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Governor Mike Braun
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Forms

View all state forms using the State Form Catalog.

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

Form

Request for Records
State Form 24019		 

Form

Rental Vehicle Use Agreement -
State Form 53553		 PDF
DOC
Temporary Vehicle Agreement -
State Form 52297		 Form
SF16 - Records Destruction Notification  Form
SF48883 - State Archives Record Transmittal and Receipt  Form

Form NameInstructions
Official Letterhead in WordBrand Resources

Form NameInstructionsForm
Assessment Criteria Instructions 
Authorization for Out of State Travel (formerly G-10) -
State Form 823		 Form
Certification for Missing Receipt -
State Form 42275		 Form
Cheat Sheet InstructionsForm
Employee Statement of Employer Provided Vehicle Use -
State Form 49632		 Form
Indiana Business Preferences Instructions 
Indiana Economic Impact Form -
State Form 51778		 Form
Requisition/Purchase Order - State Form 37773 Form
Official Station  Form
Record of Telephone Price Quotations -
State Form 43464		 Form
Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement for Employees Using the IDOH Fitness Center
State Form 54729		 Form
Report of Collections/Receipts (Due Treasurer of State) -
State Form 14311		 Form
Request for Special Procurement -
State Form 54650		 Form
Surplus Spreadsheet InstructionsForm
Temporary Employee Request Instructions and Templates  
Strategic Hiring Request Template for Knowledge Services Positions Forms 
Job Description for Knowledge Services Requests Template Form 
Travel Advance -
State Form 49630		InstructionsForm
Travel Status Memo InstructionsForm
Vendor Information Form
State Form 53788 		 Form

Form NameForm
Request to Acquire New Funding - State Form 51757Form
Grant Award Notification TemplateForm

Form NameForm
First Report of Injury/Illness -
State Form 34401 (R10/1-02)		Form
Outside Employment Disclosure -
State Form 53182		Form

Form Name Form
Agreement for Release of Data Containing Confidential Information
State Form 52104		 Form
Request For Approval of Memorandum of Understanding
State Form 53555		 Form
Consent To Release Social Security Number -
State Form 53190		 Form
Request for Internal Legal Advice  Form
Request for Approval of Special Agreement -
State Form 53676		 Form
Request for Assistance with Contract, Memorandum of Understanding (MOU) or Special Agreement -
State Form 53559		 Form
Request for Assistance with Rules Promulgation -
State Form 52702		 Form
Data Privacy Incident Report Form Link

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

Link

Find under “Responsible Data Sharing.”

IDOH Incident Report Form

For any questions, please contact Eliza Bradley.

Form

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