Forms: Treasury Board of Canada Secretariat
Access to Information and Privacy
- Access to Information Request Form
(TBC/CTC 350-57) - Personal Information Request Form
(TBC/CTC 350-58) - Consent for a Personal Information Request Form
(TBC/CTC 350-60E) - Authorizing a Personal Information Request to be Made on Your Behalf Form
(TBC/CTC 350-55E) - Access to Information Tracking Document
(TBC/CTC 350-59) - Record Correction Request Form
(TBS/SCT 350-11) - Report on the Access to Information Act
(TBS/SCT 350-62) - Report on the Privacy Act
(TBS/SCT 350-63)
Claim expenses, financial losses and damages caused by Phoenix
- Claim out-of-pocket expenses
If you incurred expenses such as interest charges or late fees because of Phoenix, you can submit a claim. - Claims for impacts on income taxes and government benefits
If you were owed salary from one year that was only paid the following year, you might pay too much income tax or receive reduced government benefits and credits, such as the Canada child benefit. - Request an advance for government benefits
If your government benefits, such as the Canada child benefit, or other credits were reduced because you were overpaid by Phoenix, you can request an advance to help you during this time. - Reimbursement for tax advice
Find out if you are eligible for reimbursement of expenses related to tax advice. - Claim compensation for severe impacts
If you experienced severe personal or financial hardships, such as financial costs, lost investment income, or impacts to your career or well-being, you can submit a claim. - Claim general compensation for damages related to Phoenix
Former employees can claim financial compensation equivalent to leave through the 2019 Phoenix pay system damages agreement.
Disability Insurance
The Disability Insurance Plan claim forms below can be found on the Sun Life DI webpage: www.sunlife.ca/DI.
- Employee’s Statement (490L-M-12500-E)
- Attending Physician’s Questionnaire (490L-P-12500-GEN-E, 490L-P-12500-MHC-E, or 490L-P-12500-MSK-E)
- Employer’s Statement (Immediate Supervisor or Manager)(4841-E)
- Employer’s Statement (Compensation Advisor)(4811-E)
Leave
- Application for Leave with Income Averaging
(TBS/SCT 325-10) - Application for Pre-retirement Transition Leave
(TBS/SCT 325-9)
Dental Care
- Public Service Dental Care Plan - Claim form
(The Canada Life Assurance Company) - Public Service Dental Care Plan - Authorization for Claims Submission and Redirection of Payment
(The Canada Life Assurance Company)
Pensioners’ Dental Services Plan
Some PDSP forms were made obsolete as of . For more information on PDSP enrolment and eligibility, see the PDSP menu.
Public Service Health Care Plan
- PSHCP Claim Form (PDF Document – 614 KB)
(Public Service Health Care Administration Authority Web Site) - PSHCP Claim Form-Out-of-Country claims (Comprehensive Coverage) (PDF Document – 655 KB)
(Public Service Health Care Administration Authority Web Site)
Public Service Management Insurance Plan
The claim forms for the Public Service Management Insurance Plan (PSMIP) can be found below:
- Claim Forms for Long-Term Disability:
- Employee’s Statement (F54-1011A-57)
- Attending Physician’s Questionnaire (F54-1014A-57 for a mental health condition), or (F54-1015A-57 for a musculoskeletal condition), or (F54-1016A-57 for all other medical conditions)
- Employer’s Statement (F54-1012A-57 immediate supervisor or manager)
- Employer’s Statement (F54-1013A-57 departmental compensation/Human Resources advisor)
- Claim Form for Accidental Dismemberment Benefit
(TBS/SCT 5954, 5955) - Claim Form for Death Benefit
(TBS/SCT 5948, 5949)
Security
Security in Contracting
- Security Requirements Check List (SRCL)
(TBS/SCT 350-103) (Rev 2004/12)
Security Screening
- Security Screening Application and Consent Form
- Security Screening Certificate and Briefing Form
(TBS/SCT 330-47) - Notification of Change in Security Clearance
(CSIS/SCRS 4160e) (Canadian Security Intelligence Service Web Site) - Personnel Screening, Consent and Authorization Form Archived
(TBS/SCT 330-23e) - Security Clearance Form Archived
(TBS/SCT 330-60e)
TB Submission
- Treasury Board Submission
(TBC 300-1) - Specimen Signature
(GC 136)
Labour Relations
- Bargaining Agent Identification - Notice of Change
(TBS/SCT 340-51) - Employee Consent to Provide Personal Information to Bargaining Agents
(TBS/SCT 340-51a) - Grievance Transmittal Form
(TBS/SCT 340-54) - Managerial or Confidential Position
(TBS/SCT 340-10) - Group Grievance Presentation (PSLRA s. 215)
(TBS/SCT 340-56) - Individual Grievance Presentation (PSLRA s. 208)
(TBS/SCT 340-55) - Policy Grievance Presentation (PSLRA s. 220)
(TBS/SCT 340-53)
Miscellaneous
- Application for the Refund of Union Dues
(TBS/SCT 340-50) - Objection on Grounds of Conscience to Dues Check-off
(TBS/SCT 340-52)