| SFN | Entity | Title | Size | Date | Fillable |
|
11
|
Human Services, Department of
|
Emergency Assistance Action Plan
|
208 kb
|
|
N
|
|
21
|
Human Services, Department of
|
Transmittal Between Units
|
204 kb
|
2/22/2007
|
Y
|
|
37
|
Human Services, Department of
|
Authorization for Services or Material
|
347 kb
|
6/8/2009
|
Y
|
|
38
|
Human Services, Department of
|
Emergency Assistance Service Application
|
206 kb
|
|
Y
|
|
45
|
Human Services, Department of
|
Notice of Change
|
111 kb
|
|
Y
|
|
56
|
Human Services, Department of
|
Expanded SPED Program Pool Data
|
110 kb
|
|
Y
|
|
62
|
Human Services, Department of
|
Emergency Assistance Application
|
326 kb
|
|
Y
|
|
65
|
Human Services, Department of
|
Daily Remittance List
|
150 kb
|
|
Y
|
|
75
|
Human Services, Department of
|
Miscellaneous Payment Worksheet
|
273 kb
|
|
Y
|
|
76
|
Human Services, Department of
|
Fixed Assets Data Entry
|
361 kb
|
11/4/2008
|
Y
|
|
98
|
Human Services, Department of
|
Case Management Inter-Agency Referral Form
|
178 kb
|
|
Y
|
|
128
|
Human Services, Department of
|
North Dakota Family Caregiver Support Program Provider Agreement
|
338 kb
|
9/30/2008
|
Y
|
|
136
|
Human Services, Department of
|
Informed Consent for Psychological Testing
|
221 kb
|
|
Y
|
|
143
|
Human Services, Department of
|
Civil Rights Complaint
|
220 kb
|
2/3/2009
|
N
|
|
150
|
Human Services, Department of
|
60-Month Lifetime Exemption Background Report
|
175 kb
|
|
Y
|
|
152
|
Human Services, Department of
|
Child Support Verification
|
108 kb
|
|
Y
|
|
165
|
Human Services, Department of
|
Caregiver Option Plan
|
347 kb
|
5/1/2009
|
Y
|
|
170
|
Human Services, Department of
|
Taxi Transportation Voucher
|
263 kb
|
|
Y
|
|
171
|
Human Services, Department of
|
Foster Program Subsidized Employment Agreement
|
254 kb
|
9/14/2009
|
Y
|
|
187
|
Human Services, Department of
|
Medical Expense Worksheet
|
215 kb
|
|
Y
|
|
196
|
Human Services, Department of
|
Ability to Pay - Fee Action Request
|
338 kb
|
1/9/2009
|
Y
|
|
202
|
Human Services, Department of
|
Group Homes and Drug/Alcohol Treatment Centers Monthly Listing
|
133 kb
|
|
Y
|
|
208
|
Human Services, Department of
|
Card Problem Report
|
179 kb
|
|
Y
|
|
229
|
Human Services, Department of
|
Social Contract
|
102 kb
|
|
Y
|
|
244
|
Human Services, Department of
|
Purchase Card Confirmation
|
288 kb
|
10/29/2009
|
Y
|
|
293
|
Human Services, Department of
|
Food Assistance Program Negative Case Review
|
391 kb
|
2/7/2008
|
Y
|
|
298
|
Human Services, Department of
|
Protective Service Alert Report
|
171 kb
|
|
Y
|
|
302
|
Human Services, Department of
|
Authorization and Request for Payment
|
372 kb
|
3/20/2008
|
Y
|
|
307
|
Human Services, Department of
|
Request for Safety/Permanency Funds
|
326 kb
|
1/26/2009
|
Y
|
|
319
|
Human Services, Department of
|
Monthly EBT Inventory Control Log
|
285 kb
|
6/2/2009
|
Y
|
|
321
|
Human Services, Department of
|
Daily Card Issuance Log
|
224 kb
|
|
Y
|
|
325
|
Human Services, Department of
|
EBT Card Stock Transfer
|
176 kb
|
2/19/2009
|
Y
|
|
329
|
Human Services, Department of
|
Diversion Assistance Cheatsheet
|
296 kb
|
1/14/2008
|
Y
|
|
331
|
Human Services, Department of
|
NDFCSP Notice Of Service Denial, Closure or Termination
|
183 kb
|
10/19/2007
|
Y
|
|
337
|
Human Services, Department of
|
Food Assistance Program Claim Review
|
260 kb
|
2/21/2007
|
Y
|
|
338
|
Human Services, Department of
|
Child Care Checklist
|
502 kb
|
4/1/2008
|
Y
|
|
339
|
Human Services, Department of
|
Monthly Case Management Billing & Reporting Form
|
359 kb
|
12/26/2007
|
Y
|
|
348
|
Human Services, Department of
|
Reasons for Filing a Petition to Terminate Parental Rights
|
185 kb
|
|
Y
|
|
362
|
Human Services, Department of
|
Food Stamp Computation Sheet
|
376 kb
|
5/20/2009
|
Y
|
|
375
|
Human Services, Department of
|
Notice of Assignment of Support Rights-Foster Care
|
138 kb
|
|
Y
|
|
376
|
Human Services, Department of
|
Drug-Related Felony Review
|
224 kb
|
4/30/2008
|
Y
|
|
379
|
Human Services, Department of
|
Immediate Correction Order
|
216 kb
|
|
Y
|
|
385
|
Human Services, Department of
|
Affidavit for SNAP Requirements
|
204 kb
|
11/12/2008
|
Y
|
|
387
|
Human Services, Department of
|
ICPC Supervision Report
|
248 kb
|
2/26/2009
|
Y
|
|
395
|
Human Services, Department of
|
ICPC Financial and Medical Plan
|
102 kb
|
|
Y
|
|
408
|
Human Services, Department of
|
Request for Non-State Employee to Operate State Vehicle
|
226 kb
|
|
Y
|
|
411
|
Human Services, Department of
|
Aid to the Blind/Remedial-Denial Notice
|
164 kb
|
|
Y
|
|
412
|
Human Services, Department of
|
Aid to the Blind/Remedial-Approval Notice
|
99 kb
|
|
Y
|
|
417
|
Human Services, Department of
|
Reconciliation with Inventory Records
|
167 kb
|
|
Y
|
|
419
|
Human Services, Department of
|
Request to Division of Vital Statistics for Confidential Verification of Birth
|
89 kb
|
|
Y
|
|
420
|
Human Services, Department of
|
Request to Division of Vital Statistics for Confidential Verification of Death
|
89 kb
|
|
Y
|
|
421
|
Human Services, Department of
|
Request for Verification of Marriage
|
89 kb
|
|
Y
|
|
422
|
Human Services, Department of
|
Request for Verification of Divorce
|
87 kb
|
|
Y
|
|
424
|
Human Services, Department of
|
Kinship Care Agreement
|
110 kb
|
|
Y
|
|
426
|
Human Services, Department of
|
Kinship Care Study
|
1220 kb
|
1/14/2008
|
Y
|
|
440
|
Human Services, Department of
|
Action Required Report
|
214 kb
|
5/28/2009
|
Y
|
|
445
|
Human Services, Department of
|
Family Evacuation Disaster Plan
|
400 kb
|
3/16/2009
|
Y
|
|
450
|
Human Services, Department of
|
County Social Service Office On-Site Review Report
|
218 kb
|
|
Y
|
|
455
|
Human Services, Department of
|
Safety/Strength/Risk Assessment
|
106 kb
|
|
Y
|
|
462
|
Human Services, Department of
|
Request for Appeal of the CA/N Assessment Decision
|
109 kb
|
|
Y
|
|
465
|
Human Services, Department of
|
Request for Grievance Meeting to Review the Conduct of CA/N Assessment
|
53 kb
|
|
Y
|
|
474
|
Human Services, Department of
|
HCBS Case Closure/Transfer Notice
|
168 kb
|
|
Y
|
|
488
|
Human Services, Department of
|
Food Assistance Program Case Review
|
394 kb
|
3/12/2009
|
Y
|
|
496
|
Human Services, Department of
|
Child Protection Services Case Review
|
653 kb
|
10/19/2009
|
Y
|
|
499
|
Human Services, Department of
|
Affidavit of Mailing
|
165 kb
|
6/4/2007
|
Y
|
|
500
|
Human Services, Department of
|
SNAP Targeted Case Review
|
348 kb
|
4/21/2009
|
Y
|
|
501
|
Human Services, Department of
|
TANF Re-assessment
|
130 kb
|
|
Y
|
|
507
|
Human Services, Department of
|
Step One: Voluntary Treatment Program Application
|
676 kb
|
|
Y
|
|
527
|
Human Services, Department of
|
Family Coverage Budget Worksheet
|
311 kb
|
4/14/2008
|
Y
|
|
529
|
Human Services, Department of
|
Application: Heating Assistance Program
|
1418 kb
|
7/20/2009
|
Y
|
|
530
|
Human Services, Department of
|
Eligibility and Benefit Worksheet
|
232 kb
|
|
N
|
|
540
|
Human Services, Department of
|
Confidential Report of Job Service Unemployment Insurance
|
260 kb
|
|
Y
|
|
549
|
Human Services, Department of
|
Respite Home Evaluation
|
298 kb
|
|
Y
|
|
559
|
Human Services, Department of
|
Recipient Explanation of Medical Benefits
|
197 kb
|
3/17/2008
|
Y
|
|
605
|
Human Services, Department of
|
Mandatory VAPS Worksheet
|
506 kb
|
1/26/2009
|
Y
|
|
642
|
Human Services, Department of
|
Title IV-E Title XIX Redetermination-Foster Care
|
157 kb
|
|
Y
|
|
643
|
Human Services, Department of
|
Quality Improvement Report
|
114 kb
|
2/21/2007
|
Y
|
|
655
|
Human Services, Department of
|
LIHEAP - Case Review
|
713 kb
|
1/30/2008
|
Y
|
|
659
|
Human Services, Department of
|
Respite Home Evaluation
|
295 kb
|
|
Y
|
|
662
|
Human Services, Department of
|
Personal Care Plan
|
521 kb
|
10/2/2009
|
Y
|
|
663
|
Human Services, Department of
|
Authorization to Provide Personal Care Services
|
441 kb
|
12/5/2007
|
Y
|
|
669
|
Human Services, Department of
|
Initial Licensing Study-Adult Family Foster Care
|
1104 kb
|
6/23/2008
|
N
|
|
676
|
Human Services, Department of
|
Add New Record to MMIS Eligibility File SPED
|
235 kb
|
|
N
|
|
677
|
Human Services, Department of
|
Add New Record to MMIS Eligibility File - Expanded SPED
|
228 kb
|
|
N
|
|
679
|
Human Services, Department of
|
Employment Communication Orientation Referral
|
52 kb
|
|
Y
|
|
687
|
Human Services, Department of
|
Medicaid Budget Worksheet
|
257 kb
|
|
Y
|
|
700
|
Human Services, Department of
|
Case Transfer Log
|
135 kb
|
|
Y
|
|
701
|
Human Services, Department of
|
Case Review
|
599 kb
|
3/12/2009
|
Y
|
|
737
|
Human Services, Department of
|
Diversion Assistance Action Plan
|
428 kb
|
11/29/2007
|
Y
|
|
740
|
Human Services, Department of
|
Initial/Strength/Full Assessment
|
395 kb
|
|
Y
|
|
747
|
Human Services, Department of
|
Appeal Form
|
227 kb
|
10/16/2007
|
Y
|
|
770
|
Human Services, Department of
|
EBT Card Issued by Mail
|
199 kb
|
5/26/2009
|
Y
|
|
772
|
Human Services, Department of
|
Absent Parent/Relative Search Record
|
243 kb
|
2/23/2009
|
Y
|
|
773
|
Human Services, Department of
|
Cancellation of Warrants or Checks
|
367 kb
|
9/25/2009
|
Y
|
|
788
|
Human Services, Department of
|
Group Living Arrangement And Drug/Alcohol Treatment Center Report
|
199 kb
|
|
Y
|
|
790
|
Human Services, Department of
|
Child Care Assistance Program Review
|
692 kb
|
5/28/2009
|
Y
|
|
816
|
Human Services, Department of
|
Change Report for Adoption Assistance
|
270 kb
|
|
Y
|
|
817
|
Human Services, Department of
|
Health Insurance Cost-Effectiveness Review
|
246 kb
|
|
Y
|
|
820
|
Human Services, Department of
|
SPED Income and Assets
|
234 kb
|
8/27/2007
|
Y
|
|
827
|
Human Services, Department of
|
Credit Form
|
303 kb
|
1/23/2008
|
Y
|
|
828
|
Human Services, Department of
|
Credit Form-Medicare Premium/Medicaid/Healthy Steps/Basic Care/Expanded SPED/Clawback
|
366 kb
|
8/4/2009
|
Y
|
|
832
|
Human Services, Department of
|
Application to be Licensed/Early Childhood Services
|
582 kb
|
12/2/2008
|
Y
|
|
833
|
Human Services, Department of
|
Patient Consent for a Telemedicine Encounter
|
97 kb
|
3/12/2008
|
N
|
|
854
|
Human Services, Department of
|
Title IV-E Adoption Subsidy Application
|
275 kb
|
|
Y
|
|
856
|
Human Services, Department of
|
Adoption Subsidy Agreement Annual Review
|
266 kb
|
|
Y
|
|
869
|
Human Services, Department of
|
Title IV-E Initial Eligibility
|
721 kb
|
4/9/2008
|
Y
|
|
870
|
Human Services, Department of
|
Title IV-E Reimbursability
|
256 kb
|
|
Y
|
|
871
|
Human Services, Department of
|
ND Health Tracks Screening Results
|
49 kb
|
|
Y
|
|
873
|
Human Services, Department of
|
Income Calculation Worksheet
|
123 kb
|
|
Y
|
|
880
|
Human Services, Department of
|
Contractual Right to Receive Money Payments Valuation Request
|
207 kb
|
|
Y
|
|
915
|
Human Services, Department of
|
Adult Family Foster Care Home Affidavit of Standard Compliance-In Lieu of License
|
36 kb
|
|
N
|
|
944
|
Human Services, Department of
|
Request for Attendant Care Services
|
393 kb
|
3/3/2008
|
Y
|
|
961
|
Human Services, Department of
|
Child Protection Report
|
98 kb
|
|
Y
|
|
965
|
Human Services, Department of
|
Interstate Compact on the Placement of Children Request-ICPC 100A
|
253 kb
|
|
Y
|
|
966
|
Human Services, Department of
|
Interstate Compact on the Placement of Children Report on Child's Placement Status-ICPC 100B
|
255 kb
|
|
Y
|
|
1005
|
Human Services, Department of
|
Application For Community Residential Services
|
812 kb
|
|
Y
|
|
1012
|
Human Services, Department of
|
Monthly Rate Worksheet - Live In Care
|
620 kb
|
7/1/2009
|
Y
|
|
1013
|
Human Services, Department of
|
Application to Provide Adult Family Foster Care
|
345 kb
|
9/24/2007
|
Y
|
|
1031
|
Human Services, Department of
|
Relicensing Study-Adult Family Foster Care
|
1103 kb
|
7/2/2008
|
Y
|
|
1032
|
Human Services, Department of
|
Request for Law Enforcement
|
195 kb
|
|
Y
|
|
1076
|
Human Services, Department of
|
Grower's Statement
|
235 kb
|
|
Y
|
|
1168
|
Human Services, Department of
|
Ownership Controlling Interest & Conviction Information
|
368 kb
|
3/12/2009
|
Y
|
|
1186
|
Human Services, Department of
|
Notice to Insurer of Annuity of State's Right as A Preferred Remainder Beneficiary Due to Medicaid Benefits Provided
|
203 kb
|
5/28/2008
|
Y
|
|
1221
|
Human Services, Department of
|
Intensive In-Home Family Services Log
|
176 kb
|
|
Y
|
|
1226
|
Human Services, Department of
|
Financial Redetermination Form
|
105 kb
|
|
N
|
|
1265
|
Human Services, Department of
|
ND Vulnerable Adult Protective Services/Data Collection
|
210 kb
|
|
Y
|
|
1266
|
Human Services, Department of
|
ND Vulnerable Adult Protective Service Recommendations/Plans
|
96 kb
|
|
Y
|
|
1267
|
Human Services, Department of
|
ND Vulnerable Adult Protective Services/Risk Assessment
|
606 kb
|
|
Y
|
|
1268
|
Human Services, Department of
|
ND Vulnerable Adult Protective Services Screening Report
|
132 kb
|
|
Y
|
|
1269
|
Human Services, Department of
|
Child Care Concern Form
|
164 kb
|
|
Y
|
|
1288
|
Human Services, Department of
|
CSSB Request for HCBS NF Determination
|
133 kb
|
2/22/2007
|
Y
|
|
1467
|
Human Services, Department of
|
Individual Care Plan
|
411 kb
|
10/10/2007
|
Y
|
|
1540
|
Human Services, Department of
|
Income Averaging/Annualizing Worksheet
|
360 kb
|
|
Y
|
|
1597
|
Human Services, Department of
|
Explanation of Client Choice-Medicaid Waiver for the Aged and Disabled
|
235 kb
|
|
Y
|
|
1647
|
Human Services, Department of
|
HCBS Notice of Denial or Termination
|
194 kb
|
4/3/2007
|
Y
|
|
1681
|
Human Services, Department of
|
Near Zero Income Sheet
|
172 kb
|
|
Y
|
|
1699
|
Human Services, Department of
|
Authorization to Provide Services
|
636 kb
|
7/2/2008
|
Y
|
|
1703
|
Human Services, Department of
|
Compliance Checklist/Adult Day Care Standards
|
70 kb
|
|
Y
|
|
1765
|
Human Services, Department of
|
Request for Reimbursement/Non-State Employee
|
231 kb
|
|
Y
|
|
1781
|
Human Services, Department of
|
Understanding of the Parties for Continued Foster Care Services
|
180 kb
|
|
Y
|
|
1784
|
Human Services, Department of
|
Appeal Background Report
|
78 kb
|
|
Y
|
|
1803
|
Human Services, Department of
|
Subsidized Adoption Agreement
|
310 kb
|
|
Y
|
|
1820
|
Human Services, Department of
|
SPED Program Pool Data
|
192 kb
|
|
Y
|
|
1830
|
Human Services, Department of
|
Application for Continued Guardianship Subsidy After Age 18
|
208 kb
|
|
Y
|
|
1831
|
Human Services, Department of
|
Guardianship Subsidy Agreement - Annual Review
|
183 kb
|
|
Y
|
|
1832
|
Human Services, Department of
|
Agreement for Subsidized Guardianship
|
159 kb
|
|
Y
|
|
1833
|
Human Services, Department of
|
Application for Subsidized Guardianship
|
176 kb
|
|
Y
|
|
1834
|
Human Services, Department of
|
Subsidized Guardianship Contingent Approval Request
|
208 kb
|
|
Y
|
|
1865
|
Human Services, Department of
|
Specialized Family Foster Care/Adoption Assistance Level of Care Evaluation
|
139 kb
|
|
Y
|
|
1906
|
Human Services, Department of
|
Anticipated Self-Employment Worksheet
|
293 kb
|
|
Y
|
|
1906
|
Human Services, Department of
|
Anticipated Self-Employment Worksheet (Printable)
|
216 kb
|
|
N
|
|
1920
|
Human Services, Department of
|
Administrative Assessment or Referral
|
501 kb
|
4/30/2009
|
Y
|
|
1940
|
Human Services, Department of
|
TANF/Food Stamp Notice of Suspected Intentional Program Violation
|
472 kb
|
2/3/2009
|
Y
|
|
2042
|
Information Tech Dept
|
Record Series Description
|
506 kb
|
2/3/2009
|
Y
|
|
2044
|
Information Tech Dept
|
Records Disposal Request
|
45 kb
|
|
Y
|
|
2049
|
Information Tech Dept
|
Microfilm Certification
|
26 kb
|
|
Y
|
|
2053
|
Information Tech Dept
|
Microfilm Divider
|
101 kb
|
9/26/2007
|
Y
|
|
2426
|
Office of Management and Budget
|
State Surplus Property Disposal
|
259 kb
|
10/7/2009
|
Y
|
|
2490
|
Office of Management and Budget
|
Request For Printing
|
121 kb
|
|
Y
|
|
2565
|
Office of Management and Budget
|
Formal Complaint
|
49 kb
|
|
Y
|
|
2566
|
Office of Management and Budget
|
Delegation of Purchase Authority
|
228 kb
|
|
Y
|
|
2567
|
Office of Management and Budget
|
Requisition to Central Supply
|
72 kb
|
|
Y
|
|
2580
|
Office of Management and Budget
|
Emergency Commission Request
|
492 kb
|
|
Y
|
|
2706
|
Office of Management and Budget
|
Request for Telephone Quote
|
128 kb
|
|
Y
|
|
2708
|
Office of Management and Budget
|
Request for Faxed Quote
|
57 kb
|
|
Y
|
|
2715
|
Office of Management and Budget
|
Sample Inventory
|
190 kb
|
|
Y
|
|
3168
|
Office of Management and Budget
|
State Employee Request for Leave
|
172 kb
|
2/29/2008
|
Y
|
|
7546
|
Aeronautics Commission
|
Application and License for Commercial Aerial Applicator
|
226 kb
|
|
Y
|
|
7672
|
Aeronautics Commission
|
Application For Dealer's License
|
148 kb
|
|
Y
|
|
10247
|
State Treasurer
|
Monthly State Tax Collection Report
|
331 kb
|
10/22/2008
|
Y
|
|
10706
|
Insurance Department
|
Boiler Inspection Report
|
270 kb
|
|
Y
|
|
11627
|
Aeronautics Commission
|
Application for Registration of Aircraft/Ultralight and Remittance of Excise Tax
|
580 kb
|
7/20/2009
|
Y
|
|
11639
|
Aeronautics Commission
|
Request For State Airport Aid
|
370 kb
|
|
Y
|
|
13090
|
Office of Management and Budget
|
HRMS/Payroll
|
53 kb
|
|
N
|
|
13091
|
Office of Management and Budget
|
State HRMS Personal Data
|
587 kb
|
11/17/2009
|
Y
|
|
13092
|
Office of Management and Budget
|
One-Time Deduction Worksheet
|
45 kb
|
|
N
|
|
14339
|
Office of Management and Budget
|
General Deduction Worksheet
|
52 kb
|
|
N
|
|
14355
|
Office of Management and Budget
|
Hour Adjustment Worksheet
|
41 kb
|
|
N
|
|
17313
|
Department Not On File
|
Fax Cover Sheet
|
230 kb
|
9/4/2008
|
Y
|
|
17440
|
Information Tech Dept
|
In-City Travel Report
|
246 kb
|
8/12/2009
|
Y
|
|
17606
|
Information Tech Dept
|
Exit Interview
|
236 kb
|
3/25/2008
|
Y
|
|
17818
|
Administrative Hearings, Office of
|
Request For Administrative Law Judge - Complaint
|
269 kb
|
5/8/2009
|
Y
|
|
17819
|
Administrative Hearings, Office of
|
Request For Administrative Law Judge - Appeal, Application, or Petition
|
282 kb
|
5/8/2009
|
Y
|
|
17820
|
Administrative Hearings, Office of
|
Request For Administrative Law Judge - Rules Hearing
|
18 kb
|
5/8/2009
|
Y
|
|
17821
|
Administrative Hearings, Office of
|
Request For Administrative Law Judge - Alternative Dispute Resolution
|
29 kb
|
5/8/2009
|
Y
|
|
18649
|
Bank of North Dakota
|
Send ACH Worksheet
|
91 kb
|
9/16/2008
|
N
|
|
18701
|
Bank of North Dakota
|
Screening/Referral Report
|
250 kb
|
9/16/2008
|
Y
|
|
18709
|
Office of Management and Budget
|
Travel Request
|
70 kb
|
|
Y
|
|
19023
|
Bank of North Dakota
|
ACH Originator Request
|
187 kb
|
9/16/2008
|
Y
|
|
19291
|
Insurance Department
|
Employee Suggestion Incentive Program
|
238 kb
|
1/14/2008
|
Y
|
|
19292
|
Office of Management and Budget
|
State Employee Donation of Leave
|
173 kb
|
|
Y
|
|
50428
|
Office of Management and Budget
|
Direct Deposit Employee Authorization
|
556 kb
|
11/17/2009
|
Y
|
|
50508
|
Risk Management
|
Risk Management Fund Incident Report
|
117 kb
|
|
Y
|
|
50552
|
Risk Management
|
State Risk Management Fund Notice of Claim
|
66 kb
|
|
Y
|
|
51230
|
Insurance Department
|
Anhydrous Ammonia Storage Facility-Inspection Check List
|
803 kb
|
5/12/2008
|
Y
|
|
51231
|
Insurance Department
|
Anhydrous Ammonia Storage Facility-Inspection Checklist Nurse Tank Inspection Items
|
174 kb
|
|
Y
|
|
51301
|
Risk Management
|
Risk Management Fund Motor Vehicle Accident Report
|
302 kb
|
8/17/2007
|
Y
|
|
51403
|
Office of Management and Budget
|
Alternate Procurement Request
|
157 kb
|
|
Y
|
|
51502
|
ND Highway Patrol
|
Bomb Threat Report
|
141 kb
|
4/30/2008
|
N
|
|
52163
|
Office of Management and Budget
|
Purchasing Card Record
|
116 kb
|
2/21/2007
|
Y
|
|
52180
|
ND Highway Patrol
|
Key/Card Access Issue and Return
|
333 kb
|
7/15/2009
|
Y
|
|
52237
|
Office of Management and Budget
|
State Surplus Property Disposal for Political Subdivisions
|
63 kb
|
|
Y
|
|
52280
|
Risk Management
|
Risk Management Motor Vehicle Accident Review Board Report
|
32 kb
|
|
Y
|
|
52376
|
Risk Management
|
Destruction Hold Notice
|
56 kb
|
|
Y
|
|
52378
|
Information Tech Dept
|
Password Change Information
|
185 kb
|
11/13/2009
|
Y
|
|
52579
|
Insurance Department
|
Payment Voucher/Authorization
|
185 kb
|
9/18/2007
|
Y
|
|
52655
|
Insurance Department
|
Commercial Roof Questionnaire
|
250 kb
|
|
Y
|
|
52785
|
Office of Management and Budget
|
Travel Expense Voucher
|
431 kb
|
2/21/2007
|
Y
|
|
53012
|
Central Services Division
|
Formal Complaint
|
18 kb
|
|
N
|
|
53053
|
Central Services Division
|
Herman Miller System Furniture Inventory Sheet
|
54 kb
|
|
Y
|
|
53111
|
Office of Management and Budget
|
Request for Level 1 Certification
|
79 kb
|
8/13/2007
|
Y
|
|
53112
|
Office of Management and Budget
|
Procurement Liaison Designation
|
108 kb
|
|
Y
|
|
53424
|
Risk Management
|
Risk Management Fund Contribution Discount Program Application
|
270 kb
|
5/11/2009
|
Y
|
|
53425
|
Risk Management
|
Risk Management Workers Compensation Premium Discount Application
|
83 kb
|
|
Y
|
|
53601
|
Risk Management
|
Risk Management Medical Services Incident Report
|
280 kb
|
|
Y
|
|
53607
|
Information Tech Dept
|
ITD Disaster Recovery Notification Process *
|
60 kb
|
|
Y
|
|
54176
|
Office of Management and Budget
|
ConnectND HRMS Security Access Request
|
218 kb
|
8/17/2007
|
Y
|
|
54180
|
Insurance Department
|
Large Group Health Insurance Data Report
|
85 kb
|
|
Y
|
|
54181
|
Insurance Department
|
Small Group Health Insurance Data Report
|
77 kb
|
|
Y
|
|
54182
|
Insurance Department
|
Individual Health Insurance Data Report
|
100 kb
|
|
Y
|
|
54201
|
Office of Management and Budget
|
Authorized Representatives
|
181 kb
|
10/7/2009
|
Y
|
|
54202
|
Office of Management and Budget
|
Term Contract Exemption Request
|
114 kb
|
2/20/2007
|
Y
|
|
54325
|
Office of Management and Budget
|
Job Duty Analysis Questionnaire
|
339 kb
|
7/18/2007
|
N
|
|
54326
|
Office of Management and Budget
|
Job Duty Analysis of Work Demands
|
1944 kb
|
7/18/2007
|
N
|
|
54345
|
Risk Management
|
Application for Approval to Limit the Liability of a Vendor
|
193 kb
|
|
Y
|
|
54417
|
Office of Management and Budget
|
Agency Personnel for Authorizing Security for PeopleSoft Applications
|
160 kb
|
|
Y
|
|
54418
|
Office of Management and Budget
|
ConnectND Financials Security Access Request
|
604 kb
|
2/23/2009
|
Y
|
|
54472
|
Office of Management and Budget
|
Voucher Entry
|
246 kb
|
|
Y
|
|
58180
|
State Treasurer
|
Senior Citizens Mill Levey/Match Annual Report
|
388 kb
|
12/15/2008
|
Y
|
|
58292
|
State Treasurer
|
County Township Road Mileage Certification
|
443 kb
|
10/16/2008
|
Y
|
|
58370
|
Insurance Department
|
Prescription Connection Intake Application
|
471 kb
|
6/16/2009
|
Y
|
|
58548
|
Human Resource Management Services
|
Employee Request for Family Medical Leave
|
215 kb
|
11/12/2009
|
Y
|
|
58571
|
Office of Management and Budget
|
Application to Require a More Stringent Indemnification Provision
|
30 kb
|
7/19/2007
|
N
|
|
58613
|
Office of Management and Budget
|
Information Release Authorization for Background Investigation
|
49 kb
|
7/19/2007
|
N
|
|
58670
|
Office of Management and Budget
|
Promotional Agency Request
|
194 kb
|
9/28/2007
|
Y
|
|
58675
|
Office of Management and Budget
|
State of North Dakota Fingerprint Bill To Form
|
235 kb
|
10/16/2007
|
Y
|
|
58710
|
Central Services Division
|
Vendor Registry Office Fax Cover Sheet
|
220 kb
|
1/29/2008
|
Y
|
|
58855
|
Financial Institutions, Department of
|
Criminal History Record Check
|
176 kb
|
7/14/2008
|
Y
|
|
58914
|
Bank of North Dakota
|
Program/Supervisor Referral
|
168 kb
|
9/16/2008
|
Y
|
|
59018
|
Insurance Department
|
Information Required to Insure Radio Towers and Equipment
|
273 kb
|
1/23/2009
|
Y
|
|
59053
|
Office of Management and Budget
|
Card Holder Employee Agreement
|
179 kb
|
4/13/2009
|
Y
|
|
59054
|
Office of Management and Budget
|
Card Administrator Change Request
|
146 kb
|
3/4/2009
|
Y
|
|
59165
|
Office of Management and Budget
|
FIN/HCM Business Intelligence Security Access Request
|
267 kb
|
11/19/2009
|
Y
|
|
59193
|
Commerce, Department of
|
Centers of Excellence Application Evaluation
|
172 kb
|
9/18/2009
|
Y
|
|
59194
|
Commerce, Department of
|
Centers of Excellence Verification of Private Section Participation
|
341 kb
|
9/18/2009
|
Y
|
|
59195
|
Commerce, Department of
|
Centers for Excellence Enhancement Grants Application
|
435 kb
|
9/18/2009
|
Y
|
|
401Instr
|
Insurance Department
|
General Instructions for Companies to Complete Checklist
|
395 kb
|
12/22/2008
|
N
|
|
17726 & 54201
|
Office of Management and Budget
|
Eligibility Application/Authorized Representatives
|
595 kb
|
10/7/2009
|
Y
|
