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FORMS

The following forms are for internal use by FSSA employees. If the form you are looking for is not listed or you are looking for a form used by the public, please search the State forms catalog. If you believe a form needs to be added email WebRequests@fssa.IN.gov.

Please note that the forms with an asterisk (*) are accessible only to FSSA employees and require a login to access them. To access the forms use the following steps (all fields are case sensitive):

1. Select "State Employee Login".
2. Input your user name (usually last name followed by a first and middle initial or first initial followed by the last name).
3. Enter your password (your current network password).
4. Enter the domain (FSSA).
5. Click "OK".
6. Enter the form number or fill in other fields as needed.

Human Resources & Payroll

• Attendance report (A4) SF 14303
• Employee compensatory time worksheet SF 42386
• Employee exit questionnaire SF 49221
• Family medical leave log SF 48730

Printing, business cards, and publications

• Business card printing request SF 54197
• Request for distribution of forms & publications SF 1140
• Staff instructions to obtain material from the warehouse, printed stationery, business cards, and large volume copying

Technology

• Cognos user request form
• PC training request
• IT training request form
• PC hardware request form

Voter registration

• Voter portal website