G-l/ADJ (b) MCO 5600

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

COMMANDING GENERAL'S EVALUATION MCIEAS'f-MCB CAMLEJ/CIG/HQ/1 REPORT CIG l2-Aug-12

MCIEAST-MCB CAMLEJ/CIG/HQ/2 Action Request CIG l2-Jul-l2

MCIEAST-MCB CAMLEJ/CIG/HQ/3 Fax Cover Sheet CIG l2-Aug-12

MCIEAST-MCB CAMLEJ/CIG/HQ/5 Community Service Agreement CIG 12-Aug-l2

MCIEAST-MCB CAMLEJ/CIG/HQ/6 Appeal To The Command Inspector CIG 12-Aug-12 MCIEAST-MCB CAMLEJ/G-8/2 Time Keepers for SLDCADA G-8 12-Aug-l2

MCIEAST-MCB CAMLEJ/G-8 /LMD/7 Work Schedule Change G-8 12-Aug-l2

MCIEAST-MCB CAMLEJ/G-8/ 5400.3/8 Risk Assessment Test Script G-8 12-Aug-12 MCIEAST-MCB CAMLEJ/G-8/9 Reimbursable Account Check-In G-8 12 Aug-12

MCIEAST-MCB CAMLEJ/G-8/ 5400.3/10 Control Assessment Test Script G-8 12-Aug-12

MCIEAST-MCB CAMLEJ/G-8/ 5400.3/11 Internal Control Accomplishment G-8 12-Aug-12

MCIEAST-MCB CAMLEJ/G-8/ 5400.3/12 Corrective Action Plan G-8 12-Aug-12

MCIEAST-MCB CAMLEJ/G-8/ 5400.3/13 Assessable Unit Listing G-8 12-0ct-12 MCIEAST/CONT/l Purchase Card Purchase Request CONT 12-May-12 MCIEAST/CONT/2 Justification for Urgency CONT 12-May-12

MCIEAST/CONT/3 Justification for SAP Sole Source CONT 12-May-12

MCIEAST-MCB CAMLEJ/G-l MCIEAST-MCB CAMLEJ FOIA Request /ADJ/5720 .1/1 Form G-l/ADJ 12-Jun-12

MCIEAST-MCB CAMLEJ/G-l /ADJ/1650.2/2 Service Member of the Month G-l/ADJ 21-May-12

MCIEAST-MCB CAMLE.J /G-l MCIEAST-MCB CAMLEJ Privacy Act /ADJ/5720 .1/3 Request G-l/ADJ 21-May-12

MCIEAST-MCB CAMLEJ/G-l /ADJ/4 Reports Evaluation Checklist G-l/ADJ 21-May-12

Page 1

Enclosure (1)

MCIEAST-MCB CAMLEJBul 5213

lIQgL201~ CHECKLIST OF CURRENT MCIEAST-MCB CAMLEJ FORMS

IDENTIFIER TITLE SPONSOR DATE

MCIEAST Directive Managers MCIEAST-MCB CAMLEJ/G-1 /ADJ/5 Control Checklist G-l/ADJ 2l-May-12

MCIEAST-MCB CAMLEJ CONGRINT MCIEAST-MCB CAMLEJ/G-l /ADJ/7 Privacy Act Statement G-l/ADJ 21-May-12

MCIEAST-MCB CAMLEJ Telephonic MCIEAST-MCB CAMLEJ/G-1 /ADJ/8 CONGRINT/SPLINT G-l/ADJ 21-May-12

MCIEAST-MCB CAMLEJ/G-l /ADJ/5400.1/9 MCIEAST-MCB CAMLEJ Route Sheet G-l/ADJ 21-May-12

MCIEAST-MCB CAMLEJ/G-l /ADJ/5211.1/10 PA Disclosure Form G-1/ADJ 2l-May-12

MCIEAST-MCB CAMLEJ/G-1 /ADJ/ll ECP Application Checklist G-1/ADJ 21-May-12

MCIEAST-MCB CAMLEJ/G-l /ADJ/12 MECEP Application Checklist G-l/ADJ 21-May-12

MCIEAST-MCB CAMLEJ/G-l REGULAR WARRANT OFFICER /ADJ/13 APPLICATION CHECKLIST G-l/ADJ 21-May-12

MCIEAST-MCB CAMLEJ/G-1 LIMITED DUTY OFFICER APPLICATION /ADJ/14 CHECKLIST G-1/ADJ 2l-May-12

MCIEAST-MCB CAMLEJ/G-l /ADJ/5360.3/15 MCB Hold Harmless Agreement G-1/ADJ 21-May-12

MCIEAST-MCB CAMLEJ/G-l /ADJ/16 Annual Form Review Letter G-l/ADJ 21-May-12

MCIEAST-MCB CAMLEJ/G-1 /ADJ/17 Training Roster G-1/ADJ 21-May-12

MCIEAST-MCB CAMLEJ/G-1 MCIEAST-MCB CAMLEJ Conference /ADJ/PLOO2-12/19 Request G-l/ADJ 21-May-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)


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-1/CHRO- Civilian Employee Clearance G-1/ CHRO E/12715.1/12 Checklist (RESTRICTED) E 12-Jul-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- G-1/ CHRO E/12810 .1/13 Occupational Health Permit E 12-Jul-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- Civil Service Employee of the G-1/ CHRO E/15 Quarter/Year Nomination E 12-Jun-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- G-l/ CHRO E/12630.5/16 Prior Civilian Work Experience E 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- G-1/ CHRO E/12630.5/l7 Request for Crediting E 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- Environmental Differential Pay G-1/ CHRO E/12550 .1/21 (EDP) Request E 12-May-12

Employment Statement Regarding Retirement, Severance Pay,

MCIEAST-MCB CAMLEJ/G-1/CHRO- Repayment of Voluntary G-1/ CHRO E/23 Separation Incentive E 12-May-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- Statement of Understanding for G-l/ CHRO E/24 Former Military Members E 12-May-l2

MCIEAST-MCB CAMLEJ/G-l/CHRO- Gen Notice of Drug Testing under G-l/ CHRO E/25 DON Drug-Free Workplace Program E 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- Language Proficiency G-l/ CHRO E/26 Questionnaire E 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- G-1/ CHRO E/27 Personal Information Data E 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- Requirement to Participate in the G-1/ CHRO E/28 Mandatory EFT E 12-May-12

Page 3

Enclosure (1)


11 OCT 2012 CHECKLIST OF CURRENT MCIEAST-MCB CAMLEJ FORMS


MCIEAST-MCB CAMLEJ/G-1/CHRO- Selective Service Male Applicants G-1/ CHRO E/29 Only E 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- G-1/ CHRO E/30 Standards of Conduct E 12-May-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- G-1/ CHRO E/31 Disclosure of SSN E 12-May-12

Statement of Understanding MCIEAST-MCB CAMLEJ/G-1/CHRO- Regarding Conditions of Term G-1/ CHRO E/32 Appointment E 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- G-l/ CHRO E/33 Civilian Identification Card E 12-May-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- G-1/ CHRO E/34 Notice of Random Drug Testing MCB E 12-May-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- Statement of Understanding G-1/ CHRO E/35 Temporary Employment E 12-May-12

MCIEAST-MCB CAMLEJ/G-1/CHRO Justification for Paysetting of G-1/ CHRO E/12531.1/37 Reinstatement Eligible E 12-Apr-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- Individual Leadership Development G-1/ CHRO E/WFLC/2 Plan (ILDP) E 12-0ct-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- G-l/ CHRO E/WFLC/5 Mentor and Participant Agreement E 12-0ct-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- G-1/ CHRO E/WFLC/6 Mentor Action Plan E 12-0ct-12

MCIEAST-MCB CAMLEJ/G-1/CHRO- Individual Development Plan (IDP) G-1/ CHRO E/WFLC/7 for Non-Supervisory Personnel E 12-0ct-12

MCIEAST-MCB CAMLEJ/G-J./CHRO- G-1/ CHRO E/WFLC/9 CCLD Registration Form E 12-0ct-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- Individual Development Plan (IDP) G-l/ CHRO E/WFLC/I0 for Supervisory Personnel E 12-0ct-12

MCIEAST-MCB CAMLEJ/G-l/CHRO- G-l/ CHRO E/WFLC/ll Reimbursement Agreement E 12-0ct-12

MCIEAST-MCB CAM LEJ(G-l REPORT OF LOST OR STOLEN /IDCC/5512.1/1 IDENTIFICATION CARD G-l/IDCC 12-Jul-12

MCIEAST-MCB CAM LEJ/G-l /IDCC/SS12.1/2 Signature Card G-l/IDCC 12-Jul-12

MCIEAST-MCB CAM LEJ/G-l Construction/Contractor Pass /IDCC/7 Request G-1/lDCC 12-Jul-12

MCIEAST-MCB CAM LEJ/G-l /JRC/SOOO.S/1.3 Red Cross Message Worksheet G-l/JRC 12-Jul-12

MCIEAST-MCB CAM LEJ/G-l Non-Funded Temporary Additional /PERS/1320.9/1 Duty Request G-l/PERS 12-Aug-12

MCIEAST-MCB CAM LEJ/G-l Leave Extension Authorization /PERS/SOO5.5/5 Form G-l/PERS 12-Aug-12



11 OCT 2012 -----CHECKLIST OF CURRENT MCIEAST-MCB CAMLEJ FORMS IDENTIFIER TITLE SPONSOR DATE

MCIEAST-MCB CAM LEJ/G-l /PERS/5005.5/6 Desertion Form G-l/PERS l2-Aug-12

MCIEAST-MCB CAM LEJ/G-l /PERS/1320 .12/7 Youth Sponsorship Request Form G-l/PERS l2-Aug-12

MCIEAST-MCB CAM LEJ/G-l /PERS/1320.12/8 Sponsorship Request Form G-l/PERS 12-Aug-12

MCIEAST-MCB CAM LEJ/G-1 Retiree Appreciation Day/Luncheon /RAO/l After Action Report G-1/RAO 12-Aug-12

MCIEAST-MCB CAM LEJ/G-l Individual Augmentation After /IA/1OO1.2/1 Action Questionaire G-1/IA 12-Jul-12

MCIEAST-MCB CAM LEJ/G-l Individual Augmentation /IA/1001.2/2 Eligibility Checklist G-l/IA 12-Jui-12

MCIEAST-MCB CAM LEJ/G-l MCIEAST-MCB CAMLEJ AAU /AAU/5040.5/l DISCREPANCY NOTICE G-l/RLO 12-Jul-12

MCIEAST-MCB CAM LEJ/G-l MCIEAST-MCB CAMLEJ Reserve Order /RLO/I00L 1/1 Request G-l/RLO 12-Aug-12

MCIEAST-MCB CAM LEJ/G-1 MCIEAST-MCB CAMLEJ IMA Unit /RLO/1OO1.l/2 Muster Sheet G-l/RLO 12-Aug-12

GIS Authorization Access Request MCIEAST-MCB CAMLEJ/G-F /GEO/1 (GAAR) G-F/GEO 1-Oct-12

Web-Enabled Map Services Access MCIEAST-MCB CAMLEJ/G-F /GEO/2 Request Form G-F/GEO l-Oct-12

MCIEAST-MCB CAMLEJ IG&S Map MCIEAST-MCB CAMLEJ/G-F /GEO/3 Request G-F/GEO 1-Oct-12

MCIEAST-MCB CAMLEJ/G-F AFFADAVIT In Support of Request /BHD/P1IOO12.3/l for BAH G-F/BHD 1-Oct-12

MCIEAST-MCB CAMLEJ/G-F/ BHD/2 Bachelor Housing Voucher G-F/BHD 1-Oct-12

MCIEAST-MCB CAMLEJ/G-F/ EMD/1 MSDS Add Form G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F/ Request for Environmental Impact EMD/5090 .12/3 Data Review G-F/EMD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F/ Field Exercise Request for EMD/s090.12/4 Environmental Impact Review G-F/EMD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F/ EMD/s090 .115/7 Hunting Pass (RESTRICTED) G-F/EMD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F/ GSRA & OLF, Oak Grove Security EMD/s090 .115/8 and Key Agreement (SAMPLE) G-F/EMD 1-0ct-12

Waiver of Liability and MCIEAST-MCB CAMLE,J/G-F/ Assumption of Risk Assessment EMD/5090 .115/9 (SAMPLE) G-F/EMD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F/ Certificate of Understanding EMD/5090 .115/10 (Sample) G-F/EMD 1-0ct-12

Page 5

Enclosure (1)


U9P 2012 CHECKLIST OF CURRENT MCIEAST-MCB CAMLEJ FORMS


MCIEAST-MCB CAMLEJ/G-F/ Certificate of Release of the EMD/5090 .115/11 Government (SAMPLE) G-F/EMD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F/ EMD/5090.91/12 Pollution Abatement Form G-F/EMD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F /EMD/13 EMD-Label Request/Shelf Life G-F/EMD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F /EMD/14 EMD - Work Request G-F/EMD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F /EMD/15 EMD-Incidental Fuel Request G-F/EMD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F EMD-Hazardous Material/Waste Turn-/EMD/16 In Request G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F /EMD/17 EMD-AHML Approval Request G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F /EMD/18 EMD-Unit Level Spill Form G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F /EMD/24 Earth Day Registration Form G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F Daily Above Ground Storage Tank /EMD/S090.91/25 Inspection Log G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F /EMD/5090.9/26 Monthly ECO Checklist G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F /EMD/S090.9/27 ECO Record Of Training G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F Medical Waste Storage Tank Turn-/EMD/S090.9/28 In Log G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F /EMD/5090.9/29 Quarterly ECC Checklist G-F/EMD NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-F /FHD/3 Housing Referal Service G-F/FHD 1-0ct-12

MCIEAST-MCB CAMLEJ/G-F /FHD/6 Sales/Rental Listings G-F/FHD 1-Oct-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 -.---


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

MCIEAST-MCB CAMLEJ/G-4/HQ/l G-4 INTERNAL ROUTE SHEET G-4/HQ 27-Jun-12

MCIEAST-MCB CAMLEJ/G-4/HQ/3 MCIEAST Plans and Accomplishments G-4/HQ 27-Jun-12

MCIEAST-MCB CAMLEJ/G-4/ BMT/l Motor Transport Vehicle Request G-4/BMT 27-Jun-12

Motor Transport Vehicle Safety MCIEAST-MCB CAMLEJ/G-4/ BMT/2 Inspection Checklist G-4/BMT 27-Jun-12

MCIEAST-MCB CAMLEJ/G-4/ BMT/4 Condition Inspection Checklist G-4/BMT 27-Jun-12

MCIEAST-MCB CAMLEJ/G-4/ BMT/7 Fork Maintenance Inspection Form G-4/BMT 27-Jun-12

Vehicle Assignment and MCIEAST-MCB CAMLEJ/G-4/ BMT/9 Termination G-4/BMT 27-Jun-12

MCIEAST-MCB CAMLEJ/G-4/ Notice of Ammunition/Explosives G-4/ SAFETY/2 Safety Violation Discrepancy SAFETY 27-Apr-11

MCIEAST-MCB CAMLEJ/G-4/ MCB Fuel Farm Vehicle Operator G-4/ SUPPLY/4 Checklist SAFETY 27-Jun<-12

MCIEAST-MCB CAMLEJ/G-3 5 -/HQ/1 G-3 5 Route Sheet G-3 5/HQ 17-Jul-12

MCIEAST-MCB CAMLEJ/G-3 5 -/CBC/5750 .1/1 Oral History Release Form G-3 5/CBC 1-Jul-12

MCIEAST-MCB CAMLEJ/G-3 5/ 0--

P/3440.5/1 BSI Installation Worksheet G-3 5/0&P 1-Jul-12

MCIEAST-MCB CAMLEJ/G-3 5 Range Control Safety Card (2 -/RCD/l sided) (RESTRICTED) G-3 5/RCD 1-Jul-12

MCIEAST-MCB CAMLEJ/G-3 - 5 Waiver of Liability and /RCD/3570 .112 Assumption Risk Management G-3 5/RCD I-Jul-12

MCIEAST-MCB CAMLEJ/G-3 5 -/RCD/3 Range Check-Out/Signature Sheet G-3 5/RCD 1-Jul-12

MCIEAST-MCB CAMLEJ/G-3 5 Range Modification and -/RCD/7 Cancellation Request Form G-3 5/RCD l-Jul-12

MCIEAST-MCB CAMLEJ/G-3 5 -

/TSD/l Simulator Reservation Form G-3 5/TSD 1-Jul-12

MCIEAST-MCB CAMLEJ/G-3 5 Mobile Aircraft Firefighting G-3 5/ APP - -

/APPI3710.6/1 Training Device Action Form ATC I-Jul-12

Page 7

Enclosure (1)

MCIEAST-MCB CAMLEJBul 5213 J 7 OCT 201~ I!i'o._--'-


Mobile Aircraft Firefighting MCIEAST-MCB CAMLEJ/G-3 5 Training Device Monthly Usage G-3 5/ APP - -/APP/3710.6/2 Report ATC I-Jul-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3 5/ APP - -ATC/3722.3/4 ATC Order Change Request ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP Standardized Monthly Training G-3 5/ APP - -ATC/3722.3/5 ReportlQuarterly Situation Report ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 lAPP Standardized Monthly Training G-3 51 APP -ATC/3722.3/6 Situation Report ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 lAPP Quarterly MCIEAST Situation G-3 51 APP _. -ATC/3722.3/7 Report for Quarter ATC NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-3 5 lAPP MCIEAST Training Evaluation G-3 5/ APP -ATC/3722.3/8 Report-5 day Evaluation ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 lAPP MCIEAST Training Evaluation G-3 51 APP - -ATC/3722.3/9 Report-l day Evaluation ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 lAPP G-3 5/ APP - -ATC/3722.3/10 Record Of Audit ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3 5/ APP - -ATC/3722.3/11 Formal Training History ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 lAPP G-3 51 APP -ATC/3722.3/12 Facility position Qualification ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3_51 APP -ATC/3722.3/13 Equipment Certification ATC l-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3 51 APP - -

ATC/3722.3/14 History of Designations ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3 51 APP - -ATC/3722.3/15 Annual position Evaluation ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3 5/ APP - -ATC/3722 .. 3/16 Deferred T&R Syllabus ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3 51 APP -

ATC/3722.3/l7 Annual Proficiency Training ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3_5/ APP -ATC/3722.3/18 Record of Deployment ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 lAPP G-3 51 APP - -ATC/3722.3/19 NATOPS Evaluation Checklist ATC NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-3 5 /APP MCIEAST ATC Order Procedure G-3 51 APP - -ATC/3722.3/20 Tracking Record ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 lAPP Precision Approach Radar (GCAI G-3 5/ APP· - -ATC/3722.3/22 Data ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3 51 APP - -ATC/3722.3/23 MCIEAST ATC Hazard/Mishap Report ATC I-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP Flight Demo/Static After Action G-3 5/ APP - -

ATC/3710 .1/24 Report Encl (1 I ATC I-May-12

Page 8

Enclosure (II


l1 OCT 2012 CHECKLIST OF CURRENT MCIEAST-MCB CAMLEJ FORMS


MCIEAST-MCB CAMLEJ/G-3 5 /APP Quarterly Expenditure Report Enel G-3_5/ APP -ATC/3710.1/25 (3 ) ATC NOT COMPLETE

MCIEAST-MCB CAMLEJ/G-3 5 /APP MCIEAST Aviation Flash Report G-3 5/ APP -ATC/3710 .1/26 Encl (4 ) ATC 1-May-12

MCIEAST-MCB CAMLEJ/G-3 5 /APP G-3 5/ APP - -

ATC/3710 .1/27 A&E Certification Format Encl (7 ) ATC 1-May-12

MCIEAST-MCB CAMLEJ/G-6/HQ/l G-6 INTERNAL ROUTE SHEET G-6/HQ 1-Jul-12

MCIEAST-MCB CAMLEJ/G-6/HQ/2 MCIEAST Plans and Accomplishments G-6/HQ 1-Jul-12

MCIEAST-MCB CAMLEJ/G-6/HQ/3 IT Waiver Request G-6/HQ 15-0ct-12

Communications Electronics MCIEAST-MCB CAMLEJ/G-6/ COM/l Support G-6/COM 1-Jul-12

MCIEAST-MCB CAMLEJ/S-6/ TELECOM/l Telecommunication Service Request G-6/TELCOM 1-Apr-12

MCIEAST-MCB CAMLEJ/ Hearing Conservation Application NAVHOSP/OHPMU/6260.4/1 (SAMPLE) NAVHOSP l-Aug-12

MCIEAST-MCB CAMLEJ/ Occupational Exposure Registry NAVHOSP/OHPMU/6260.4/3 (OER) Requirements (SAMPLE) NAVHOSP 1-Aug-12

MCIEAST-MCB CAMLEJ/ Request for Onsite Audio Testing NAVHOSP/OHPMU/6260.4/4 (SAMPLE) NAVHOSP l-Aug-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


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>=--


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

HQSPTBN Check-In/Check-Out Sheet MCBCL/HQSPTBN/HQ/l (RESTRICTED) HQSPTBN 9-Jul-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)


JJ. OCT 2012 CHECKLIST OF CURRENT MCB CAMLEJ FORMS


MCBCL/I&E/BHD/2 Bachelor Housing Voucher G-F ll-Mar-12 MCBCL/I&E/EMD/11015.8E/1 Certificate of Release G-F ll-Mar-12

Request for Environmental Impact MCBCL/I&E/EMD/5090.12/3 Data Review G-F ll-Mar-12

Field Exercise Request for MCBCL/I&E/EMD/5090.12/4 Environmental Impact Review G-F ll-Mar-12 MCBCL/I&E/FHD/III01.31/36 Privacy Act Release Form G-F lO-Mar-12

MCBCL/MCCS/HQ/3 Cash Controls for Petty Cash Fund MCCS 9-Jan-12 MCBCL/MCCS/HQ/4 Cash Controls for Change Fund MCCS 9-Feb-12 MCBCL/MCCS/HQ/5 Cash Verification Form MCCS 9-Feb-12 MCBCL/MCCS/HQ/7 Inventory Cover Sheet MCCS 9-Feb-12

MCBCL/MCCS/HQ/8 Marine Corps Exchange Inventory MCCS 9-Feb-12 MCBCL/MCCS/HQ/IO Maintenance Work Request MCCS 9-Feb-12

Orders and Bulletins Signature MCBCL/MCCS/HQ/ll Receipt MCCS 9-Feb-12 MCBCL/MCCS/HQ/23 Request for MCCS TAD Orders MCCS 8-Nov-12 MCBCL/MCCS/HQ/31 Special Request for Checks MCCS 8-Sep-12 MCBCL/MCCS/HQ/33 Facsimile Transmittal MCCS 9-Feb-12

Tuition Assistance Application MCBCL/MCCS/EDU/P1560.11/1 Form MCCS lO-Nov-12 MCBCL/MCCS/HR/2 Trip Report Format MCCS 8 Oct-12

MCBCL/MCCS/CDS/5 Notification of Child's Illness MCCS 8-Sep-12 MCBCL/MCCS/CDS/7 Infant Daily Activity Schedule MCCS 9 Jan 12

Data Call for Food & Hospitality MCBCL/MCCS/FDHP/1 Division MCCS 8-Sep-12

Special Events Vendor MCBCL/MCCS/FDHP/9 Certification of Gross Sales MCCS 8-Sep-12

MCBCL/MCCS/FDHP/10 Request For Sanitation Inspection MCCS 8-Aug-12

Recommendation for Time Off MCBCL/MCCS/MMCX/2 Incentive Award MCCS 8-Jun-12

MCBCL/MCCS/MMCX/5 Uniform Alteration Authorization MCCS 8-Jul-12 MCBCL/MCCS/MMCX/9 MCCS Goals and Objectives MCCS 8-Sep-12

Camp Lejeune Youth Sports MCBCL/MCCS/SPORT/l Registration Form MCCS ll-Jan-12

Youth Sports Uniform & Equipment MCBCL/MCCS/SPORT/3 Issue Record MCCS 8-Aug-12 MCBCL/MCCS/SPORT/4 Special Request Form MCCS 8 Jun 12

Youth Sports Application for MCBCL/MCCS/SPORT/6 Volunteers MCCS lO-Oct-12

Page 12

Enclosure (1)

MCIEAST-MCB CAMLEJBul 5213 17 OCT 2012 ~""'~.-----


MCBCL/MCCS/SPORT/16 Youth Sports Participant Survey MCCS 8-Jun-12

MCBCL/MCCS/SPORT/17 Resale Lot Authorization MCCS 8-Jul-12

MCBCL/MCCS/FACM/l Building Inspection Checklist MCCS 8-Jun-12

Vehicle Maintenance Inspection MCBCL/MCCS/FACM/2 Form MCCS 9-Jul-12

Semper Fit Personal Training MCBCL/MCCS/SFFB/1 Medical Release Form MCCS 8-Jun-12

Court House Bay Climbing Wall MCBCL/MCCS/SFFB/2 Acknowledgement Lt MCCS 8-Jun-12

Safety, Policy, and Procedures MCBCL/MCCS/SFFB/3 for the Climbing Wall MCCS 8-Jun-12

MCBCL/MCCS/SFFB/20 SACO Sample Needs Assessment MCCS 8-Jul 12

MCBCL/MCCS/SFFB/2l Semper Teen Program Application MCCS 9-Feb-12

MCBCL/WTBN/l Training Area Request Form WTBN NOT COMPLETE

MCBCL/WTBN/2 Fax Cover Sheet WTBN NOT COMPLETE

MCBCL/WTBN/3 WTBN Route Sheet WTBN NOT COMPLETE

WTBN Check In/out sheet MCBCL/WTBN/4 (RESTRICTED) WTBN NOT COMPLETE

MCBCL/WTBN/5 WTBN Line Card (RESTRICTED) WTBN NOT COMPLETE

MCBCL/WTBN/6 WTBN Pit Card (RESTRICTED) WTBN NOT COMPLETE

WTBN Score Card, 1'able Two MCBCL/WTBN/7 (RESTRICTED) WTBN NOT COMPLETE

CHECKLIST OF CURRENT MCIEAST FORMS

Special Recognition Board Privacy MCIEAST/HQ/1400.2/l Act Release Statement CG HQ 9-Aug-12

MCIEAST/HQ/2 Conference Facility Request CG HQ 8 Jul-12

MCIEAST/HQ/1400.2/5 MCIEAST Board Data Sheet (SNCO) CG HQ lO-Aug-12

Distinguished Guest Quarters MCIEAST/HQ/6 Request CG HQ lO-Jun-12

Seatbelt Acknowledgement MCIEAST/SAFETY/5l00.2/2 Statement SAFETY ll-Jun-12

MCIEAST/SES!1 MCIEAST Risk Assessment Worksheet SES lO-Sep-12

Checklist for Non-Federal Entities and Informal Fund

MCIEAST/SJA/2 Activities SJA ll-Jul-12

Interview of Private MCIEAST / SJA/3 Organizations SJA ll-Jul-12

Request for Non-Appropriated MCIEAST/MCCS/HQ/1700.3/1 Funds MCCS lO-Oct-12

Page 13

Enclosure (1)


JlQCT 2012 CHECKLIST OF CANCELLED MCa CAMLEJ FORMS

IDENTIFIER TITLE SPONSOR

MCBCL/ISS/PMO/2 Limited Power of Attorney SES

MCBCL/ISS/PMO/5 Student Pass Request SES

MCBCL/DPS/PMO/5560/7 Construction/Contractor Pass Request SES

MCBCL/DPS/PMO/5560/l0 Third Party Traffic Citation SES

MCBCL/DPS/PMO/13 Decontamination and Recovery Procedures SES

MCBCL/DPS/PMO/16 Domestic Violence Supplemental Report SES

MCBCL/ISS/PMO/19 Vehicle Lockout Release of Liability SES

MCBCL/DPS/PMO/11320/25 Dispatcher SES

MCBCL/ISS/PMO/12290/27 Personnel History Card SES

MCBCL/DPS/PMO/28 Official Visitors Pass SES

MCBCL/DPS/PMO/29 Contractor Pass SES

MCBCL/DPS/PMO//30 Special Event Pass/Special Guest SES

MCBCL/DPS/PMO/31 House Guest SES

MCBCL/DPS/PMO/32 Special Security SES

MCBCL/DPS/PMO/12290/33 Memorial Service SES

MCBCL/DPS/PMO/35 Procurement Request Document SES

MCBCL/DPS/PMO/38 Special Power of Attorney SES

MCBCL/DPS/PMO/5560.3/49 Wrecker Service Pass SES

MCBCL/DPS/PMO/52 Curfew Violation Notice SES

MCBCL/ISS/SFTY/P5102.lA/6 Flash Mishap Report SES

MCBCL/DPS/SFTY/7 Building Inspection Checklist SES

MCBCL/DPS/SFTY/5104.l/l5 RAM Posting Notice SES

MCBCL/DPS/SFTY/5100.2/16 Safety Belt Usage Report SES

(DD-5100-03) SES

MCBCL/ISS/FIRE/2 Patient Discharge Instructions SES

MCBCL/ISS/FIRE/3 Naval EMS Call Report SES

MCBCL/ISS/FIRE/4 Patient Refusal of Services SES

MCBCL/HQSPTBN/ALPHA/l HQSPTBN Check-In/Check-Out Sheet HQSPTBN

MCBCL/HQSPTBN/ALPHA/2 BEQ Check-In Roster HQSPTBN

MCBCL/HQSPTBN/ADJ/P1040/7 Career Retention Specialist HQSPTBN

MCBCL/HQSPTBN/ADJ/8 lMA Muster Sheet HQSPTBN

MCBCL/HQSPTBN/ADJ/9 Meritorious Promotion Fact Sheet HQSPTBN

MCBCL/HQSPTBN/CHAP/7010.18/ 2 Religious Offering Fund Receipt Form HQSPTBN

MCBCL/HQSPTBN/S-1/l HQSPTBN, MCB Check in Check Out Sheet HQSPTBN

MCBCL/HQSPTBN/S-l/3 PCS/PCA HQSPTBN MCB Check-In Sheet HQSPTBN

MCBCL/HQSPTBN/S-1/4 PCS/PCA HQSPTBN MCB Check-Out Sheet HQSPTBN

Page 1

Enclosure (2)

MCIEAST-MCB CAMLEJBul 5213 .u OCT 2012 CHECKLIST OF CANCELLED MCB CAMLEJ FORMS

IDENTIFIER TITLE SPONSOR

MCBCL/IIQSPTBN/S-l/5 FAP/TAD/FR TAD HQSPTBN MCB Check-In Sheet HQSPTBN

MCBCL/HQSPTBN/HQ/2 Recall Information Sheet HQSPTBN

MCBCL/HQSPTBN/S-3/l HQ Company Leave and Liberty Plan HQSPTBN

MCBCL/HQSPTBN/S-3/6 Marine Combat Instructor of Water Survival HQSPTBN

MCBCL/HQSPTBN/ADJ/IO Training Roster HQSPTBN

MCBCL/MCCS/IIQ/l State of North Carolina Affidavit MCCS

Affiant's State of North Carolina MCBCL/MCCS/HQ/2 Affidavit MCCS

MCBCL/MCCS/HQ/6 Certificate of Disposition MCCS

MCBCL/MCCS/HQ/9 Return of Damaged Merchandise MCCS

MCBCL/MCCS/HQ/12 Review and Analysis Weekly Report MCCS

MCBCL/MCCS/HQ/126l0.2A/14 Overtime/Compensatory Time Authorization MCCS

MCBCL/MCCS/HQ/15 Survey Check List MCCS

MCBCL/MCCS/HQ/16 Requisition & Issue MCCS

Report of Resale Goods and Supplies MCBCL/MCCS/HQ/17 Received on Transfer MCCS

Report of Resale Goods and Supplies MCBCL/MCCS/HQ/18 Transferred MCCS

Report of Direct Delivery Goods Received MCBCL/MCCS/HQ/19 and Returned MCCS

Report of Goods Received/Returned by MCBCL/MCCS/HQ/20 Warehouse MCCS

MCBCL/MCCS/HQ/21 Local MCCS Goals and Objectives MCCS

MCBCL/MCCS/HQ/22 MCCS Course Application MCCS

MCBCL/MCCS/HQ/24 Dependent's Aide Association MCCS

MCBCL/MCCS/HQ/25 Employee Deficiencies/Counseling Record MCCS

MCBCL/MCCS/HQ/26 Background Request Form MCCS

MCBCL/MCCS/HQ/28 MCCS Patron Survey MCCS

MCBCL/MCCS/HQ/29 Hold Harmless Agreement MCCS

MCBCL/MCCS/HQ/1050.6M/30 Vehicle Maintenance Inspection Form MCCS

MCBCL/MCCS/HQ/32 Proof of Loss MCCS

Camp Lejeune Non-Appropriated Fund MCBCL/MCCS/HQ/34 Application For Employment MCCS

MCBCL/MCCS/CDS/P1754.2/1 Child's Medical Enrollment Form MCCS

MCBCL/MCCS/CDS/P1754.2/2 Daily Attendance Record MCCS

MCBCL/MCCS/CDS/P1754.2/3 CDC Daily Inspection Guide MCCS

Page 2

Enclosure (2)

MCIEAST-MCB CAMLEJBul 5213 U OCT 2012

CHECKLIST OF CANCELLED MCB CAMLEJ FORMS IDENTIFIER TITLE SPONSOR

MCBCL/MCCS/CDS/P1754.2/4 Incident Accident Report MCCS

MCBCL/MCCS/CDS/p1754.2/6 Hold Harmless Agreement MCCS

MCBCL/MCCS/CDS/P1754.2/8 Internal Child Abuse Report MCCS

MCBCL/MCCS/CDS/P1754.2/l0 Inspection Form MCCS

MCBCL/MCCS/CDS/P1754.2/11 Letter of Request for Family Home Day Care MCCS

MCBCL/MCCS/CDS/P1754.2/12 FDCH Food Program Menu Form MCCS

MCBCL/MCCS/CDS/P1754.2/13 CL Infant Meal Pattern Menu MCCS

MCBCL/MCCS/CDS/P1754.2/14 FDCH Attendance Record MCCS

Required Participation Record Child Care MCBCL/MCCS/CDS/P1754.2/15 Food Program MCCS

MCBCL/MCCS/FDHP/2 NAF Bankcard Purchase Control Log MCCS

MCBCL/MCGS/FDHP/3 Merchandise/Property Survey Board MCCS

MCBCL/MCCS/FDHP/4 Daily Report of Sales MCCS

MCBCL/MCCS/FDHP/5 Daily Report of Additional Centers MCCS

MCBCL/MCCS/FDHP/6 Cash Shortage/Overage Discrepancy MCCS

MCBCL/MCCS/FDHP/7 MCCS Fax Cover Sheet MCCS

MCBCL/MCCS/FDHP/8 Daily Cash Register Reading Report MCCS

MCBCL/MCCS/FDHP/5100/11 MCCS Fax Cover Sheet MCCS

MCBCL/MCCS/FDHP/12 FDHP Facsimile Transmittal MCCS

MCBCL/MCCS/FDHP/5102/13 Incident Report MCCS

MCBCL/NCCS/FDHP /14 Prepaid R&I MCCS

MCBCL/MCCS/FDHP/15 Proof of Loss MCCS

MCBCL/MCCS/FOOD/I01I0.1B/l Subsistence Inventory MCCS

MCBCL/MCCS/FOOD/101I0.1B/2 Daily Cost Analysis MCCS

MCBCL/MCCS/FOOD/1OI1O.IB/3 Special Meal Request MCCS

MCBCL/MCCS/FOOD/4061/4 Dining Facility Cashier MCCS

MCBCL/MCCS/FOOD/406l-2/5 Dining Facility Personnel Listing MCCS

MCBCL/MCCS/MKTG/l MCCS Marketing Request Form MCCS

MCBCL/MCCS/MKTG/2 Publicity/Advertising Form MCCS

MCBCL/MCCS/MMCX/l Resale Lot Authorization/Registration MCCS

MCBCL/MCCS/MMCX/3 Special Request for Checks MCCS

MCBCL/MCCS/MMCX/126l0.2/4 Compensatory Time Used MCCS

MCBCL/MCCS/MMCX/6 Merchandise/Property Survey Record MCCS


MCIEAST-MCB CAMLEJBul 5213 Jl OCT 20,.

CHECKLIST OF CANCELLED MCa CAMLEJ FORMS • IDENTIFIER TITLE SPONSOR

MCBCL/MCCS/MMCX/7 Control Report of Retail Value Goods MCCS

MCBCL/MCCS/MMCX/8 General Ledger Price Change Voucher MCCS

MCBCL/MCCS/RECR/l Onslow Beach Facsimile Transmittal Sheet MCCS

MCBCL/MCCS/RECR/2 Beach House Reservation Form MCCS

TT Fitness Center Playroom Service Initial MCBCL/MCCS/SFFB/4 Sheet MCCS

MCBCL/MCCS/SFFB/5 TT Waiver of Liability and Risk MCCS

MCBCL/MCCS/SFFB/6 TT Child Data Sheet MCCS

French Creek Agreement & Liability Form MCBCL/MCCS/SFFB/7 for Participation MCCS

Medical Referral Source Return to MCBCL/MCCS/SFFB/8 Readiness Referral Form MCCS

MCBCL/MCCS/SFFB/9 Semper Fit Return to Readiness Form MCCS

MCBCL/MCCS/SFFB/IO Return to Readiness Health Risk Screening MCCS

Semper Fit Return to Readiness Exercise MCBCL/MCCS/SFFB/ll Test MCCS

Semper Fit Return to Readiness Injury MCBCL/MCCS/SFFB/12 Evaluation MCCS

MCBCL/MCCS/SFFB/13 physical Exam MCCS

Semper Fit Return to Readiness Testing and MCBCL/MCCS/SFFB/14 Exercise Recommendations MCCS

Return to Readiness Discharge MCBCL/MCCS/SFFB/15 Questionnaire MCCS

MCBCL/MCCS/SFFB/16 Return to Readiness Client Appointments MCCS

Return to Readiness Flow Sheet Monthly MCBCL/MCCS/SFFB/17 Totals MCCS

MCBCL/MCCS/SFFB/P1700.24/22 Drug Testing Program Testing Register MCCS

Camp Lejeune Youth Sports Parent I s Code of MCBCL/MCCS/SPORT/2 Ethics MCCS

MCBCL/MCCS/SPORT/5 Request for Background Check MCCS

MCBCL/MCCS/SPORT/7 Volunteer Agreement MCCS

MCBCL/MCCS/SPORT/8 Team Management Form MCCS

MCBCL/MCCS/SPORT/9 Application for Trial and Training Event MCCS

MCBCL/MCCS/SPORT/IO Affidavit and Certifications MCCS

MCBCL/MCCS/SPORT/ll Liability Agreement and Release MCCS

East Coast Regional Golf Championship MCBCL/MCCS/SPORT/12 Entry Form MCCS

MCBCL/MCCS/SPORT/13 Equipment Issue MCCS

Page 4

Enclosure (2)

MCIEAST-MCB CAMLEJBul 5213 Jl OCT 2012

CHECKLIST OF CANCELLED MCB CAMLEJ FORMS IDENTIFIER TITLE SPONSOR

USA Boxing Championships Official Non-MCBCL/MCCS/SPORT/14 Athlete Entry Form MCCS

MCBCL/MCCS/SPORT/15 USA Boxing Consent/Release Form MCCS

Unit Letter Requesting Military Clothing MCBCL/MCCS/MMCX/I0120.6/10 Support MCCS

Individual Military Clothing Support Block MCBCL/MCCS/MMCX/I0120.6/ll Allowance/ Memorandum Receipt Listing MCCS

MCBCL/MCCS/MMCX/I0120.6/12 Monetary Ledger for Accounting Purposes MCCS

MCBCL/MCCS/MMCX/I0120.6/13 Daily Disbursing Cash Turn-in Receipt MCCS

MCBCL/MCCS/HR/l Reassignment Request MCCS

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

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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


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

MCBCL/WfBN/8 WTBN S-I Check·in Checklist (RESTRICTED) WTBN

MCBCL/WfBN/9 WTBN S-I Check out Checklist (RESTRICTED) WTBN

MCBCL/WfBN/IO WTBN S-l EAS Personnel Checldist (RESTRICTED) WTBN

MCBCL/WfBN/ll WTBN 5-1 TAO{fravelfVoucher Binder checklist WTBN

MCBCL.WTBN/12 WTBN S-I NIP/UPB Checklist WTBN

CHECKLIST OF CANCELLED MCIEAST FORMS

MCIEAST/HQ/3 MCIEAST Board Data Sheet(Marine) CG HQ

MCIEAST/HQ/4 MCIEAST Board Data Sheet (Navy) CG HQ

Addendum to Housing Application MCIEAST/SJA/11103.1/1 Form DD 1746 SJA

Page 7

Enclosure (2)

Documents

G-l/ADJ (b) MCO 5600