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Forms (Alphabetical)

The forms listed below are PDF files. They include graphics, fillable form fields, scripts and functionality that work best with the free Adobe Reader. While other browsers and viewers may open these files, they may not function as intended unless you download and install the latest version of Adobe Reader.

Name Number Description
ACH (Direct Deposit) Payment Destination Confirmation (login required) PDF 74-227 Used by agencies who must require payees to confirm whether their state payments are destined to be forwarded outside of the U.S.
Agency Authorization for Warrant Pickup (login required) PDF 74-189 Used by agencies to authorize personnel to pick up warrants.
Agency Enterprise Resource Planning (ERP) Project Request PDF 74-222

Used by agencies and institutions to request authorization for Enterprise Resource Planning (ERP) projects in compliance with Government Code Section 2101.037(a).

Annual Certification of Estimated Optional Retirement Program (ORP) State Contributions PDF 74-210 Used by junior/community colleges to submit an estimate of state matching contribution funds needed for employees participating in the Optional Retirement Program.
Application for Texas Identification Number (login required) PDF AP-152 Used by agencies to obtain necessary information from payees to set up a Texas Identification Number (TIN).
Application to Report Indebtedness (login required) PDF 74-188 Used by agencies requesting to report state debts or change existing hold agency information.
Bailment Contract (login required) PDF 74-190 Used as an agreement between a state agency and the Comptroller’s office that allows the agency to receive post-dated payroll warrants before payday
Banking and Electronic Processing Forms (Treasury Operations) -- Used by agencies to request chargebacks for forged warrants or by financial institutions to request payment for lost warrants that have been cashed.
Batch Header PDF 73-240 Used by agencies for all Uniform Statewide Accounting System (USAS) transactions to group together like documents, with the batch type determining the screen layout.

Benefit Voucher Data Worksheet (Excel)
-- Used by agencies and institutions to submit for data entry budget documents with completed batch headers to receive budget to pay for employees’ benefit payments for the new appropriation year per Accounting Policy Statement (APS) 019.
Budget Revision PDF 73-181 Used by agencies to set up and make corrections to original budgets (when authority exists), to make budget transfers between direct strategies, to move a budget from one year to another and to lapse funds according to Accounting Policy Statement (APS) 018.
Certification of Physical Inventory Conducted by Agency PDF 73-283 Used by agencies to document their annual physical inventories.
Certification of Request for Agency Reporting Status (SPA) PDF 73-284 Used by an agency to notify the Comptroller’s office that the agency will use the State Property Accounting System (SPA) as its own system.
Confidential Treatment of Information Acknowledgement (CTIA) PDF

Comptroller’s Public Information Summary Disclosure Manual PDF – users must read manual before signing CTIA form
70-223 Required of all agency users of the Comptroller statewide financial systems. Agency security coordinators must have a signed form from every user on file at their agency prior to granting access to the systems.
Contact List Update Form -- Used by agencies to update all their contacts on Fiscal Management contact lists.
Corrective Action Plan PDF -- Lists findings from audits and recommendations for corrective action.
Debtor Hold File Extract Request (login required) -- Used by agencies to request the daily debtor hold extract file.
Deposit Slip PDF 82-198 Used by agencies to make deposits to the Texas Comptroller of Public Accounts.
Direct Deposit Authorization Form (login required) PDF 74-176 Used by agencies to provide to payees who wish to receive state payments by direct deposit or change/cancel existing direct deposit information.
Direct Deposit Payment Trace Number Request (login required) PDF 74-229 Used by agencies to request an ACH trace number for a state direct deposit payment.
Direct Deposit Reversal Request (login required) PDF 74-191 Used by agencies to request an erroneous direct deposit payment be reversed through the Automated Clearing House (ACH) system.
Disbursement Method Indicator (DMI) Change Request (login required) -- Used by agencies to request an override of the disbursement indicator in the Uniform Statewide Accounting System (USAS) so a future-dated payment can be processed overnight.
Email Subscriptions -- Used by agencies to sign up for Fiscal Management email publications and announcements.
Enterprise Resource Planning (ERP) E-mail Subscription Form -- Used to subscribe to updates on the Enterprise Resource Planning project news and events.
FMXtra Subscription Form -- Used to subscribe to the weekly e-mail newsletter highlighting “What’s New” on FMX.
HRIS EFT Specifications Form PDF 73-162 Form required during the fiscal year Reappointment process.
Hold Transaction (login required) PDF 74-154 Used by a hold source agency to set up, change or release hold information for a state debtor.
Interagency Contact Update Form -- Included in master Contact List Update Form used by agencies to update their Fiscal Management contact lists.
Journal Voucher PDF 73-180 Used by agencies to correct non-payment-related transactions, process cash operating transfers and process adjustments.
Letter of Authorization Signature List for HRIS/SPRS/USPS/CAPPS Data Changes PDF 73-318 Used by agencies to name the people authorized to request changes to an agency’s data by a Letter of Authorization (LOA). This form must be accompanied by a letter written and signed by the agency head or governing body.
Letter of Authorization for Data Change PDF 73-313 Used by agencies or by an authorized Comptroller employee to authorize changes to data in the Human Resource Information System (HRIS), Uniform Statewide Payroll/ Personnel System (USPS) or the Standardized Payroll/Personnel Reporting System (SPRS).
Letter of Authorization for SPRS Payroll Override PDF

Contact the SPRS Production Support staff if you need the Excel version.
74-204


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Used by agencies to request a payroll override in the Standardized Payroll/Personnel Reporting System (SPRS).
Miscellaneous Claim Application PDF 74-209 Used by payees to file a claim against the state of Texas for an obligation when the appropriation period has expired or does not exist.
Miscellaneous Claims Approval Form PDF 74-208 Used by agencies, the attorney general and the Comptroller’s office to officially approve or deny a miscellaneous claim.
Missing, Damaged or Stolen Property Report PDF 74-194 Used by agencies to report property that is missing, damaged or stolen.
Notice of Agency Head and Designation of Property Manager PDF 73-286 Used by agencies to notify the Comptroller’s office of a new agency head or property manager.
Optional Retirement Program (ORP) Monthly Payment Request PDF 74-211 Used by junior/community colleges to request the monthly reimbursement of their state matching contribution funds for employees participating in the Optional Retirement Program.
PayCard Enrollment Authorization (login required)PDF 74-224 This form is used by employees to sign up to receive payroll payments through the Employee PayCard program.
Payee Change Request (login required) PDF 74-157 Used by agencies requesting updates to payee information in the Texas Identification Number System (TINS); may be provided by the agencies to their payees.
Payment Cancellation Voucher (login required) PDF 73-179 Used by agencies to request cancellations of forged warrants that are reinstated or for post-dated payroll deduction warrants.
Petty Cash Account Certification PDF 74-213 Used by agencies to identify the type of petty cash account requested and other necessary information, such as requested amount, funding source and total petty cash disbursements for the fiscal year.
Post-Payment Audit Contract PDF -- Contract between the Texas Comptroller of Public Accounts and the contracting agency for audits of documents after payment or posting.
Post-Payment Audit Questionnaire (Preview Only) PDF -- Gives agencies preliminary access to a non-interactive (preview only) version of the most recent Post-Payment Audit Questionnaire so they can begin gathering the necessary information for their pending audit.
Post-Payment Audit Survey -- Allows agency representatives to rate the level of service during their recent audit.
Property Destruction Record PDF (login required) -- Used by agencies to record property that has become depleted, worn out, damaged or obsolete through use, time or accident and can no longer serve the purpose for which is was originally intended. This is not a required form, but it is suggested for use at the time of cannibalization/disposal of salvage property.
Property Transfer Receipt PDF (login required) -- Used by agencies to document a property transfer. This form is suggested but not required.
Purchase Voucher (Automated Form) (Excel) 73-170 Used by state agencies to organize data for online entry into the agency’s accounting system. This form can be used as part of an agency’s internal control process and to document required approvals.
Quarterly Certification of Binding Encumbrances/Payables

Annual Certification of Binding Encumbrances/Payables
-- Used by the chief fiscal officer or higher official for each agency to certify that the binding encumbrance and payable entries have processed in USAS for the first three quarters of the fiscal year and to certify that the binding encumbrance and payable entries have processed and all unobligated balances have been lapsed or brought forward for previous year appropriations (includes the fourth quarter of the previous appropriation year) per APS 018.
Reclamation Request for ACH Transactions (login required) PDF 74-226 Used by a agencies upon notification of a payee’s death to reclaim a pension, annuity or benefit payment made by direct deposit for which the payee or its estate was not entitled.
Request to Increase Maximum Lodging Rate -- Used by agencies to internally document the request for and approval of an increase to the maximum lodging rate issued by the Comptroller’s office.
SFS Users Semiannual Security Access Attestation PDF 73-326 Used by agency security coordinators to verify their users’ access.
SPA Accounting Processed Transaction File Request (login required) -- Used by agencies to request a Processed Transaction File each time data are loaded in batch to the State Property Accounting System (SPA).
SPA Contact List Update Form -- Included in master Contact List Update Form used by agencies to update their Fiscal Management contact lists.
SPA Property Destruction Record PDF -- Used by agencies at time of cannibalization/disposal of salvage property. This is a suggested but not required form.
SPA Property Transfer Receipt PDF -- Used by agencies at time of physical transfer of property. This is a suggested but not required form.
SPA State Property Accounting EFT Request (login required) -- Used by agencies to request file extracts online in the State Property Accounting System (SPA) and to retrieve these downloads the following business day via electronic file transfer (EFT).
SPRS Agency Conversion Request PDF 74-228 Used by agencies converting to the Standardized Payroll/Personnel Reporting System (SPRS).
Salary Supplementation Report 74-197 Used by agencies and institutions of higher education to report salaries supplemented from non-appropriated funds.
Settlements or Judgments Coding Block Form PDF 74-218 Used by agencies to provide the Comptroller’s office with a coding block for processing the payment of a settlement and/or judgment that involves a special fund.
Summary Number Application (login required) PDF 74-216 Used by agencies to apply for a special payee identification number for low dollar, one-time payments to multiple payees.
Super Security Delete Request PDF 73-310 Used by agencies to request removal of posted payment transactions from Uniform Statewide Accounting System (USAS) production.
Tax Refund Direct Deposit Authorization (login required) PDF 74-221 Used by the Comptroller’s Revenue Accounting Division to provide to taxpayers who wish to receive tax refund payments by direct deposit.
Travel Voucher PDF 73-174 Used by state agency personnel to document information required for reimbursement of business-related travel expenses.
USAS Extract Requests (login required) -- Used by agencies to request a specific data file from the Comptroller’s System Input/Output (SIO) group.
Vendor Payment Contact Update Form -- Included in master Contact List Update Form used by agencies to update their Fiscal Management contact lists.
Warrant Release or Reinstatement Request (login required) PDF 00-432 Used by a hold source agency to authorize the release of a held warrant.

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