Louisiana Division of Administration

Forms

Forms for agency use

Form No. Form Name Revision Date
OSUP/F2 Replacement Employee Check/EFT Nov. 29, 2004
OSUP/F3 Reverse Employee Check/EFT 20060922Sept. 22, 2006
OSUP/F4 Stop Check Payment Request 20041115Nov. 15, 2004
OSUP/F5 Certificate of Lost Payrol Check 20041124Nov. 24, 2004
OSUP/F6 Affidavit of Lost Payroll Check, Certificate of Indemnity 20041124Nov. 24, 2004
OSUP/F6A Affidavit of Lost Vendor Check/Certificate of Indemnity 20041124Nov. 24, 2004
OSUP/F7 Affidavit of Forged Endorsement 20041026Oct. 26, 2004
OSUP/F12A Direct Deposit Enrollment Authorization, Main Bank (Primary Account) 20110105Jan. 5, 2011
OSUP/F12B Direct Deposit Enrollment Authorization, Other Bank 20110105Jan. 5, 2011
OSUP/F20 OSUP Form 1099 Request 20151112Nov. 12, 2015
OSUP/F25 Aged Outstanding Payroll Checks Certification Form 20150512May 12, 2015
OSUP/F37 Request for Duplicate IRS Tax Form (W2, 1099, 1095-C) 20190215Feb. 15, 2019
OSUP/F44 Agency Request to Establish Payment Plan for Retroactive Tax Model/Benefit Plan Changes Via Recoup Net Offset and Non Wage Recovery Wage Types 20050705July 5, 2005
OSUP/F46 Request for Direct Deposit Waiver 20110105Jan. 5, 2011
OSUP/F71 Agency Contact Setup/Change Form 20091001Oct. 1, 2009
OSUP/F86 Certification of Overpayment of Taxes Form 20090922Sept. 22, 2009
OSUP/F89 Certification of Employee Attestations for International ACH Transactions (IAT) 20110105Jan. 5, 2011
OSUP/F90 Employee Attestation for International ACH Transactions (IAT) 20110105Jan. 5, 2011
OSUP/F96 OSUP E-Verify Enrollment Form 20110914Sept. 14, 2011
OSUP/F98 State Combined Charitable Campaign Agency/Department Contact 20140627June 27, 2014
OSUP/F100 ACA Newly Hired Employee Offer of Coverage Worksheet 20150701July 1, 2015
OSUP/F102 Agency Claims Attestation 20151030Oct. 30, 2015