Forms for State Agencies and Employees

Form # Form Name and Resources Format

Accounting

AC 22‑S Journal Voucher Excel
AC 909‑S Report of Moneys Received Excel
AC 1286‑S Refund of Appropriation Excel
AC 3286‑A Federal Grant Amendment Information for SFS Fillable PDF
AC 3286‑P Federal Grant Pre-Award Information for SFS Fillable PDF
AC 3312‑S AR Deposit Form Excel
AC 3329‑S Cash Advance Account Confirmation & Reconciliation Form Fillable PDF

Contracts

AC 340-S Contract Encumbrance Request (SFS)
  • Original AC 340 with revisions highlighted and fields defined (PDF)
Excel
Fillable PDF
AC 1782‑S Bureau of Contracts Authorized Signature Form Fillable PDF
AC 3268‑S Simplified Renewal Agreement Word
AC 3269‑S State of New York Multi-Year Agreement Word
AC 3270‑S Competitive Grants Procurement Record Checklist Word
AC 3271‑S New York State Consultant Services Contractor's Planned Employment Word
AC 3272‑S New York State Consultant Services Contractor's Annual Employment Report Word
AC 3273‑S Vendor Responsibility Profile Word
PDF
AC 3276‑S Novation Agreement Template (All Parties)
Novation Agreement Template (No Transferor)
Word
Word
AC 3277‑S Contract Certification Form for Quick Contract Processing Fillable PDF
AC 3278‑S Quick Contract Boilerplate Agreement Word
AC 3279‑S Checklist for Legislative Initiative Word
AC 3280‑S Request for Exception to OSC Encumbrance Policy For Programs with Multiple Grant Awards Word
PDF
AC 3281‑S Governmental Entity Representation Concerning Compliance with State Finance Law §§139-j and 139-k Fillable PDF
AC 3357 Online Services Bureau of Contracts Applications Account Maintenance Fillable PDF
AC 3358 Online Services Government Account Authorization Fillable PDF

Payroll

AC 230 Report of Check Returned for Refund or Exchange Fillable PDF
AC 873 Extra Service Payroll Voucher Fillable PDF
AC 934‑P Next of Kin Affidavit for Bureau of State Payroll Services Fillable PDF
AC 1394 Application & Account for Partial Payment of Salary Print Only
AC 1476‑P Report of Check Exchange Fillable PDF
AC 1588 Dual Employment/Extra Service Approval Form Fillable PDF
AC 2674 W-2 Correction Worksheet Fillable PDF
AC 2714 Undeliverable Payroll Check Report Fillable PDF
AC 2772 Direct Deposit Form
Guide to Completing AC-2772 Direct Deposit Form
Fillable PDF
AC 2822

Bureau of State Payroll Services Payroll Transaction Authorization Form

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

Fillable PDF
AC 3173 Agency Report of Taxable Value of Personal Use of an Employer-Provided Vehicle Fillable PDF
AC 3197 Request for Direct Deposit Stop/Reversal Fillable PDF
AC 3202 Payroll Certification Form Fillable PDF
AC 3206 Prior Year Social Security and Medicare Tax Refund Certification Fillable PDF for NYS
Fillable PDF for CUNY
AC 3216 Personal Privacy Protection Law Release Form
  • Instructions (PDF)
PDF
AC 3217 Extra Service Position Data Request Form Fillable PDF
AC 3218 NYS Position Data Request Form Fillable PDF
AC 3219 Position Data Request Form Fillable PDF
AC 3300‑S Certification for Payment of Pre-Adjudicatory Settlement Agreements Fillable PDF
AC 3340 Application by Payee or Agency Representative for Issuance of Replacement Check Fillable PDF

Purchasing and Payments

AC 92 Standard Voucher PDF
Word template
AC 130‑S Purchase Order (Stand-alone)
  • Original AC 130 with revisions highlighted and fields defined (PDF)
  • Terms and Conditions (PDF)
PDF
AC 852‑S Business Unit Voucher Authorizer Designation Fillable PDF
AC 902‑S Purchase Order Change Notice (SFS)
  • Original AC 902 with revisions highlighted and fields defined (PDF)
Fillable PDF
AC 946 Tax Exempt Certificate Fillable PDF
AC 1171 State Aid Voucher PDF
AC 1366‑S Land Claims Payment Voucher (SFS)
  • Fields numbered and defined (PDF)
Fillable PDF
AC 2397 Voucher Charge Continuation with Tail Fillable PDF
AC 3253‑S Claim for Payment
  • Instructions for Users (PDF)
  • Fields numbered and defined (PDF)
Fillable PDF 
(with auto-calculate)
AC 3254‑S PeopleSoft Charge Continuation
  • Instructions for Users (PDF)
  • Fields numbered and defined (PDF)
Fillable PDF
TD- 346 Request for Stop Payment, Replacement Check, Photocopy of Check or Forgery Affidavit Fillable PDF

Travel

AC 132‑A Travel Voucher Form AC 132-A is now obsolete and has been replaced by form AC 132-S
AC 132‑S Employee Report of Travel Expenses and Claim for Payment
  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 160‑S Statement of Automobile Travel
  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 1099‑S Request/Agreement for Moving Expense Reimbursement
  • Fields numbered and defined (PDF)
Fillable PDF
AC 3256‑S Statement of State Corporate Travel Card Charges
  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 3257‑S Claim for Travel Reimbursement by a Non-Employee
  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 3258‑S Statement of Meals Claimed
  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word
AC 3259‑S Statement of Incidental and Transportation Expenses (previously on AC 148)
  • Fields numbered and defined (PDF)
Fillable PDF
Fillable Word 
 

Vendors

AC 3237‑S New York State Substitute Form W-9 Fillable PDF
AC 3261‑S Special Use Vendor ID Request Fillable PDF
AC 3266‑S Single Payment Vendor ID Request Fillable PDF
AC 3267‑S Foreign Vendor Registration Request Fillable PDF
AC 3317 Customer ID Request Form Fillable PDF

Other

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