UNITED STATES MARINE CORPS MARINE CORPS INSTALLATIONS EAST-MARINE CORPS BASE CAHP LEJEUNE PSG BOX 20005 CAMP LEJEUNE NC 28542-0005 Canc: Oct 2013 MCIEAST-MCB CAMLEJBul 5213 G-l/ADJ 17 Oct 12 MARINE CORPS INSTALLATIONS EAST-MARINE CORPS BASE CAMP LEJEUNE BULLETIN 5213 From: To: Subj: Commanding General Distribution List FORMS MANAGEMENT PROGRAM ANNUAL CHECKLIST Ref: (a) SECNAV M-5213.1 (b) MCO 5600.31 Encl: (c) MCIEASTO 5213.1 (1) Checklist of Current MCIEAST-MCB CAMLEJ, MCB CAMLEJ, and MCIEAST Forms (2) Checklist of Cancelled MCB CAMLEJ, and MCIEAST Forms 1, Purpose. To publish a listing of current and cancelled local command forms per references (a) through (c). 2. Cancellation. MCIEASTBul 5213 of 7 Oct 11 (canc: Oct 12) and BBul 5213 (canc: Oct 12). 3. Background. Each command shall provide for continuing analysis, review and control of all forms originated or sponsored by this command to ensure that forms are effective efficient and economical in serving their intended purpose. 4. Action a. Comrnanderfs Intent and Concept of Operations (1) Commanding General's Intent. Establish the guidelines for update and submission of all Marine Corps Installations East-Marine Corps Base Camp Lejeune (MCIEAST-MCB CAMLEJ) forms. (2) Concept of Operations. Sections will regularly review the MCIEAST-MCB CAMLEJ forms they sponsor for currency and relevance. Obsolete forms will be cancelled or revised. b. Subordinate Element Missions. Follow and comply with this Bulletin. c. Coordinating Instructions. All new MCIEAST-MCB CAMLEJ forms and requests for changes to current forms must be routed through the MCIEAST Adjutant. (1) MCIEAST-MCB CAMLEJ forms are located on the MCIEAST shared portal at https://intranet.mcieast.usmc.mil. DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited.
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UNITED STATES MARINE CORPS MARINE CORPS INSTALLATIONS EAST-MARINE CORPS BASE CAHP LEJEUNE
PSG BOX 20005 CAMP LEJEUNE NC 28542-0005
Canc: Oct 2013
MCIEAST-MCB CAMLEJBul 5213 G-l/ADJ 17 Oct 12
MARINE CORPS INSTALLATIONS EAST-MARINE CORPS BASE CAMP LEJEUNE BULLETIN 5213
From: To:
Subj:
Commanding General Distribution List
FORMS MANAGEMENT PROGRAM ANNUAL CHECKLIST
Ref: (a) SECNAV M-5213.1 (b) MCO 5600.31
Encl:
(c) MCIEASTO 5213.1
(1) Checklist of Current MCIEAST-MCB CAMLEJ, MCB CAMLEJ, and MCIEAST Forms
(2) Checklist of Cancelled MCB CAMLEJ, and MCIEAST Forms
1, Purpose. To publish a listing of current and cancelled local command forms per references (a) through (c).
2. Cancellation. MCIEASTBul 5213 of 7 Oct 11 (canc: Oct 12) and BBul 5213 (canc: Oct 12).
3. Background. Each command shall provide for continuing analysis, review and control of all forms originated or sponsored by this command to ensure that forms are effective efficient and economical in serving their intended purpose.
4. Action
a. Comrnanderfs Intent and Concept of Operations
(1) Commanding General's Intent. Establish the guidelines for update and submission of all Marine Corps Installations East-Marine Corps Base Camp Lejeune (MCIEAST-MCB CAMLEJ) forms.
(2) Concept of Operations. Sections will regularly review the MCIEAST-MCB CAMLEJ forms they sponsor for currency and relevance. Obsolete forms will be cancelled or revised.
b. Subordinate Element Missions. Follow and comply with this Bulletin.
c. Coordinating Instructions. All new MCIEAST-MCB CAMLEJ forms and requests for changes to current forms must be routed through the MCIEAST Adjutant.
(1) MCIEAST-MCB CAMLEJ forms are located on the MCIEAST shared portal at https://intranet.mcieast.usmc.mil.
DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited.
MCIEAST-MCB CAMLEJBul 5213 17 Oct 12
(2) This Bulletin is canceled upon receipt of the next consolidated annual checklist.
(3) For further assistance contact the MCIEAST-MCB CAMLEJ Forms Management Coordinator at commercial (910) 451-4452 or DSN 751-4452.
5. Reserve Applicability. This Bulletin is applicable to all personnel assigned to Headquarters MCIEAST-MCB CAMLEJ.
~~~':~~ By direction ,.~
DISTRIBUTION: AlB
2
MCIEAST-MCB CAMLEJBul 5213 1L OCI2012
CHECKLIST OF CURRENT MCIEAST-MCB CAMLEJ FORMS IDENTIFIER TITLE SPONSOR DATE
MCIEAST/BPO/8 Notification of CPI Event BPO 12-0ct-12
MCIEAST/BPO/9 Project Charter BPO 12-0ct-12
Disbursement Request/Religious MCIEAST-MCB CAMLEJ / CHAP /1 Offering Fund Chaplain 12-Aug-12
Marine Corps Base Camp Lejeune MCIEAST-MCB CAMLEJ Application For Use of Chapel /CHAP/1730.9/3 Facilities Chaplain 12-Aug-l2
Clergy and Religious Support MCIEAST-MCB CAMLEJ/CHAP/4 Providers Application for Base Chaplain 12-Aug-12
MCIEAST-MCB CAMLEJ/G-l /ADJ/20 Records Management Report G-l/ADJ 21-May-12
MCIEAST-MCB CAMLEJ/G-l /ADJ/5211.6/25 PA Self Assessment Form G-l/ADJ 2l-May-12
MCIEAST-MCB CAMLEJ/G-l /ADJ/26 Classified Material Receipt G-l/ADJ 2l-May-12
MCIEAST-MCB CAMLEJ/G-l Civil Service Employee of the /ADJ/27 Quarter Voting Form G-l/ADJ 21-May-12
MCIEAST-MCB CAMLEJ/G-1 Civil Service Employee of the /ADJ/28 Year Voting Form G-l/ADJ 21-May-12 MCIEAST-MCB CAMLEJ/G-1 /POSTAL/5112.1/1 Deployed Mail Cover Sheet G-l/ADJ 25-Jul-12
MCIEAST-MCB CAMLEJ/G-l Mail Orderly Statement of /POSTAL/5112.1/2 Understanding G-l/POSTAL 25-Jul-12
MCIEAST-MCB CAMLEJ/G-1/CHRO- G-l/ CHRO E/1271l.1/1 Record of Official Time E 12-Jul-12
MCIEAST-MCB CAMLEJ/G-l/CHRO- Confirmation of Reasonable G-l/ CHRO E/12700.1/3 Accommodation Request Form E 12-Jul-12
Page 2 Enclosure (1)
MCIEAST-MCB CAMLEJBul 5213
11 OCT 2012 CHECKLIST OF CURRENT MCIEAST-MCB CAMLEJ FORMS
IDENTIFIER TITLE SPONSOR DATE MCIEAST-MCB CAMLEJ/G-1/CHRO- Reasonable Accommodation Request G-1/ CHRO E/12700.1/4 Checklist E 12-May-12
MCIEAST-MCB CAMLEJ/G-1/CHRO- G-1/ CHRO E/5 Recommendation For Award E 12-Jul-12
MCIEAST-MCB CAMLEJ/G-1/CHRO- Reasonable Accommodation Annual G-1/ CHRO E/12700.1/6 Report Tracking Information E 12-Jul-12
MCIEAST-MCB CAMLEJ/G-1/CHRO- Change in Official Personnel G-1/ CHRO E/7 Record E 12-May-12
MCIEAST-MCB CAMLEJ/G-1/CHRO- Justification for Pay Setting of G-1/ CHRO E/8 a Reinstatement Eligible E 12-Jul-12
MCIEAST-MCB CAMLEJ/G-1/CHRO- G-1/ CHRO E/9 Personal History Card E 12-Jul-12
MCIEAST-MCB CAMLEJ/G-1/CHRO- Orientation Checklist for New G-1/ CHRO E/10 Employees E 12-Jul-12
MCIEAST-MCB CAMLEJ/G-1/CHRO- G-1/ CHRO E/ll Civilian Personnel Worksheet E 12-Jul-12
MCIEAST-MCB CAMLEJ/G-F /FHD/7 Active Waiting List Letter G-F/FHD 1-0ct-12
MCIEAST-MCB CAMLEJ/G-F /FHD/1l Letter of Intent G-F/FHD 1-Oct-12
MCIEAST-MCB CAMLEJ/G-F Family Housing Customer Service /FHD/17 Document G-F/FHD 1-0ct-12
MCIEAST-MCB CAMLEJ/G-F Statement of Understanding for /FHD/26 the Rental Partnership Program G-F/FHD 1-0ct-12
MCIEAST-MCB CAMLEJ/G-F /FHD/28 Verification of Eligibility G-F/FHD 1-Oct-12
MCIEAST-MCB CAMLEJ/G-F Rental Partnership Program /FHD/33 Application G-F/FHD 1-0ct-12
Page 6
Enclosure (1)
MCIEAST-MCB CAMLEJBul 5213 27 OCT 2012 -.---
CHECKLIST OF CURRENT MCIEAST-MCB CAMLEJ FORMS IDENTIFIER TITLE SPONSOR DATE
MCIEAST-MCB CAMLEJ/G-F Statement of Understanding for On-/FHD/35 Base Housing G-F/FHD 1-Oct-12 MCIEAST-MCB CAMLEJ/G-F /FHD/11101.31/36 Privacy Act Release Form G-F/FHD 1-0ct-12 MCIEAST-MCB CAMLEJ/G-F Minor Construction Project /IDD/11013.4/1 Validation Form G-F/IDD 1-0ct-12
CHECKLIST OF CURRENT MCB CAMLEJ FORMS MCBCL/DPS/HQ/l Routing and Transmittal Slip SES 8-May-12 MCBCL/DPS/BRIG/l Brig Privacy Statement SES 8-Jul-12
Marks/Scars/Physical Violence MCBCL/DPS/BRIG/2 Report SES lO-Oct-12
SOP for Confinement, Restraint MCBCL/DPS/BRIG/1640.9/4 and Release SES 8-Jul-12
Notice to Accused Upon Pretrial MCBCL/DPS/BRIG/1640.10/3 Confinement SES 8-Jul-12
EMSS Patient Discharge MCBCL/DPS/FIRE/1 Information (RESTRICTED) SES 9-Dec-12 MCBCL/DPS/FIRE/5 Apparatus Check sheet SES 10 Apr-12 MCBCL/DPS/FIRE/6 Fire Extinguisher Service SES 10-0ct 12
MCBCL/DPS/OPS/2 Request for Funeral Pass SES 10 Oct-12
Request for VIP/Special Event MCBCL/DPS/OPS/3 Pass SES lO-Oct-12
MCBCL/DPS/OPS/5 Request for Wedding Pass SES 10 Oct-12
MCBCL/DPS/PMO/1 Notification Form/ Checklist SES 8-Dec-12
MCBCL/DPS/PMO/3 Animal Redemption SES 8-Dec-12 MCBCL/DPS/PMO/4 Request For Animal Trap SES 8-Dec-12 MCBCL/DPS/PMO/6 Juvenile Miranda Rights SES 11-Mar-12
MCBCL/DPS/PMO/8 PMO Vehicle Information Sheet SES 10 Nov 12
MCBCL/DPS/PMO/9 Suspension of Base Privileges SES 11 Mar-12
Page 9 Enclosure (1)
MCIEAST-MCB CAMLEJBu1 5213
j 7 OCT 2012 -----~-.
CHECKLIST OF CURRENT MCB CAMLEJ FORMS IDENTIFIER TITLE SPONSOR DATE
MCBCL/OPS/PMO/P5560.2/12 Decal Action Sheet (RESTRICTED) SES 8-0ec-12 MCBCL/OPS/PMO/15 Field Interview Card SES 9-Jul-12
Curfew Violation Notice MCBCL/OPS/PMO/17 (RESTRICTED) SES 10-Nov-12
MCBCL/OPS/PMO/18 Minor Offense Report (RESTRICTED) SES 8-0ec-12
MCBCL/OPS/PMO/20 Lost/Stolen Cellular Phone Report SES 8-0ec-12 MCBCL/OPS/PMO/21 Field Sobriety Test Worksheet SES 8-0ec-12 MCBCL/OPS/PMO/22 Vehicle Impound Slip SES 10-0ec-12 MCBCL/OPS/PMO/23 Vehicle Impound ~'1arning Slip SES 10-0ct-12
Temporary Vehicle Pass MCBCL/OPS/PMO/26 (RESTRICTED) SES 10-Jan-12 MCBCL/OPS/PMO/34 Non-Criminal Damage Report SES 10-0ct-12 MCBCL/OPS/PMO/4450.4/36 Vehicle Storage Record SES ll-Mar-12 MCBCL/OPS/PMO/37 Stray/Nuisance/Bite Report SES ll-Mar-12
Vehicle Safety Inspection MCBCL/DPS/PMO/39 Checklist SES 8-Dec-12
Third Party Traffic Violation MCBCL/DPS/PMO/40 Reporting Form SES 8-Dec-12
Animal Pickup Authorization MCBCL/DPS/PMO/I0570.1/41 Certification Form SES 9-Dec-12
Letter for Seizure Destruction of MCBCL/DPS/PMO/I0570.1/42 a Domesticated Animal SES 9-0ec-12 MCBCL/OPS/PMO/43 Information Exchange Slip SF:S 10-Jun-12 MCBCL/DPS/PMO/44 Physical Security Survey SES ll-Mar-12
(SAMPLE) SES MCBCL/OPS/PMO/45 Crime Prevention Survey SES ll-Feb-12
MCBCL/DPS/PMO/5500.3/46 Telephone Bomb Threat Checklist SES 10-Jan-12 MCBCL/DPS/PMO/47 Disposition Form SES 10-Nov-12
Rotational Wrecker Towing MCBCL/OPS/PMO/5560.3/48 Agreement SES 10-Jun-12
Operation Identification Property MCBCL/DPS/PMO/5822.4/50 Registration Form SES ll-Mar-12
MCBCL/DPS/PMO/5822.4/51 Private Property Inventory List SES ll-Mar-12 MCBCL/DPS/PMO/53 Weapons Registration Form SES 10-Feb-12
MCBCL/DPS/SFTY/l Prescription Protective Eyewear SES 8-0ec-12
Authorization to Ship Radioactive MCBCL/OPS/SFTY/2 Material SES ll-Feb-12
Radioact.ive Material (RAM)
MCBCL/DPS/SFTY/5104.1/3 Movement. Form SES lO-Mar-12
Page 10
Enclosure (1)
MCIEAST-MCB CAMLEJBul 5213 17 OCT 2(". P.ii>=--
CHECKLIST OF CURRENT MCB CAMLEJ FORMS IDENTIFIER TITLE SPONSOR DATE
MCBCL/DPS/SFTY/4 Confined Space Entry Permit SES 11 Feb-12
Flammable/ Explosive Vapor Test MCBCL/DPS/SFTY/5 (SAMPLE) SES 9-Apr-12
Mishap Investigation Report MCBCL/DPS/SFTY/8 (SAMPLE) SES 10-Jan-12
User Incident Reporting Worksheet MCBCL/DPS/SFTY/9 (SAMPLE) SES 11-Jan-12 MCBCL/DPS/SFTY/5104.1/10 RSO Incident Report Checklist SES 10 Feb-12
Radiation Safety Training Record MCBCL/DPS/SFTY/5104.1/11 for Females SES 11-Mar-12 MCBCL/DPS/SFTY/5104.1/12 Letter Declaring Pregnancy SES 10 Oct-12
Radiological Controls Program MCBCL/DPS/SFTY/5104.1/13 Review Checklist SES 11-Feb-12
Headquarters & Support Battalion Leave and Liberty Personal Travel
MCBCL/HQSPTBN/HQ/3 Form HQSPTBN 10-Oct-12 MCBCL/HQSPTBN/ADJ/l Voting Sign-In Roster HQSP'fBN 8-Jul-12 MCBCL/HQSPTBN/ADJ/2 Mail Pickup Sign in Sheet HQSPTBN 8-Jul-12 MCBCL/HQSPTBN/ADJ/3 Awards Confirmation Fax Sheet HQSPTBN 9-Apr-12 MCBCL/HQSPTBN/ADJ/4 Fax Cover Sheet HQSPTBN 9-Apr-12 MCBCL/HQSPTBN/ADJ/5 HQSPTBN Route Sheet HQSPTBN 9-Mar-12 MCBCL/HQSPTBN/ADJ/6 Request For AA Form HQSPTBN 8-Jul-12 MCBCL/HQSPTBN/ADJ/ll BEQ Check-In FORM HQSPTBN 10-0ct-12
Disbursement Request/ Religious MCBCL/HQSPT/CHAP/7010.18/1 Offering Fund HQSPTBN 8-Jun-12
Marine Corps Base Camp Lejeune Application For Use of Chapel
MCBCL/HQSPTBN/CHAP/3 Facilities HQSPTBN 10-Feb-12
Clergy and Religious Support MCBCL/HQSPTBN/CHAP/4 Providers Application for Base HQSPTBN 10-Feb-12 MCBCL/HQSPTBN/LEGAL/l Restraint Muster Record HQSPTBN 10 Oct-12 MCBCL/HQSPTBN/LEGAL/2 Report of Violation Form HQSPTBN 8-May-12
CO I S Screening/lntervie\"/ Guide-MCBCL/HQSPTBN/S-3/2 Airborne School HQSPTBN 10-0ct-12 MCBCL/HQSPTBN/S-3/3 Code Of Conduct HQSPTBN 10-0ct-12 MCBCL/HQSPTBN/S-3/5 Rif Qualification HQSPTBN 10-0ct-12
Division Marksmanship Training MCBCL/HQSPTBN/S-3/7 Unit Coaches Course HQSPTBN 10-0ct-12
Martial Arts Instructor Trainer MCBCL/HQSPTBN/S-3/8 Course HQSPTBN 10-Oct-12 MCBCL/HQSPTBN/S 3/9 SOP for Resident Enlisted PME HQSPTBN 10 Oct-12
AFFADAVIT In Support of Request MCBCL/I&E/BHD/l for BAQ G-F ll-Mar-12
Page 11
Enclosure (1)
MCIEAST-MCB CAMLEJBul 5213
JJ. OCT 2012 CHECKLIST OF CURRENT MCB CAMLEJ FORMS
MCBCL/S-l/IPAC/Command Support Branch/3 Temporary Additional Duty Audit Checklist I PAC MCBCL/S-l/IPAC/Command Support Branch/5 Kickback Cover Sheet I PAC
MCBCL/S-l/IPAC/Command Support Branch/6 To/ATT TAD Audit Checklist I PAC
MCBCL/S-l/IPAC/INBOUND/7 Discount Meal Statement I PAC
MCBCL/S-l/IPAC/INBOUND/8 Quality Control Sheet I PAC
MCBCL/S-l/IPAC/INBOUND/9 Request for Housing Voucher I PAC
MCBCL/S-l/IPAC/INBOUND/IO Travel Claim Correction Form I PAC
I PAC Inbounds Unit Diary to Second Stage MCBCL/S-l/IPAC/INBOUND/11 Audits I PAC
Personal Data Sheet for Permanent Change MCBCL/S-1/IPAC/OUTBOUND/2 of Station PCS Orders (Overseas) I PAC
Permanent Change of Assignment (PCA) Data MCBCL/S-1/IPAC/OUTBOUND/4 Sheet I PAC
Checklist for personnel transferred overseas via permanent Change of Station
MCBCL/S-1/IPAC/OUTBOUND/7 Orders I PAC
MCBCL/S-l/IPAC/OUTBOUND/10 Guidelines for Pet Movement on AMC I PAC
MCBCL/S-1/IPAC/OUTBOUND/12 Diary Cheat Sheet I PAC
MCBCL/S-1/IPAC/12 To TAD Checklist I PAC
MCBCL/S-l/IPAC/13 From TAD Checklist I PAC
MCBCL/S-1/IPAC/14 PCS/PCA Checklist I PAC
MCBCL/S-1/IPAC/15 Unit Dairy Checklist I PAC
MCBCL/IPAC/16 Duplicate Terminal Leave Request I PAC
MCBCL/I PAC/1 7 Other Personnel Check In I PAC
Page 5
Enclosure (2)
MCIEAST-MCB CAMLE,JBul 5213 Jl. OCT 2012
CHECKLIST OF CANCELLED MCB CAMLEJ FORMS • IDENTIFIER TITLE SPONSOR
Unit Deployment Branch Checklist for MCBCL/S-l/IPAC/ODB/l Returning from Deployment (Individual) I PAC
UDS Going on Deployment Checklist-MCBCL/S-l/IPAC/UDB/2 Afghanistan I PAC
MCBCL/S-l/IPAC/UDB/3 ODB Going to the Field Checklist I PAC
MCBCL/S-l/IPAC/UDB/4 UDB Going on Deployment - IRAQ I PAC
MCBCL/S-l/IPAC/UDB/5 UDB Going on Deployment - SHIP I PAC
Pre-Deployment Survey Site (PDSS) MCBCL/S-l/IPAC/UDB/6 Checklist I PAC
MCBCL/S-l/IPAC/UDB/7 Returning from Field Exercise I PAC
MCBCL/S-l/IPAC/UDB/8 Record of Emergency Data (RED) Cheat Sheet I PAC
Permanent Change of Assignment (PCA) Data MCBCL/IPAC/IO Sheet I PAC
MCBCL/S-l/IPAC/WWBN/l WWBN Diary Cheat Sheet I PAC
MCBCL/S-l/IPAC/WWBN/2 WWBN Separations Checklist I PAC
MCBCL/S-l/IPAC/WWBN/3 WWBN Separations Cover Sheet I PAC
MCBCL/S-l/IPAC/WWBN/4 WWBN Casualty Checklist I PAC
MCBCL/S-l/IPAC/WWBN/5 WWBN NJP Checklist I PAC
MCBCL/S-l/IPAC/WWBN/6 WWBN Member Married to Member Data Sheet I PAC
MCBCL/S-l/IPAC/WWBN/7 WWBN Dual Active Duty BAH Application I PAC
MCBCL/S-l/IPAC/WWBN/8 WWBN Inbound Checklist I PAC
MCBCL/S-l/IPAC/WWBN/9 WWBN Second Phase Join Audit Coversheet I PAC
MCBCL/S-1/IPl\C/\'I11BN/lO I'/\'IBN SRB Order/Discrepancy Page I PAC
MCBCL/S-l/IPAC/WWBN/ll WWBN Limited Duty Checklist I PAC
MCBCL/SJA/9 Childcare Agreement Worksheet SJA
MCBCL/SJA/ll General Power of Attorney SJA
Special Power of Attorney Real Estate MCBCL/SJA/12 Purchase SJA
MCBCL/SJA/13 Special Power of Attorney Real Estate Sale SJA
MCBCL/SJA/15 Special Pm ... er of Attorney Rental Lease SJA
MCBCL/SJA/16 Special Power of Attorney Taxes SJA
MCBCL/SJA/18 Special Power of Attorney Household Goods SJA
Special Power of Attorney (In LOCO MCBCL/SJA/19 Parents) SJA
Special Power of Attorney (Gov Quarters MCBCL/SJA/20 Atlantic Marine) SJA
MCBCL/SJA/21 Special Power of Attorney Banking SJA
Page 6 Enclosure (2)
MCIEAST,MCB CAMLEJBul 5213 Jl OCT 2012
CHECKLIST OF CANCELLED MCB CAMLEJ FORMS . IDENTIFIER TITLE SPONSOR
Special Power of Attorney Government MCBCL/SJA/22 Quarters SJA MCBCL/SJA/23 Special Power of Attorney Auto Sale SJA
Special Power of Attorney (Automobile MCBCL/SJA/24 Shipment) SJA
Special Pm'ler of Attorney Auto MCBCL/SJA/25 Registration SJA
MCBCL/SJA/27 Special Power of Attorney Auto Banking SJA
MCBCL/SJA/28 Special Power of Attorney Auto Banking SJA