The forms provided on this web page are provided for the following purposes:
1) to allow you to print out a paper copy of the form; or 2) to provide you with
a pc fillable form that can then be printed and submitted. Most of these forms
require an authorizing signature before being submitted and therefore are not
online submittable.
Some of the documents on this
web page are provided in Adobe Portable Document Format
(.pdf).
In order to view or print these documents, you will need to download and
install the free Adobe Acrobat Reader (
click
here for instructions on obtaining Adobe Acrobat).
Please note that the "Word" documents provided below are the
original documents constructed in Microsoft Word and were designed for the purpose of
printing a hard copy of the forms. These were not designed to be fillable forms.
Many of the Word documents can be filled in by turning on "overtype" ('insert'
key on your keyboard) and pressing "U" (Underline) on your Word toolbar.
All Excel workbooks are pc fillable and should be downloaded in their entirety - including
instruction worksheet and accompanying macros. To save to your pc without first opening
the file, right click on the link and select "Save Target As (IE5)" or "Save
Link As (Netscape)". Those Excel files marked with an asterick (
* ) are multi-part forms which include instructions for printing
all parts of the form.
| Accounting Forms |
(Click here for Payroll forms) |
|
| Form # |
Form Name |
File Format |
AR-70
(rev 06/01/09) |
Request for Warrant Image |
pdf |
XLS |
| AR-95 (rev 07-05) |
Claim for Warrant Cancelled One Year After Date of Issuance |
pdf (f) |
Word |
| AR-97 (rev 06-11) |
Claim Against an Agency of the State of Kansas for Services
Rendered or Purchases Made in a Prior Fiscal Year For Which Payment Has Not Been Received |
pdf |
|
| AR-98 (rev 12-98) |
Personal Injury or Property Damage or Loss Claim Against the
State of Kansas |
pdf |
Word |
| Bid Form |
Moving Expense Bid Form (not pc fillable) |
pdf |
Word |
BPC Cardholder
Agreement (rev 3-06) |
Moved to Div of Purchases see http://da.ks.gov/purch/pcard/bpc.htm |
|
|
| DA-3 (discontinued) |
Receipt Voucher - this form has been discontinued. SMART must
be used for all deposit transactions. |
|
|
| DA-6 |
Lost Warrant Statement |
|
Excel |
| DA-22 (rev 11-98) |
Agreement for Reimbursement of Moving Expenses |
pdf |
Word |
| DA-26 (rev 6-99) |
Agency Travel Approval - Out-of-State Travel and Lodging Reimbursement
Rates |
pdf |
Word |
| DA-27 (rev 07-11) |
Notice of Unavailability of the Executive Aircraft |
pdf |
|
| DA-29 (rev 02-03) |
Request to Pay Expenses of Out-of-State Applicants |
pdf |
|
| DA-32 (rev 07-11) |
Annual Report - Accounts/Other Receivables |
|
Excel |
| DA-34 (rev 07-11) |
Subsistence Extension Request |
pdf |
|
| DA-35 (rev obsolete) |
STARS Transaction Entry (Journal Voucher) |
|
|
| DA-35A (rev obsolete) |
STARS Transaction Entry (modified for corrections to Payment
Vouchers and Receipt Vouchers only) |
|
|
| DA-35R (rev obsolete) |
Request for Correction by Journal Voucher |
|
|
| DA-37 (rev 07-11) |
Request for Reduced Subsistence Allowance |
pdf |
|
| DA-40 (rev 02-00) |
Magnetic Tape/Dataset Voucher Transmittal |
pdf |
Excel |
| DA-43 (rev obsolete) |
1099 Information to be Submitted via Magnetic Media by the
State of Kansas to the Internal Revenue Service |
|
|
| DA-43a (rev obsolete) |
1099 Information to be Submitted via Magnetic Media by the
State of Kansas to the Internal Revenue Service - Corrected Returns |
|
|
| DA-47 (rev obsolete) |
Real Estate Lease Cover Sheet |
|
|
DA-56 (rev 01-11)
|
List of Delinquent Accounts (Setoff) |
pdf |
Excel |
| DA-60 (rev obsolete) |
Payment Voucher Authorization |
|
|
| DA-61 (rev obsolete) |
Cash Receipts Voucher |
|
|
| DA-62 (rev 10-98) |
Trust Fund Ledger Account |
pdf |
|
| DA-63 (rev 10-98) |
Trust Fund Bank Account Reconciliation |
pdf |
|
| DA-65 (rev 10-00) |
Reconciliation of Trust Fund |
pdf |
|
| DA-67 (rev obsolete) |
Reconciliation of Advance Fund - Independent Parcel Delivery
Service |
|
|
| DA-68 (rev 10-00) |
Application/Report on Canteens, Work Therapy Funds, Canteen
Funds and Benefit Funds |
pdf |
|
| DA-71 (rev 04-03) |
Application for Petty Cash Fund |
pdf |
Excel |
| DA-73 (rev 04-03) |
Reconciliation of Petty Cash Fund |
pdf |
Excel |
| DA-74 (rev 04-03) |
Application to Establish Change Fund |
pdf |
Excel |
| DA-74a (rev 04-03) |
Application to Establish Check Cashing Change Fund |
pdf |
Excel |
| DA-75 (rev 11-98) |
Reconciliation of Change Fund |
pdf |
|
| DA-75a (rev 11-98) |
Reconciliation of Check Cashing Change Fund |
pdf |
|
| DA-76 (rev 11-98) |
Record of Cash Long or Short |
pdf |
|
| DA-77 (rev obsolete) |
Application for Independent Parcel Delivery Service Advance
Fund |
|
|
| DA-78 (new 04-03) |
Petty Cash Fund Log |
pdf |
Excel |
| DA-82 (rev 02-03) |
Certification of Fixed Asset Inspection |
pdf |
Word |
| DA-83 (rev obsolete) |
Corrections or Additions to Capital Asset Records |
|
|
| DA-84 (rev obsolete) |
Land Inventory |
|
|
| DA-85 (rev 10-93) |
Affidavit of Payees Failure to Provide Taxpayer Identification
Number |
pdf |
|
| DA-86 (rev obsolete) |
Building and Improvements Inventory |
|
|
| DA-87 (rev obsolete) |
Annual Capital Asset Reporting + instructions |
|
|
| DA-88 (rev 12-98) |
Statement of Forgery Affidavit |
pdf |
|
| DA-89 (rev 8-11) |
Schedule of Expenditures of Federal Awards (SEFA) |
|
Excel |
| DA-102 (rev obsolete) |
Interfund Voucher
(obsolete. Use SMART system instead) |
|
|
| DA-103 (rev obsolete) |
Agency Purchase Order |
|
|
| DA-107 (rev obsolete) |
Encumbrance Authorization or Adjustment |
|
|
| DA-108 (rev obsolete) |
Purchase Order Change Advice (Div. of Purchases form) |
|
|
| DA-110 (rev obsolete) |
Disposition of Property |
|
|
| DA-115 |
Signature Verification Form |
pdf |
Excel |
| DA-116 (rev obsolete) |
SOKI3 Primary Contact Designation |
|
|
| DA-116a (rev obsolete) |
SOKI3 User ID Request and Maintenance |
|
|
| DA-118 (obsolete) |
List of Outstanding Obligations |
|
|
| DA-119 (obsolete) |
List of Outstanding Obligations Detail |
|
|
| DA-120 (obsolete) |
Payment Voucher |
|
|
| DA-121 (rev 5-02) |
Travel Expense Detail * |
pdf |
Excel |
| DA-124 (rev obsolete) |
Contract Estimate Voucher
(For optional use by agencies. No longer required by A&R or DFM Architectural Services.) |
|
|
| DA-125 (rev obsolete) |
Travel Payment Voucher |
|
|
| DA-130 (rev 5-99) |
Authorization for Electronic Deposit of Vendor Payment
For copy of DA-130 contact Accounts and Reports at
(785) 296-2311 |
|
|
| DA-136 (rev obsolete) |
Payment Funding Continuation / Standard Transaction Line |
|
|
| DA-137 (rev obsolete) |
Payment Funding Continuation / Condensed Transaction Line |
|
|
| DA-146 (rev obsolete) |
Contract Cover Sheet |
|
|
| DA-146a (rev 01-01) |
Contractual Provisions Attachment |
|
Word |
| DA-152 (rev 02-00) |
Checkbook Record - Imprest Fund |
pdf |
excel |
| DA-153 (rev 02-00) |
Monthly Imprest Fund Reconciliation |
pdf |
excel |
| DA-154 (rev 02-00) |
Imprest Fund Maintenance |
pdf |
excel |
| DA-160 (rev 10-00) |
Application for Key Deposit Fund |
pdf |
|
| DA-161 (rev 10-98) |
Monthly Reconciliation of Financial Institution Account |
pdf |
|
| DA-162 (rev 10-00) |
Reconciliation of Key Deposit Fund |
pdf |
|
| DA-164 (rev 10-00) |
Application for Employee Use Fund |
pdf |
|
| DA-171 (rev 06-00) |
Housing, Food Service and Other Employee Maintenance Policy |
pdf |
|
| DA-199 (rev obsolete) |
STARS Batch Sheet |
|
|
| TM-21 (rev 11-00) |
STARS Vendor Edit Table Maintenance Form |
pdf |
Excel |
| TM-96 (rev obsolete) |
STARS Security Sign-On Request |
|
|
| W-9 (KS) |
Request for Taxpayer Identification Number and Certification
- fillable .pdf format |
pdf |
|
| Payroll Forms |
[back to top of list] |
|
|
| DA-6P (rev 5-06) |
Paycheck Stop Payment Request |
pdf |
Excel |
| DA-179 (rev 5-06) |
Sharp Maximum Arrears Payback
(Internal Agency Use Only) |
pdf |
Excel |
| DA-180 (rev 5-06) |
Sharp Paycheck Reversal/Adjustment/Supplemental |
pdf |
Excel |
| DA-182 (rev 5-06) |
Sharp Paycheck Reprint Request
(Internal Agency Use Only) |
pdf |
Excel |
| DA-191 |
Employee Organization Application for Payroll Deduction of Membership Dues |
|
|
| DA-192 |
Membership Dues Deduction Agreement |
pdf |
|
| DA-194 |
Notice of Regular Bi-weekly Dues Certified by Employee Organization |
pdf |
|
DA-219A (rev 7-07)
|
Combination Code Maintenance |
pdf |
Excel |
| B (rev 7-07) |
Position Pool ID Maintenance |
|
|
| C (rev 7-07) |
Department Budget Earnings/Deductions/Taxes
(Internal Agency Use Only) |
|
|
| W-4 |
Employee's Withholding Allowance Certificate provided
by the IRS in fillable .pdf format. |
pdf |
|
| W-5 (2010) |
2010 Earned Income Credit Advance Payment Certificate
provided by the IRS in fillable .pdf format. |
pdf |
|
| K-4 (2008) |
Kansas Employee's Withholdings Allowance Certification (Use may begin on or after 12/26/2007) |
pdf |
|
