on Proprietary Education | 48905.pdf |
| Request & Consent for Military Discharge (Read-Only) | Dept. of Veterans' Affairs | 52347.pdf |
| Request for Administrative Forms & Information Materials | Dept. of Health | 53274.pdf |
| Request for Administrative Hearing | Family and Social Service Admin -- Division of Family Resources | 47845.pdf |
| Request for Approval of Expenditure | Protection and Advocacy Services | 41184.pdf |
| Request for Approval of Expenditure | Protection and Advocacy Services | 41184.doc |
| Request for Approval of New/Revised Form (This revision also covers Electronic Forms and replaces the obsolete State Form 48874. Please download and read the new instructions before use.) |
Commission on Public Records | 36040.pdf |
| Request for Assistance (Read-Only) | Worker's Compensation Board | 45442.pdf |
| Request for Authorization for Audiology Services | Family and Social Service Admin -- Division of Family Resources | 51930.pdf |
| Request for Authorization for Transition Meeting/Transition Checklist | Family and Social Service Admin -- Division of Family Resources | 51670.pdf |
| Request for Case Closure | Dept. of Child Services - Child Support Bureau | 51797.pdf |
| Request for Certification Maintenance Activity Approval | Family and Social Service Admin. - Division of Disability and Rehabilitation | 12061.pdf |
| Request for Change of Name and/or Address | Public Employees Retirement Fund | 00946.pdf |
| Request for Delegation of Purchasing Authority (Read-Only) | Dept. of Administration - Procurement Division | 52083.pdf |
| Request for Distribution of Forms and Publications | Dept. of Correction | 01140.pdf |
| Request for Driving Records and/or Motor Vehicle or Watercraft Information | Bureau of Motor Vehicles | 53789.pdf |
| Request for Estimate of Benefits | Public Employees Retirement Fund | 29211.pdf |
| Request for Estimate of Benefits / To Purchase Service – Judges’ Retirement System | Public Employees Retirement Fund | 53712.pdf |
| Request for Evening/Weekend Access (Read-Only) | Dept. of Administration, Conference Center | 50697.pdf |
| Request for Evening/Weekend Access | Dept. of Administration, Conference Center | 50697.doc |
| Request For Exemption For Coal Extraction Incidental to the Extraction of Other Minerals (Read-Only) | DNR - Div. of Reclamation | 50614.pdf |
| Request for Floodplain Information (Read-Only) | DNR-Division of Water | 50356.pdf |
| Request for Indiana Sport Hunting and Fishing Licenses (Read-Only) | DNR, Division of Fish and Wildlife | 35872.pdf |
| Request for Information for SR21 (Read-Only) | Bureau of Motor Vehicles | 43307.pdf |
| Request for Information Mortality Review (Read-Only) | Family and Social Service Admin -- Division of Aging | 53266.pdf |
| Request for Inspection & Wage Information (Read-Only) | Dept. of Workforce Development | 22393.pdf |
| Request for Issuance/Transfer of Indiana Trainee Appraiser License (Read-Only) | Professional Licensing Agency | 50670.pdf |
| Request for Leave | Commission on Public Records | 00056.pdf |
| Request for Limited Criminal History / Review Challenge (Full) | Indiana State Police | 08053.pdf |
| Request for Medicaid Expenditures | Family and Social Services Admin. | 06533.pdf |
| Request for Modification - Contract Termination (Read-Only) | Dept. of Workforce Development | 52732.pdf |
| Request for Out of State Title to Perfect Lien (Read-Only) | Bureau of Motor Vehicles | 01014.pdf |
| Request for Permission to Destroy or Transfer Certain Public Records (PR-1) | Commission on Public Records | 30505.pdf |
| Request for Personal Reference Statement for Foster Family Home License Applicants | Dept. of Child Services - Child Welfare | 53203.pdf |
| Request for Photo Exempt License / ID - Temporary or Verification | Bureau of Motor Vehicles | 45811.pdf |
| Request for Prevailing Wage | Dept. of Workforce Development | 48364.pdf |
| Request for Print Services | Dept. of Administration - Central Printing / Pitney Bowes | 44874.pdf |
| Request for Print Services | Dept. of Administration - Central Printing / Pitney Bowes | 44874.doc |
| Request for Printing Services | Dept. of Workforce Development | 39141.xls |
| Request for Public Records | Public Employees Retirement Fund | 52005.pdf |
| Request for Re-Employment (Read-Only) | Dept. of Personnel | 51729.pdf |
| Request for Re-Employment | State Personnel Department | 51729.doc |
| Request for Rollover Account Beneficiary Designation Change (Read-Only) | Teachers' Retirement Fund | 52332.pdf |
| Request for Room Reservation (Read-Only) | Dept. of Administration | 45292.pdf |
| Request for Room Reservation | Dept. of Administration, Conference Center | 45292.doc |
| Request for Scanned Record | Commission on Public Records | 53944.pdf |
| Request for Scanned Record | Commission on Public Records | 53944.doc |
| Request for SDO Account Establishment, Adjustments and New Officer | Auditor of State | 49068.pdf |
| Request for Space Planning/Building Rearrangement (Read-Only) | Dept. of Administration, Facilities Mgt. | 52484.doc |
| Request for Special/Courtesy Test Affidavit (Read-Only) | Bureau of Motor Vehicles | 50190.pdf |
| Request for Student Income and Expenses | FSSA - Division of Family Resources | 42755.pdf |
| Request for TB Drugs (Read-Only) | Dept. of Health | 48085.pdf |
| Request for Transfer Statement | Bureau of Motor Vehicles | 53330.pdf |
| Request for Transportation (Read-Only) | FSSA - Division of Family Resources | 47300.pdf |
| Request for Use of an Air Curtain Open Pit Destructor (Read-Only) | Dept. of Environmental Management | 43688.pdf |
| Request for Use of an Air Curtain Open Pit Destructor | Dept. of Environmental Management | 43688.doc |
| Request for Variance from 326 IAC 4-1 (Fire Training) (Read-Only) | Dept. of Environmental Management | 49634.pdf |
| Request for Variance from 326 IAC 4-1 (Fire Training) | Dept. of Environmental Management | 49634.doc |
| Request for Variance from 326 IAC 4-1 (Motor Vehicle Fire Training) (Read-Only) | Dept. of Environmental Management | 50337.pdf |
| Request for Variance from 326 IAC 4-1 (Motor Vehicle Fire Training) | Dept. of Environmental Management | 50337.doc |
| Request for Variance from 326 IAC 4-1 (Prescribed Vegetation Burn) (Read-Only) | Dept. of Environmental Management | 50864.pdf |
| Request for Variance from 326 IAC 4-1 (Prescribed Vegetation Burn) | Dept. of Environmental Management | 50864.doc |
| Request for Variance from 326 IAC 4-1 (Tree Waste or Clean Wood Waste) (Read-Only) | Dept. of Environmental Management | 43692.pdf |
| Request for Variance from 326 IAC 4-1 (Tree Waste or Clean Wood Waste) | Dept. of Environmental Management | 43692.doc |
| Request for Waiver (Read-Only) | Bureau of Motor Vehicles | 28622.pdf |
| Request for Waiver of Direct Deposit Requirement (Read-Only) | Auditor of State | 52254.pdf |
| Request for Waiver of Six Month Experience Requirement to Manage a Salon | Professional Licensing Agency | 46221.pdf |
| Request to Allocate Annuity Savings Account (Read-Only) | Teacher's Retirement Fund | 19368.pdf |
| Request to Allocate Annuity Savings Account | Teachers' Retirement Fund | 19368.doc |
| Request to Allocate Rollover Account (Read-Only) | Teacher's Retirement Fund | 52178.pdf |
| Request to Lease Space | Dept. of Administration | 00202.pdf |
| Request to Purchase Additional Service Credit [PERF] | Public Employees Retirement Fund | 50941.pdf |
| Request to Purchase Additional Service Credit [ITRF] (Read-Only) | Teacher's Retirement Fund | 52006.pdf |
| Request to Purchase Out of State Service | Public Employees Retirement Fund | 48789.pdf |
| Request to Purchase Prior Military Service | Public Employees Retirement Fund | 54011.pdf |
| Request to Purchase Prior Military Service Credit – 1977 Police Officers’ & Firefighters’ Pension & Disability Fund | Public Employees Retirement Fund | 53971.pdf |
| Request to Store | Dept. of Correction | 53163.pdf |
| Request to Store | Dept. of Correction | 53163.doc |
| Requests for Permit Change in Regard to Changes in 326 IAC 2-6 (Read-Only) | Dept. of Environmental Management | 51655.pdf |
| Required Supplement to W-4P | Public Employees Retirement Fund | 53993.pdf |
| Required Supplement to WH-4P | Public Employees Retirement Fund | 53992.pdf |
| Requisition | Dept. of Administration, Procurement Division | 21301.pdf |
| Researching the Occupation - Interview Questionnaire (Read-Only) | FSSA - Division of Family Resources | 48416.pdf |
| Researching Vocational or Job Skills Training Program (Read-Only) | FSSA - Division of Family Resources | 48417.pdf |
| Reservation for Practical Skills Examination | Dept. of Homeland Security | 53533.pdf |
| Residential / Hospital / Sentinel Event / Assertive Community Treatment (ACT) Incident Report | Family and Social Service Admin. - Division of Mental Health and Addiction | 53808.pdf |
| Resolution Authorizing an Agent to Accept Pension Liability on Behalf of the Governing Body | Public Employees Retirement Fund | 52658.pdf |
| Restatement of Articles of Incorporation (Read-Only) | Secretary of State - Business Services Division | 42152.pdf |
| Restricted Waste Site Type I or II Inspection Report | Dept. of Environmental Management | 53908.doc |
| Restricted Waste Site Type III Inspection Report | Dept. of Environmental Management | 53909.doc |
| Retired Member Data Change (Read-Only) | Teacher's Retirement Fund | 44504.pdf |
| Retiree Application for Change of Beneficiary and/or Pension Option | Public Employees Retirement Fund | 49432.pdf |
| Return for Interstate Carriers (Form 103-I) | Dept. of Local Government Finance | 22649.pdf |
| Return of Special Tools (Form 103-T) | Dept. of Local Government Finance | 22667.pdf |
| Revenue Received Log | Indiana Protection and Advocacy Services | 06977.doc |
| Review of Field Mentor by Trainee | Dept. of Child Services - Child Welfare | 53206.pdf |
| Rider to Self-Bond Indemnity Agreement and Absolute Corporate Guaranty (Read-Only) | DNR - Div. of Reclamation | 51951.pdf |
| Rider to Self-Bond Indemnity Agreement and Absolute Corporate Guaranty (SE-1) (Read-Only) | DNR - Div. of Reclamation | 51894.pdf |
| Risk Integrated System of Closure Technical Guidance Document & User's Guide Order Form (Read-Only) | Dept. of Environmental Management | 50389.pdf |
| Rollover Account Application for Distribution with Disability or Retirement Benefits | Public Employees Retirement Fund | 51927.pdf |
| Rollover Account Claim for Distribution of Contributions | Public Employees Retirement Fund | 51019.pdf |
| Rollover Account Investment Direction | Public Employees Retirement Fund | 51004.pdf |
| Roster for Students Participating in Cognitive Examinations | Dept. of Homeland Security | 48105.pdf |
| Roster Listing-Architect and Landscape Architect | Professional Licensing Agency | 04061.pdf |
| Roster of Primary Instructors | Dept. of Homeland Security | 46089.pdf |
| Rule 5 - Notice of Intent (NOI) (Read-Only) | Dept. of Environmental Management | 47487.pdf |
| Rule 5 - Notice of Intent (NOI) | Dept. of Environmental Management | 47487.doc |
| Rule 5 - Notice of Termination (NOT) Storm Water Runoff Associated With Construction Activity (Read-Only) | Dept. of Environmental Management | 51514.pdf |
| Rule 6 Industrial Storm Water General Permit – Storm Water Discharge Monitoring Report | Dept. of Environmental Management | 53590.pdf |
| Rule 6 - Notice of Intent (NOI) Letter | Dept. of Environmental Management | 51286.pdf |
| Rule 6 - Notice of Intent (NOI) Letter (Read-Only) | Dept. of Environmental Management | 51286.doc |
| Rule 6 - Storm Water Pollution Prevention Plan (SWP3)- Certification Checklist | Dept. of Environmental Management | 51287.pdf |
| Rule 6 - Storm Water Pollution Prevention Plan (SWP3)- Certification Checklist | Dept. of Environmental Management | 51287.doc |
| Rule 13 Annual Report | Dept. of Environmental Management | 51278.pdf |
| Rule 13 Annual Report | Dept. of Environmental Management | 51278.doc |
| Rule 13 Certification of the Development and Implementation, of a Program to Reduce Pollutant Run-Off from Municipal Operations for the Municipal Operations Pollution Prevention and Good Housekeeping MCM | Dept. of Environmental Management | 51281.pdf |
| Rule 13 Certification of the Development and Implementation, of a Program to Reduce Pollutant Run-Off from Municipal Operations for the Municipal Operations Pollution Prevention and Good Housekeeping MCM | Dept. of Environmental Management | 51281.doc |
| Rule 13 Certification of the Development, Implementation, Management and Enforcement of an Erosion and Sediment Control Program for the Construction Site Storm Water Run-Off Control MCM (Read-Only) | Dept. of Environmental Management | 51272.pdf |
| Rule 13 Certification of the Development, Implementation, Management and Enforcement of an Erosion and Sediment Control Program for the Construction Site Storm Water Run-Off Control MCM | Dept. of Environmental Management | 51272.doc |
| Rule 13 Certification of the Development, Implementation, Management and Enforcement of a Postconstruction Storm Water Run-Off Control Program for the Postconstruction Storm Water Run-Off Control MCM (Read-Only) | Dept. of Environmental Management | 51274.pdf |
| Rule 13 Certification of the Development, Implementation, Management and Enforcement of a Postconstruction Storm Water Run-Off Control Program for the Postconstruction Storm Water Run-Off Control MCM | Dept. of Environmental Management | 51274.doc |
| Rule 13 Certification of the Informational Program for the Public Education and Outreach MCM | Dept. of Environmental Management | 51279.pdf |
| Rule 13 Certification of the Informational Program for the Public Education and Outreach MCM | Dept. of Environmental Management | 51279.doc |
| Rule 13 Certification of the Plan to Detect, Address and Eliminate Illicit Discharges for the Illicit Detection and Elimination MCM (Read-Only) | Dept. of Environmental Management | 51271.pdf |
| Rule 13 Certification of the Plan to Detect, Address and Eliminate Illicit Discharges for the Illicit Detection and Elimination MCM | Dept. of Environmental Management | 51271.doc |
| Rule 13 Certification of the Public Participation and Involvement Program for the Public Participation and Involvement MCM (Read-Only) | Dept. of Environmental Management | 51273.pdf |
| Rule 13 Certification of the Public Participation and Involvement Program for the Public Participation and Involvement MCM | Dept. of Environmental Management | 51273.doc |
| Rule 13 - Monthly Summary Report of Construction Projects (Read-Only) | Dept. of Environmental Management | 51276.pdf |
| Rule 13 - Monthly Summary Report of Construction Projects | Dept. of Environmental Management | 51276.doc |
| Rule 13 Notice of Intent (NOI) Letter (Read-Only) | Dept. of Environmental Management | 51270.pdf |
| Rule 13 Notice of Intent (NOI) Letter | Dept. of Environmental Management | 51270.doc |
| Rule 13 Storm Water Quality Management Plan (SWQMP) - Part A: Initial Application Certification Submittal and Checklist (Read-Only) | Dept. of Environmental Management | 51277.pdf |
| Rule 13 Storm Water Quality Management Plan (SWQMP) - Part A: Initial Application Certification Submittal and Checklist | Dept. of Environmental Management | 51277.doc |
| Rule 13 Storm Water Quality Management Plan (SWQMP) - Part B: Baseline Characterization and Report Certification Checklist (Read-Only) | Dept. of Environmental Management | 51275.pdf |
| Rule 13 Storm Water Quality Management Plan (SWQMP) - Part B: Baseline Characterization and Report Certification Checklist | Dept. of Environmental Management | 51275.doc |
| Rule 13 Storm Water Quality Management Plan (SWQMP) - Part C: Program Implementation Certification Checklist | Dept. of Environmental Management | 51280.pdf |
| Rule 13 Storm Water Quality Management Plan (SWQMP) - Part C: Program Implementation Certification Checklist | Dept. of Environmental Management | 51280.doc |
| Sales Certificate (Read-Only) | Bureau of Motor Vehicles | 23104.pdf |
| Sales Disclosure Form | Dept. of Local Government Finance | 46021.pdf |
| Salvage Title Affidavit (Read-Only) | Bureau of Motor Vehicles | 49891.pdf |
| Schedule A-3 - Air Pollution Control Equipment | Dept. of Local Government Finance | 47337.pdf |
| Schedule A-4 - Water Pollution Control Equipment (Read-Only) | Dept. of Local Government Finance | 47336.pdf |
| Schedule A-5 - REMC Schedule | Dept. of Local Government Finance | 47338.pdf |
| Schedule A-6 - Pipe Valuation | Dept. of Local Government Finance | 47339.pdf |
| Schedule A-7 - Utility Distributable Property of Pipeline Companies | Dept. of Local Government Finance | 47340.pdf |
| Schedule A-8 - Value of Buses and Tires | Dept. of Local Government Finance | 47341.pdf |
| Schedule of Deduction from Assessed Valuation - Personal Property in Economic Revitalization Area (Form 103-ERA) | Dept. of Local Government Finance | 52503.pdf |
| Schedule of Deduction from Assessed Valuation - Utility Distributable Property in Economic Revitalization Area (UD-ERA) (Read-Only) | Dept. of Local Government Finance | 52447.pdf |
| Schedule of Deduction from Assessed Valuation - Utility Property Investment Deduction (Form UD-ID) (Read-Only) | Dept. of Local Government Finance | 52511.pdf |
| Schedule of Deduction from Assessed Value - Pool 5 Property in Economic Revitalization Area (Form 103-P5 / ERA) | Dept. of Local Government Finance | 52498.pdf |
| Schedule of Adjustments to Business Tangible Personal Property Return (Form 106) | Dept. of Local Government Finance | 12980.pdf |
| School Hearing Screening Report | Dept. of Health | 39986.pdf |
| School Scoliosis Screening Report | Dept. of Health | 04685.doc |
| Scientific Purposes License Annual Report (Read-Only) | DNR - Fish and Wildlife | 48566.pdf |
| Scope of Work (Read-Only) | Dept. of Environmental Management | 51955.pdf |
| Scope of Work | Dept. of Environmental Management | 51955.doc |
| SEA 368 Inspection Report (Read-Only) | Dept. of Natural Resources - Div. of Water | 51594.pdf |
| Section 319 Nonpoint Source Pollution Grant Application | Dept. of Environmental Management | 49367.doc |
| Section 401 WQC Regional General Permit Notification Form | Dept. of Environmental Management | 51937.pdf |
| Section Corner Reference (Read-Only) | Dept. of Transportation | 40180.pdf |
| Self-Bond Indemnity Agreement and Absolute Corporate Guaranty (Read-Only) | DNR - Div. of Reclamation | 51892.pdf |
| Seller's Residential Real Estate Sales Disclosure (Read-Only) | Professional Licensing Agency | 46234.pdf |
| Semi-Annual Seeding Report (B-601) (Read-Only) | DNR - Div. of Reclamation | 50619.pdf |
| Service Change To The IFSP Checklist | FSSA - Division of Family Resources | 51921.pdf |
| Service Credit Purchase Form (Read-Only) | Teachers' Retirement Fund | 34865.pdf |
| Service Credit Purchase Form | Teachers' Retirement Fund | 34865.doc |
| Shelter Reservation Request (Read-Only) | Dept. of Natural Resources -- Division of Forestry | 50696.pdf |
| Shipping Request | Dept. of Administration - Central Printing / Pitney Bowes | 53793.pdf |
| Shovel Ready Application | Economic Development Corporation | 53262.pdf |
| Signature Affidavit | Dept. of Transportation | 34910.pdf |
| Single Return – Business Tangible Personal Property (Form 103-SR) | Dept. of Local Government Finance | 53854.pdf |
| Single Return – Business Tangible Personal Property (Form 104-SR) | Dept. of Local Government Finance | 53855.pdf |
| Site Categorization For Prioritization of Claims (Read-Only) | Dept. of Environmental Management | 51920.pdf |
| Site Categorization For Prioritization of Claims | Dept. of Environmental Management | 51920.doc |
| Small Estate Affidavit ($50,000) | Public Employees Retirement Fund | 49284.pdf |
| Social Security Consent Form (Read-Only) | Teachers' Retirement Fund | 50824.pdf |
| Social Security Consent Form | Teachers' Retirement Fund | 50824.doc |
| Social Security Number Affidavit (Read-Only) | DNR - Fish and Wildlife | 52012.pdf |
| Social Services Block Grant | Family and Social Service Admin. - Division of Disability and Rehabilitation | 48203.pdf |
| Soil Evaluation for Onsite Sewage Systems | Dept. of Health | 48100.pdf |
| Soil Evaluation for Onsite Sewage Systems | Dept. of Health | 48100.doc |
| Solicitud Para Asistencia - Parte 3 - Certificacion del Cliente y Asignacion (Read-Only) | FSSA - Division of Family Resources | 48400.pdf |
| Solicitud Para Hoosier Healthwise Para Ninos & Mujeres Embarazadas (Read-Only) | FSSA - Division of Family Resources | 48974.pdf |
| Solid Manure Staging Record (Personal Document) (Read-Only) | Dept. of Environmental Management | 51827.pdf |
| Solid Waste Disposal Fee Report (Read-Only) | Dept. of Environmental Management | 50413.pdf |
| Solid Waste Facility Permit Application & Registration Fee Transmittal Form (Read-Only) | Dept. of Environmental Management | 47215.pdf |
| Solid Waste Facility Permit Application & Registration Fee Transmittal Form | Dept. of Environmental Management | 47215.doc |
| Solid Waste Facility Permit Renewal Application | Dept. of Environmental Management | 50387.pdf |
| Solid Waste Facility Permit Transfer Application SWF-13 (Read-Only) | Dept. of Environmental Management | 50393.pdf |
| Solid Waste Land Disposal Facility Permit Application (Read-Only) | Dept. of Environmental Management | 50404.pdf |
| Solid Waste Land Disposal Facility Permit Application | Dept. of Environmental Management | 50404.doc |
| Solid Waste Land Disposal Facility Permit Renewal Application | Dept. of Environmental Management | 50386.doc |
| Solid Waste Land Disposal Facility Quarterly Report (Read-Only) | Dept. of Environmental Management | 51908.pdf |
| Solid Waste Land Disposal Facility Quarterly Report | Dept. of Environmental Management | 51908.doc |
| Solid Waste Processing Facilities and Incinerators - New Facility and Major Modification Permit Application Checklist | Dept. of Environmental Management | 53315.doc |
| Solid Waste Processing Facility Permit Application (Read-Only) | Dept. of Environmental Management | 50392.pdf |
| Solid Waste Processing Facility Permit Application | Dept. of Environmental Management | 50392.doc |
| Solid Waste Processing Facility Quarterly Report (Read-Only) | Dept. of Environmental Management | 51909.pdf |
| Solid Waste Processing Facility Quarterly Report | Dept. of Environmental Management | 51909.doc |
| Special Disbursing Officer Reimbursement Voucher (Read-Only) | Auditor of State | 11649.pdf |
| SR21 Indiana Operator's Proof of Insurance/Crash Report | Bureau of Motor Vehicles | 52441.pdf |
| Stage I Vapor Recovery Inspection 326 IAC 8-4-6 | Dept. of Envionmental Management | 49361.pdf |
| Stage II Vapor Recovery Inspection 326 IAC 8-4-6 | Dept. of Envionmental Management | 49364.pdf |
| Stallion Directory Advertisement Reservation | Horse Racing Commission | 53374.pdf |
| Start Notification for Administrator-In-Training Program | Professional Licensing Agency | 52638.pdf |
| State Agency Order Form (Read-Only) | Dept. of Correction | 44515.pdf |
| State Archives Record Transmittal and Receipt | Commission on Public Records | 48883.pdf |
| State Archives Record Transmittal and Receipt | Commission on Public Records | 48883.doc |
| State Employee Community Service Program Request for Leave and Verification of Services Provided | Dept. of Personnel | 49044.pdf |
| State Hospital Referral | Family and Social Svc. Admin. -- Div. of Mental Health and Addiction | 52179.pdf |
| State Micrographics Records Transmittal and Receipt | Commission on Public Records | 49433.pdf |
| Statement for Deduction from Assessed Valuation - Building Constructed of Coal Combustion Products (Form RE-CCP) | Dept. of Local Government Finance | 52500.pdf |
| Statement for Deduction of Assessed Valuation (Fertilizer and Pesticide Storage Improvements) | Dept. of Local Government Finance | 45651.pdf |
| Statement for Deduction of Assessed Valuation (Attributed to Solar Energy, Wind, Geotherm or Hydroelectric Power) (Form SES/WPD) | Dept. of Local Government Finance | 18865.pdf |
| Statement for Deduction of Assessed Valuation (Investment Property Purchased by Manufacturers of Recycled Coal Combustion Products - Form PP - CCP) (Read-Only) | Dept. of Local Government Finance | 52499.pdf |
| Statement of Attestation by Relative Regarding Relationship (Read-Only) | Dept. of Child Services - Child Welfare | 52727.pdf |
| Statement of Benefits - Personal Property (Form SB-1/PP) | Dept. of Local Government Finance | 51764.pdf |
| Statement of Benefits - Real Estate Improvements (Form SB-1 / Real Property) | Dept. of Local Government Finance | 51767.pdf |
| Statement of Benefits - Utility Distributable Property (SB - 1 / UD) (Read-Only) | Dept. of Local Government Finance | 52446.pdf |
| Statement of Book Expense (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 13734.pdf |
| Statement of Condition (Industrial Authority) (Read-Only) | Dept. of Financial Institutions | 48000.pdf |
| Statement of Existing Lease Agreement (Read-Only) | Bureau of Motor Vehicles | 12787.pdf |
| Statement of Freedom of Choice (Read-Only) | Family and Social Svc. Admin. -- Div. of Mental Health and Addiction | 51548.pdf |
| Statement of Mortgage or Contract Indebtedness for Deduction from Assessed Valuation | Dept. of Local Government Finance | 43709.pdf |
| Statement of Remediation of EBT-BA Curriculum | Dept. of Homeland Security | 53513.pdf |
| Statement of Resignation of Registered Agent (Read-Only) | Secretary of State - Business Services Division | 26285.pdf |
| Statement of Superintendent Disability Benefits Application (Read-Only) | Teachers' Retirement Fund | 17295.pdf |
| Statement With Regard to Proposed Plan of Exchange (Read-Only) | Dept. of Financial Institutions | 13755.pdf |
| State of Indiana Media Requisition | Dept. of Administration - Procurement Division | 52805.pdf |
| State of Indiana Media Requisition | Dept. of Administration, Procurement Division | 52805.doc |
| State of Indiana Out of Hospital Do Not Resuscitate Declaration and Order (Read-Only) | Dept. of Homeland Security | 49559.pdf |
| State of Indiana: Request for Phytosanitary Certificate (Read-Only) | DNR - Division of Entomolgy and Plant Pathology | 50437.pdf |
| State of Indiana Traffic Requisition | Dept. of Administration - Procurement Division | 53752.pdf |
| State of Indiana Traffic Requisition | Dept. of Administration, Procurement Division | 53752.doc |
| State-Owned Vehicles Passenger Waiver of Liability | Dept. of Administration | 53845.pdf |
| State Park Deer Reduction and Wild Turkey Application (Read-Only) | DNR, Fish and Wildlife | 52673.pdf |
| State Surplus Property Bid Sheet and Affidavit (Read-Only) | Dept. of Administration, Motor Pool | 13788.pdf |
| Status Report Agricultural Employment (Read-Only) | Dept. of Workforce Development | 46798.pdf |
| Status Report for Domestic (Household) Employment (Read-Only) | Dept. of Workforce Development | 45982.pdf |
| Submission of Public Comments & Questions for Public Meetings & Hearings | Dept. of Environmental Management | 53534.doc |
| Summary Report on the Immunization Status of First Grade Students Enrolled in School | Dept. of Health | 49455.pdf |
| Summary Report on the Immunization Status of Kindergarten Students Enrolled in School | Dept. of Health | 48973.pdf |
| Summary Report on the Immunization Status of Sixth Grade Students Enrolled in School | Dept. of Health | 48971.pdf |
| Supplemental Information (Parts A and B) (Read-Only) | Dept. of Financial Institutions | 01717a.pdf 01717b.pdf |
| Supplemental Information for Land Surveyors Application | Professional Licensing Agency | 49814.pdf |
| Supplemental Information for Land Surveyor & Land Surveying Intern Application | Professional Licensing Agency | 49856.pdf |
| Supplemental Information for Professional Engineer and Engineer in Training (EIT) Application | Professional Licensing Agency | 50938.pdf |
| Supplemental Large Contribution Report by a Candidate's Committee ($1,000 Contributions or More) (CFA-11) (Read-Only) | Election Division | 48492.pdf |
| Supplementary Information to Federal Application - End Stage Renal Disease (ESRD) Facility | State Dept. of Health | 51053.pdf |
| Supplementary Information to Federal Application Rural Health Clinic (RHC) (Read-Only) | State Dept. of Health | 51054.pdf |
| Supplement to Health Program Form, Infant - Toddler (Read-Only) | FSSA - Division of Family Resources | 45878.pdf |
| Support Service Expense Statement (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 13729.pdf |
| Surety Bond | DNR, Forestry Division | 50302.pdf |
| Surety Bond (SB-1) (Read-Only) | DNR - Div. of Reclamation | 50621.pdf |
| Surety Bond Rider (SB-2) (Read-Only) | DNR - Div. of Reclamation | 06732.pdf |
| Surety Bond | Dept. of Agriculture | 18720.pdf |
| Surety Bond | Dept. of Agriculture | 18720.doc |
| Surety Bond (Read-Only) | Professional Licensing Agency | 35229.pdf |
| Surety Bond (Appraisers) (Read-Only) | Professional Licensing Agency | 50793.pdf |
| Surface Coal Mine Reclamation Bond Pool Fund (Read-Only) | DNR - Div. of Reclamation | 51510.pdf |
| Surface Coal Mine Reclamation Bond Pool Fund Replacement (Read-Only) | DNR - Div. of Reclamation | 51509.pdf |
| Surgery for the Treatment of Morbid Obesity - Follow-up Report | State Dept. of Health | 53322.pdf |
| Surgery for the Treatment of Morbid Obesity - Initial Report | State Dept. of Health | 53321.pdf |
| Surveillance Serology Request HIV, Hepatitis B/C, Syphilis Sample Submission | Dept. of Health | 53762.pdf |
| Survey of Residential Services & Supports | Family and Social Service Admin. - Division of Disability and Rehabilitation | 51679.pdf |
| Surveyor Checklist for Room Variance (Read-Only) | Dept. of Health | 50817.doc |
| Surveyor Variance Evaluation and Recommendation for Approval (Read-Only) | Dept. of Health | 50816.doc |
| Surveyor Variance Evaluation and Recommendation for Denial (Read-Only) | Dept. of Health | 50815.doc |
| Synthetic Organic Compounds (SOCs) in Drinking Water | Dept. of Environmental Management | 53287.pdf |
| Syphilis Test Request | Dept. of Health | 13708.pdf |
| Taking Custody Of A Child Without A Verbal Or Written Court Order: Description Of Circumstances (Read-Only) | Dept. of Child Services - Child Welfare | 49584.pdf |
| Taxpayer Identification Number Request (Read-Only) | Dept. of Administration/Procurement Div. | 23743.pdf |
| Tax Return-Fixed Personal Property of Public Utilities (DGLF Form 1) (Read-Only) | Dept. of Local Government Finance | 01882.pdf |
| TB Hospital Reimbursement Claim (Read-Only) | Dept. of Health | 46596.pdf |
| Temporary Construction Dewatering Systems Report (Read-Only) | DNR-Division of Water | 50355.pdf |
| Temporary Plate Log | Secretary of State - Dealer Division | 53606.pdf |
| Termination Request for Training Acceleration Grant (TAG) | Dept. of Workforce Development | 52733.xls |
| Termination Request for Training Acceleration Grant (TAG) (Read-Only) | Dept. of Workforce Development | 52733.pdf |
| Thoroughbred Foal Registration Application for Foals of ___ (Read-Only) | Horse Racing Commission | 48657.pdf |
| Thoroughbred Mare Registration Application for Foaling Year ___ (Read-Only) | Horse Racing Commission | 48658.pdf |
| Thoroughbred Stallion Registration Application for Breeding Year ___ (Read-Only) | Horse Racing Commission | 48655.pdf |
| Title Name Change Procedure - Form 241 | Bureau of Motor Vehicles | 44605.pdf |
| Trading Partner Agreement – Electronic Data Interchange (EDI) | Dept. of Health | 51402.pdf |
| Transfer of Service Credit | Public Employees Retirement Fund/Public Employees' Retirement Fund | 36249.pdf |
| Transfer Station Annual Report (Read-Only) | Dept. of Environmental Management | 51885.pdf |
| Transfer Under the Indiana Uniform Transfers to Minors Act | Public Employees' Retirement Fund | 53674.pdf |
| Transition Meeting Notification | Family and Social Service Admin -- Division of Family Resources | 51671.pdf |
| Transmittal (Analysis) | Commission on Public Records | 43055.pdf |
| Transmittal for Medicaid Level of Care Eligibility (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 46018.pdf |
| Travel Advance | Board of Accounts | 49630.pdf |
| Travel Advance | Board of Accounts | 49630.doc |
| Travel Voucher | Auditor of State | 00980.pdf |
| Trihalomethanes & Haloacetic Acids Analyses in Drinking Water | Dept. of Environmental Management | 53288.pdf |
| Tuberculosis Contact Investigation Summary Report & Worksheet (Read-Only) | Dept. of Health | 50007.pdf |
| Tuberculosis Waiver Request (Read-Only) | State Dept. of Health | 46595.pdf |
| Uniform Conflict of Interest Ethics Disclosure Statement | Inspector General - Ethics Commission | 53345.pdf |
| Uniform Conflict of Interest Disclosure Statement (Not a state form) (Read-Only) | Board of Accounts | Form 236 |
| Unlicensed Facility Request for CD Aide Renewal Program (Read-Only) | Dept. of Health | 52533.pdf |
| Used Oil Management Report (Read-Only) | Dept. of Environmental Management | 52392.pdf |
| Used Oil Management Report | Dept. of Environmental Management | 52392.doc |
| Valuable Metal Dealer Report – Resold Metal Products | Indiana State Police | 52776.pdf |
| Value-Added Agriculture Grant Application (Read-Only) | Office of the Commissioner of Agriculture | 46235.pdf |
| Varicella (Chickenpox) Disease Surveillance Monthly Report (Read-Only) | State Dept. of Health | 51849.pdf |
| Varicella Sentinel Surveillance System - Enrollment (Read-Only) | State Dept. of Health | 51848.pdf |
| Vehicle Use Agreement | Dept. of Administration, Operations Division | 34193.pdf |
| Vendor / Contractor License Application (Read-Only) | Horse Racing Commission | 46697.pdf |
| Vendor Information | Auditor of State | 53788.pdf |
| Vendor Permit For Operation (Read-Only) | Dept. of Natural Resources -- Division of Forestry | 50717.pdf |
| Verification of Administrator-In-Training Program | Professional Licensing Agency | 42353.pdf |
| Verification of Agent Training | Commission on Proprietary Education | 39287.pdf |
| Verification of Birth | FSSA - Division of Family Resources | 53702.pdf |
| Verification of Dependent Disability(Read-Only) | State Personnel | 53388.pdf |
| Verification of Employment for Registration as Land Surveyor (Read-Only) | Professional Licensing Agency | 35178.pdf |
| Verification of Employment of Applicants for Health Facility Administrators Licensure (Read-Only) | Professional Licensing Agency | 42352.pdf |
| Verification of Full Time Student Status (Read-Only) | State Personnel | 50674.pdf |
| Verification of Indiana Accredited Private School Teaching Service (Read-Only) | Teachers' Retirement Fund | 49047.pdf |
| Verification of Out-of-State Teaching Service (Read-Only) | Teachers' Retirement Fund | 49530.pdf |
| Verification of Out-of-State Teaching Service (Read-Only) | Teachers' Retirement Fund | 49530.doc |
| Verification of Prior In State Teaching Service (Read-Only) | Teachers' Retirement Fund | 41625.pdf |
| Verification of Prior In State Teaching Service (Read-Only) | Teachers' Retirement Fund | 41625.doc |
| Verification Of Reference For Registration As Land Surveyor (Read-Only) | Professional Licensing Agency | 03826.pdf |
| Verification of State Licensure | Professional Licensing Agency | 07143.pdf |
| Verified Application for Issuance of a Certificate of Territorial Authority to be a Radio Common Carrier (RCC) or Provide Commercial Mobile Radio Service (CMRS) within the State of Indiana | Utility Regulatory Commission | 49536.pdf |
| Verified Application for Issuance of a Certificate of Territorial Authority to Resell Wide Area Telephone Service and/or Interexchange Intrastate Telecommunications Services within the State of Indiana | Utility Regulatory Commission | 50491.pdf |
| Verified Application for Release of Bond and Certificate of Deposit | DNR, Forestry Division | 50301.pdf |
| Verified Application for Release of Cash Bond | DNR, Forestry Division | 50300.pdf |
| Verified Complaint Requesting Restitution From the Preneed Consumer Protection Fund (Read-Only) | Professional Licensing Agency | 46220.pdf |
| Verified Notice of a Change in a Certificate of Territorial Authority for a Facilities-Based Provider of Local Exchange Service or Interexchange Service | Utility Regulatory Commission | 50740.pdf |
| Verified Notice of a Change in a Certificate of Territorial Authority to be a Radio Common Carrier (RCC) or Provide Commercial Mobile Radio Service (CMRS) Issued by the State of Indiana | Utility Regulatory Commission | 49537.pdf |
| Verified Notice of a Change in a Certificate of Territorial Authority to Resell Wide Area Telephone Service and/or Interexchange Intrastate Telecommunications Services Issued by the State of Indiana | Utility Regulatory Commission | 50490.pdf |
| Verified Notice of Change in a Certificate of Territorial Authority to Provide Communications Services Within the State of Indiana | Utility Regulatory Commission | 50739.pdf |
| Video Order (Read-Only) | State Dept. of Health | 36897.pdf |
| Violation of Timber Buyers Licensing Law Complaint Form | DNR, Forestry Division | 50299.pdf |
| Virology | Dept. of Health | 35212.pdf |
| VIP Challenge Pledge | Dept. of Environmental Management | 53902.pdf |
| VIP Challenge Pledge | Dept. of Environmental Management | 53902.doc |
| Virtual Private Network Request Form (Read-Only) | Dept. of Environmental Management | 50695.pdf |
| Virtual Private Network Request Form | Dept. of Environmental Management | 50695.doc |
| Volatile Organic Compounds (VOCs) in Drinking Water | Dept. of Environmental Management | 53286.pdf |
| Voluntary Contribution to Annuity Savings Account (Read-Only) | Teachers' Retirement Fund | 50895.pdf |
| Voluntary Idling Program Annual Report | Dept. of Environmental Management | 53903.pdf |
| Voluntary Idling Program Annual Report | Dept. of Environmental Management | 53903.doc |
| Voluntary Remediation Program Application With Instructions (Read-Only) | Dept. of Environmental Management | 47271.pdf |
| Voluntary Remediation Program Application With Instructions | Dept. of Environmental Management | 47271.doc |
| Volunteer Fire Assistance Federal Grant Application Addendum | DNR, Forestry Division | 50298.pdf |
| Voucher Abstract | Auditor of State | 22933.xls |
| Voucher Abstract (Read-Only) | Auditor of State | 22933.pdf |
| VRG-7p Solicitud De Registro Para Votar En Indiana (Read-Only) | Election Division | 49350.pdf |
| VRG-7p Solicitud De Registro Para Votar En Indiana | Election Division | 49350.doc |
| Waiver of Right to an Administrative Disqualification Hearing | FSSA - Division of Family Resources | 51934.pdf |
| Warehouse License Annual Renewal (2 pg) (Read-Only) | Dept. of Agriculture | 18789-1.pdf 18789-2.pdf |
| Waste Tire Grant Application - Indiana Waste Grant Recycling Program (Read-Only) | Dept. of Environmental Management | 48561.pdf |
| Waste Tire Grant Application - Indiana Waste Grant Recycling Program | Dept. of Envionmental Management | 48561.doc |
| Waste Tire Manifest (Read-Only) | Dept. of Environmental Management | 47273.pdf |
| Waste Tire Processor, Storage, & Transporter Inspection Report | Dept. of Environmental Management | 53899.doc |
| Waste Tire Transporter Registration(Read-Only) | Dept. of Environmental Management | 47220.doc |
| Wastewater Management Permit Request for Voidance (Read-Only) | Dept. of Environmental Management | 50396.doc |
| Wastewater Operator/Apprentice Continuing Education Credit Report(Read-Only) | Dept. of Environmental Management | 51139.pdf |
| Water Quality Parameters and Source Water Reporting | Dept. of Environmental Management | 53292.pdf |
| Water Test Kit Order | Dept. of Health | 46270.pdf |
| Water Treatment Additives Great Lakes Basin Dischargers | Dept. of Environmental Management | 53904.pdf |
| Water Treatment Additives Great Lakes Basin Dischargers (Read-Only) | Dept. of Environmental Management | 53904.doc |
| Water Treatment Additives Non-Great Lakes Basin Dischargers | Dept. of Environmental Management | 53905.pdf |
| Water Treatment Additives Non-Great Lakes Basin Dischargers (Read-Only) | Dept. of Environmental Management | 53905.doc |
| Wildfire Report | DNR, Forestry Division | 50296.pdf |
| Wildland Firefighting Handtool Request Application | DNR, Forestry Division | 50297.pdf |
| Work Improvement Plan (Read-Only) | Dept. of Personnel | 52405.pdf |
| Work Improvement Plan | State Personnel Department | 52405.doc |
| Workload Schedule Log (read-only) | Dept. of Health | 53727.doc |
| Worksheet for Data Entry - Termination or Denial (Read-Only) | Family and Social Service Admin. - Division of Disability and Rehabilitation | 43714.pdf |
| Written Nutrition / Food Service Program - Child Care Centers (Read-Only) | FSSA - Division of Family Resources | 46684.pdf |
| Written Nutrition / Food Service Program - Infant / Toddler Child Care Centers (Read-Only) | FSSA - Division of Family Resources | 46682.pdf |
| Written Permission for Additional Work Hours For 16 and 17 Year Olds (Read-Only) | Dept. of Labor | 48409.pdf |
| Yard Waste Composting Facility Registration Application (Read-Only) | Dept. of Environmental Management | 50414.pdf |
Notes:
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State Forms Management will only add forms to the catalogs that have been requested by the Forms Coordinator of the agency that owns or controls the form. If you would like a form included on the catalog, but the form is owned by another agency, please contact that agency's forms coordinator.
For questions about how to use this catalog, or to inform us of a technical problem, pleasee-mail the Forms Management Division.
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Dept. of Revenue: The online forms available from the Dept. of Revenue are updated by that agency, and posted on their own website: Tax Forms
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As part of the Governor's "Greening the Government Implementation Plan", the Dept. of Administration is requesting that all printing of electronic forms be done on 30% post-consumer recycled content paper whenever possible. To learn more about the state's recycling efforts, go to Greening the Government.
