kytc forms registry - kentucky transportation cabinet · kytc forms registry jul 16, ... tc 12-211...

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KYTC Forms Registry Jul 16, 2018 Number Title Revision Date Format Website TC 10-001 Project Authorization 08/1995 Paper None TC 10-420 Adopt-a-Highway Agreement 10/2010 Word SP-External TC 11-018 Title Report 06/2014 Word SP-Internal TC 11-200 Case Log 05/2010 Word SP-Internal TC 11-202 Cost Breakdown of Repairs to State Property 04/2015 Excel SP-Internal TC 11-205 Request to Inspect Public Records 05/2007 Word SP-External TC 11-208 Claim Resulting from Motor Vehicle Accident 05/2011 Word SP-External TC 11-209 Waiver & Release for Ride-Along in KYTC Vehicles & Equipment 02/2017 Word SP-Internal TC 12-001 Application for Leave 12/2014 Word SP-Internal TC 12-002 Request for Personnel Action 04/2012 Word SP-Internal TC 12-008 Local Occupational Tax Withholding Information 03/2012 Word SP-Internal TC 12-018 Request to Review Personnel File 01/2014 Word SP-Internal TC 12-023 Reasonable Suspicion Checklist 03/2015 Word SP-Internal TC 12-026 Drug or Alcohol Test Authorization 07/2014 Word SP-Internal TC 12-029 Previous Employer Information: CDL Drug or Alcohol Violations 03/2012 Word SP-Internal TC 12-030 Pre-Employment Consent 03/2012 Word SP-Internal TC 12-072 Overtime Compensation 04/2015 Word SP-Internal TC 12-081 Notification of Employee Appointment 04/2012 Word SP-Internal TC 12-201 Request for Reasonable Accommodation 04/2012 Word SP-Internal TC 12-204 Reference Check 08/2009 Word SP-Internal TC 12-206 Personalized Work Schedule Agreement 07/2015 Word SP-Internal TC 12-208 Advanced Leadership Academy Application 02/2014 Word SP-Internal TC 12-211 Manual Order Form 08/2017 Excel SP-External TC 12-214 Request for Educational Achievement Award 04/2015 Word SP-Internal TC 12-215 Review & Approval of Guidance Manual 04/2014 Word SP-Internal TC 12-222 Form Design Request 04/2014 Word SP-Internal TC 12-224 Civil Engineering Scholarship Application 10/2017 Word SP-External TC 12-227 Request for Corrective or Major Disciplinary Action 07/2014 Word SP-Internal TC 12-228 Notice of Request for Corrective Action or Major Disciplinary Action 05/2008 Word SP-Internal TC 12-230 Internal Mobility Applicants 01/2016 Word SP-External Page 1 of 22

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Page 1: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

KYTC Forms Registry Jul 16, 2018

Number Title Revision Date Format Website

TC 10-001 Project Authorization 08/1995 Paper None

TC 10-420 Adopt-a-Highway Agreement 10/2010 Word SP-External

TC 11-018 Title Report 06/2014 Word SP-Internal

TC 11-200 Case Log 05/2010 Word SP-Internal

TC 11-202 Cost Breakdown of Repairs to State Property 04/2015 Excel SP-Internal

TC 11-205 Request to Inspect Public Records 05/2007 Word SP-External

TC 11-208 Claim Resulting from Motor Vehicle Accident 05/2011 Word SP-External

TC 11-209 Waiver & Release for Ride-Along in KYTC Vehicles & Equipment

02/2017 Word SP-Internal

TC 12-001 Application for Leave 12/2014 Word SP-Internal

TC 12-002 Request for Personnel Action 04/2012 Word SP-Internal

TC 12-008 Local Occupational Tax Withholding Information 03/2012 Word SP-Internal

TC 12-018 Request to Review Personnel File 01/2014 Word SP-Internal

TC 12-023 Reasonable Suspicion Checklist 03/2015 Word SP-Internal

TC 12-026 Drug or Alcohol Test Authorization 07/2014 Word SP-Internal

TC 12-029 Previous Employer Information: CDL Drug or Alcohol Violations

03/2012 Word SP-Internal

TC 12-030 Pre-Employment Consent 03/2012 Word SP-Internal

TC 12-072 Overtime Compensation 04/2015 Word SP-Internal

TC 12-081 Notification of Employee Appointment 04/2012 Word SP-Internal

TC 12-201 Request for Reasonable Accommodation 04/2012 Word SP-Internal

TC 12-204 Reference Check 08/2009 Word SP-Internal

TC 12-206 Personalized Work Schedule Agreement 07/2015 Word SP-Internal

TC 12-208 Advanced Leadership Academy Application 02/2014 Word SP-Internal

TC 12-211 Manual Order Form 08/2017 Excel SP-External

TC 12-214 Request for Educational Achievement Award 04/2015 Word SP-Internal

TC 12-215 Review & Approval of Guidance Manual 04/2014 Word SP-Internal

TC 12-222 Form Design Request 04/2014 Word SP-Internal

TC 12-224 Civil Engineering Scholarship Application 10/2017 Word SP-External

TC 12-227 Request for Corrective or Major Disciplinary Action 07/2014 Word SP-Internal

TC 12-228 Notice of Request for Corrective Action or Major Disciplinary Action

05/2008 Word SP-Internal

TC 12-230 Internal Mobility Applicants 01/2016 Word SP-External

Page 1 of 22

Page 2: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 12-233 Screening Criteria Worksheet 03/2015 Word SP-Internal

TC 12-236 Interview Questionnaire Worksheet 02/2017 Word SP-Internal

TC 12-237 Interview Panelist Conflict of Interest Statement 10/2013 Word SP-Internal

TC 12-239 Application & Designation for Family & Medical Leave 05/2010 Word SP-Internal

TC 12-240 Request for Compensatory Time or Overtime 08/2012 Word SP-Internal

TC 12-242 External Training Request 06/2016 Word SP-Internal

TC 12-243 Internal Training Request 06/2016 Word SP-Internal

TC 12-246 Certification by Healthcare Provider for Serious Health Condition of Employee

04/2012 Word SP-Internal

TC 12-247 Certification by Healthcare Provider for Serious Health Condition of Family Member

04/2012 Word SP-Internal

TC 12-248 Certification for Serious Injury or Illness of Covered Servicemember for Military Family Leave

12/2011 Word SP-Internal

TC 12-249 Certification of Qualifying Exigency for Military Family Leave

05/2010 Word SP-Internal

TC 12-251 Employee Authorization for Disclosure of Protected Health Information to Employer

05/2010 Word SP-Internal

TC 12-252 Payroll Authorization for Cancellation of Voluntary Payroll Deductions

03/2012 Word SP-Internal

TC 12-253 Position Demands Statement 08/2010 Word SP-Internal

TC 12-254 Payroll or Leave Reporting Change 04/2013 Word SP-Internal

TC 12-258 Employee Use of Permanently Assigned Vehicles 12/2014 Word SP-Internal

TC 12-259 Temporary Modified Duty Plan 12/2014 Word SP-Internal

TC 12-261 Daily Attendance & Project Report 08/2013 Excel SP-Internal

TC 12-262 General Policy Acknowledgment 03/2015 Word SP-Internal

TC 12-263 Employee & Agent Privacy & Security of Confidential or Sensitive Information Agreement

07/2017 Word SP-Internal

TC 12-268 Civil Engineering Technology Scholarship Application 10/2017 Word SP-External

TC 12-269 Star Program Enrollment Request 09/2017 Word SP-Internal

TC 12-270 Roadmap Program Enrollment Request 11/2014 Word SP-Internal

TC 12-273 Separation Notification 09/2013 Word SP-Internal

TC 12-274 Employee Performance Self-Evaluation 10/2016 Word SP-Internal

TC 12-275 GPS Program Enrollment Request 11/2015 Word SP-Internal

TC 12-276 Request for Personnel Action - Unpaid Contractor 08/2015 Word SP-Internal

TC 12-278 County Judge Payroll Information 06/2017 Excel SP-Internal

TC 14-001 Application for Certificate of Eligibility 02/2017 Word SP-External

Page 2 of 22

Page 3: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 14-014 Proposal or Bid Bond 04/2007 Word SP-External

TC 14-027 Authority to Sign 07/2016 Word SP-External

TC 14-035 DBE Plan/Subcontract Request 07/2016 Excel SP-External

TC 14-309 Trainee Classification Form & Notice of Selection of Training Program

06/2015 Word SP-External

TC 14-310 Notice of Selection of Trainee & Trainee Work History 07/2016 Word SP-External

TC 14-311 Weekly Training Report 07/2016 Word SP-External

TC 14-312 Engineers Wage & Hour Report 06/2007 Excel SP-Internal

TC 14-313 Nondiscrimination in Employment 06/2009 Word SP-External

TC 14-314 Contractor Notice 04/2007 Word SP-External

TC 14-318 Wage Complaint by Employee 02/2013 Word SP-External

TC 14-320 Request for Joint Venture 06/2017 Word SP-External

TC 17-009 Acknowledgment of Confidentiality Agreement 12/2011 Word SP-Internal

TC 18-005 No Change Declaration 03/2011 PDF SP-External

TC 18-006 EEO Complaint 12/2014 Word SP-Internal

TC 18-007 Affidavit of Subcontractor Payment 01/2017 Word SP-External

TC 18-008 ADA/Section 504 Program Complaint 05/2018 Word SP-External

TC 18-009 DBE Interstate Certification Affidavit 06/2015 Word SP-External

TC 18-010 External Discrimination Complaint Form 08/2016 Word SP-External

TC 18-011 Application for Interpreter Assessment 06/2017 Word SP-Internal

TC 18-012 Notice of Voluntary Withdrawal 08/2017 Word SP-External

TC 18-013 Request for NAICS Code Modification 08/2017 Excel SP-External

TC 18-014 Minority Internship Program Application-Certificate Program

05/2018 Word SP-External

TC 18-015 Minority Internship Program Application-College Program 05/2018 Word SP-External

TC 20-001 Certification of Qualification for County Road Supervisor 03/2013 Word SP-Internal

TC 20-011 Projects Recommended for Rural Secondary Program 12/2015 Excel SP-Internal

TC 20-016 Municipal & County Road Aid Emergency Request 09/2017 Word SP-External

TC 20-019 Office of Local Programs Project Closure 05/2010 Word SP-External

TC 20-024 Congestion Mitigation Air Quality (CMAQ) Program Application

06/2017 Word SP-External

TC 20-026 Scenic Byways & Highways Designation Application 10/2016 Word SP-External

TC 20-029 Reimbursement Request 09/2016 Excel SP-External

TC 20-032 Local Public Agency Change Order 07/2010 Excel SP-External

TC 20-034 RS Flex Program Recommendations 09/2017 Excel SP-External

Page 3 of 22

Page 4: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 20-035 RS Bridge Program Recommendations 04/2013 Excel SP-External

TC 20-036 Transportation Alternatives Program (TAP) Application 08/2017 Word SP-External

TC 20-037 Local Public Agency (LPA) Certification of Responsibility 08/2013 Word SP-External

TC 20-038 Request for Payment 06/2014 Word SP-External

TC 20-039 Discretionary Funding Request 08/2016 Word SP-External

TC 25-002 Training Report 03/2017 Word SP-Internal

TC 25-003 Personal Protective Equipment (PPE) Acknowledgment 05/2017 Word SP-Internal

TC 25-105 Notice of Safety Violation 06/2017 Word SP-Internal

TC 25-110 Jobsite Setup Inspection 06/2017 Word SP-Internal

TC 25-151 Monthly Injury Report 02/2014 Word SP-Internal

TC 25-155 Injury & Accident Investigation 05/2017 Word SP-Internal

TC 25-156 Job Safety Analysis & PPE Certification of Hazard Assessment

05/2014 Excel SP-Internal

TC 25-157 Fall Protection Equipment Inspection Log 04/2017 Excel SP-Internal

TC 25-158 Daily Excavation & Trench Inspection 05/2017 Word SP-Internal

TC 25-159 Facility Safety Inspection 05/2017 Excel SP-Internal

TC 25-160 Energized Electrical Work Permit 05/2017 Excel SP-Internal

TC 25-161 Confined Space Entry Permit 05/2017 Excel SP-Internal

TC 25-162 Supervisor's Injury Investigation Report 06/2017 Excel SP-Internal

TC 25-163 Job Briefing 06/2017 Excel SP-Internal

TC 25-164 Safety Risk Report 07/2017 Word SP-Internal

TC 25-165 Internal Combustion Engine Industrial Truck Operation Checklist

07/2017 Excel SP-Internal

TC 25-166 Electric industrial Truck Daily Operation Checklist 07/2017 Excel SP-Internal

TC 25-167 Air Sampling Report 03/2018 Excel SP-Internal

TC 25-168 Aerial Device Bucket Truck Daily Checklist 12/2017 Excel SP-Internal

TC 25-170 Automated External Defibrillator (AED) Maintenance Checklist

01/2018 Excel SP-Internal

TC 30-100 Management Budget Change 06/2011 Excel SP-Internal

TC 30-127 KYTC eMars Security Request 02/2013 Excel SP-Internal

TC 30-128 Request for Temporary Employment 08/2016 Word SP-Internal

TC 31-020 Out-of-State Travel Authorization Request 01/2013 Excel SP-Internal

TC 31-020A Out-of-State Travel Request Cost Comparison 07/2013 Excel SP-Internal

TC 31-021 Travel Reimbursement Request 09/2016 Excel SP-Internal

TC 31-022 Out-of-Country Travel Authorization Request 02/2013 Excel SP-Internal

Page 4 of 22

Page 5: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 31-207 Miscellaneous Sales Listing 01/2013 Excel SP-Internal

TC 31-519 Standard Invoice 10/2015 Excel SP-External

TC 31-554 Task Order Agreement Completion Notification 02/2013 Excel SP-Internal

TC 31-555 Task Order Charges for Services for Governmental Entities Performed by Traffic or Maintenance

01/2013 Excel SP-Internal

TC 31-563 Template Request 02/2013 Excel SP-Internal

TC 31-564 Travel Exception Request 11/2016 Excel SP-Internal

TC 35-004 Radar Trailer Request Checklist 09/2010 Word SP-Internal

TC 35-007 Equipment Lend-Out 09/2010 Word SP-Internal

TC 35-011 Grant Application/Contract Conditions for Law Enforcement Overtime Projects

01/2018 Word SP-External

TC 35-012 Reimbursement Claim - Law Enforcement Overtime 10/2011 Excel SP-External

TC 35-013 Reimbursement Claim - Non-Law Enforcement Projects 10/2011 Excel SP-External

TC 35-014 Overtime Worksheet 10/2011 Excel SP-External

TC 35-015 Activity Reporting 10/2011 Excel SP-External

TC 35-016 Supplemental Checkpoint Reporting 10/2011 Excel SP-External

TC 35-017 Officers Overtime Detail Log 10/2011 Excel SP-External

TC 35-018 Non-Expendable Property Accountability Record 10/2011 Excel SP-External

TC 35-019 Detailed Monthly Activity 10/2011 Excel SP-External

TC 35-020 Out-of-State/Overnight Travel Request 10/2011 Excel SP-External

TC 35-021 Final Reporting - Law Enforcement Projects 02/2011 Word SP-External

TC 35-022 Final Reporting - Non-Overtime Enforcement Projects 10/2011 Excel SP-External

TC 35-023 Grant Application (CIOT) 02/2012 Word SP-External

TC 35-024 Grant Application/Contract Conditions for Non-Overtime Enforcement Projects

01/2018 Word SP-External

TC 40-001 Consulting Engineer and Related Services Prequalification Application

12/2017 PDF SP-External

TC 40-002 Engineering & Related Services Fee Proposal 12/2017 Excel SP-External

TC 40-004 Certification of Confidentiality 03/2017 Word SP-Internal

TC 40-006 Ex Parte Disclosure 03/2017 Word SP-Internal

TC 40-008 Listing of Responding Firms 03/2017 Word SP-Internal

TC 40-009 Certification of Understanding of Restrictions for Members of Professional Engineering or Engineering-Related Services Selection Committee

10/2007 Word SP-Internal

TC 40-010 Certification of Conformity with Procurement Process 03/2017 Word SP-Internal

TC 40-017 Contract Modification 09/2010 Excel SP-Internal

Page 5 of 22

Page 6: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 40-018 Committee Ranking to Determine the Three Short-Listed Consultant Firms

03/2017 Word SP-Internal

TC 40-408 Engineering and Engineering-Related Services Pay Estimate 06/2014 Excel SP-External

TC 55-001 Obstruction Evaluation Worksheet 06/2016 Excel SP-Internal

TC 55-002 Application for Permit to Construct or Alter a Structure 05/2017 Word SP-External

TC 55-003 Notification of Change in Oversight/Ownership of a Structure

06/2016 Word SP-External

TC 56-015A Request for State Funds for Airport Development 05/2005 Word SP-External

TC 56-015C Project Application for State Aid for Development of Public Airports

05/2007 Word SP-External

TC 56-016 Tentative Allocation 02/2002 Word SP-Internal

TC 56-051 Request for Use of State-Owned or State-Chartered Aircraft 08/2008 Word SP-External

TC 56-052 Irregularity Report 08/2008 Word SP-Internal

TC 56-053 Receipt for Temporary Use of Equipment 12/2009 Word SP-Internal

TC 56-055 State Flight Report 12/2012 Word SP-Internal

TC 56-56 Private Airport/Heliport Registration 08/2017 Word SP-External

TC 58-028 Project Impact Profile 01/2014 Word SP-External

TC 58-033 Air Quality Baseline Guidance & Accountability 01/2014 Excel SP-External

TC 58-034 Ecological Study Format Guidance & Accountability 01/2014 Excel SP-External

TC 58-035 Archaeological Phase I Investigation-Guidance & Accountability

01/2014 Excel SP-External

TC 58-036 Biological Assessment Guidance & Accountability 01/2014 Excel SP-External

TC 58-037 Supplier Feedback Request 01/2014 Word SP-External

TC 58-038 Environmental Assessment Guidance & Accountability 01/2014 Excel SP-External

TC 58-039 Draft Environmental Impact Statement Guidance & Accountability

01/2014 Excel SP-External

TC 58-040 FONSI Guidance & Accountability 01/2014 Excel SP-External

TC 58-041 Historical Resources-Guidance & Accountability 01/2014 Excel SP-External

TC 58-042 Noise Analysis and Abatement Guidance & Accountability 01/2014 Excel SP-External

TC 58-043 Socioeconomic Impact Guidance & Accountability 01/2014 Excel SP-External

TC 58-044 UST/Hazmat Guidance & Accountability 01/2014 Excel SP-External

TC 58-046 Surplus Property Categorical Exclusion Impact Summary Sheet

06/2016 Excel SP-External

TC 58-047 Surplus Property - Notification of Environmental Conditions 01/2014 Word SP-External

Page 6 of 22

Page 7: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 58-048 Categorical Exclusion Environmental Determination Checklist

03/2015 Excel SP-External

TC 58-049 Project Impacts Reevaluation Summary 05/2018 Word SP-External

TC 58-050 Assistance Request Form 01/2014 Word SP-External

TC 58-051 Record of Decision - Guidance & Accountability 01/2014 Excel SP-External

TC 58-052 Final EIS - Guidance & Accountability 01/2014 Excel SP-External

TC 58-054 No Effect Finding v3.0 11/2013 Word SP-External

TC 58-055 No Effect Finding - State Funded v3.0 11/2013 Word SP-External

TC 58-056 Project Reevaluation 11/2013 Word SP-External

TC 58-057 Programmatic 4(f) for Historic Bridges 01/2014 Word SP-External

TC 58-58 Section 4(f)/Section 6(f) Project Summary 12/2017 Word SP-External

TC 59-003 Traffic Count Record 08/2010 Word Planning

TC 59-004 Ferry Traffic Count 06/2016 Excel SP-External

TC 59-005 Traffic Forecast Request 04/2015 Word SP-Internal

TC 59-006 Traffic Count Request 02/2011 Excel SP-Internal

TC 59-007 Consultant Performance Evaluation 03/2016 Excel SP-Internal

TC 59-010 Auxiliary Lane Type & Width Inventory 07/2010 Word Planning

TC 59-011 Median Type & Width Inventory 08/2010 Word Planning

TC 59-012 Shoulder Type & Width Inventory 07/2010 Word Planning

TC 59-013 Kentucky Shortline Railroad Assistance Application 02/2011 Word Planning

TC 59-014 Speed Limit Inventory 08/2010 Word Planning

TC 59-015 Route Log Inventory 07/2010 Word Planning

TC 59-016 Percent Passing Sight Distance Inventory 08/2010 Word Planning

TC 59-017 Lane Type & Width Inventory 07/2010 Word Planning

TC 59-100 Coal Shipment Route & Tonnage Report 01/2013 Word SP-External

TC 59-101 Bicycle/Share the Road Warning Sign Request 10/2013 Word SP-External

TC 59-102 Kentucky Railroad Annual Report 02/2016 Excel SP-External

TC 59-103 Application for Certificate of Convenience and Necessity to Operate Intrastate Toll Ferry or Bridge Connecting with State Primary Road System

06/2016 Word SP-External

TC 59-104 Certificate of Convenience and Necessity to Operate Intrastate Toll Ferry or Bridge Connecting with State Primary Road System

06/2016 Word SP-Internal

TC 59-105 Kentucky Riverport Improvement (KRI) Application 03/2017 Excel SP-External

TC 59-106 Ferry Boat Program (FBP) Application 06/2017 Word SP-External

Page 7 of 22

Page 8: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 61-012 Right-of-Way Plans Submitted to Central Office 04/2003 Word SP-Internal

TC 61-100 Drainage Design Summary 01/2011 Excel SP-External

TC 61-120 Inlet Spacing: Curb-Opening, Grated and Slotted Pipe Inlets 01/2003 Word SP-External

TC 61-505 Storm Sewer Design: Computable Table 12/2012 Word SP-External

TC 61-507 Channel Analysis 01/2003 Word SP-Internal

TC 61-509 Preliminary Drainage Risk Assessment for Floodplain Encroachment

03/2010 Word SP-External

TC 61-512 Urbanization Technique 06/1993 Paper None

TC 61-514 Control Monument Information Sheet 12/2012 Word SP-External

TC 61-517 Storm Sewer System Summary 01/2011 Excel SP-External

TC 61-518 Drainage Structure Summary 08/2010 Word SP-External

TC 62-003 Experience Questionnaire for Fee Appraiser 09/2014 Word SP-External

TC 62-006 Invitation for Bids: Sale of Excess/Surplus Property 09/2014 PDF SP-External

TC 62-007 Checklist for Disposal of Surplus Property 09/2014 PDF SP-External

TC 62-008 Application to Purchase State Right of Way 09/2014 Word SP-External

TC 62-009 Purchase Agreement Public Sale 09/2014 Word SP-External

TC 62-017 Pre-Improvement Removal Meeting Certification 09/2014 Word SP-External

TC 62-018 Reimbursement Request for Incidental Expenses 09/2014 Word SP-External

TC 62-019 Property Owner Interview 03/2016 Word SP-External

TC 62-020.1 Appraisal - Appraisal Report 04/2011 Other RWUMS

TC 62-020.10 Appraisal - After Value Data 04/2011 Other RWUMS

TC 62-020.16 Appraisal - Appraisal Recapitulation 04/2011 Other RWUMS

TC 62-020.2 Appraisal - General Data and Property Description Summary Report

04/2011 Other RWUMS

TC 62-020.3 Photographs and Property Sketch 04/2011 Other RWUMS

TC 62-020.4 Sketch of Buildings 04/2011 Other RWUMS

TC 62-020.5/11

Appraisal - Cost Approach 04/2011 Other RWUMS

TC 62-020.6/12

Appraisal - Description and Cost of Buildings Before Value 04/2011 Other RWUMS

TC 62-020.7/13

Appraisal - Income Approach 04/2011 Other RWUMS

TC 62-020.8/14

Sales Comparison Approach 04/2011 Other RWUMS

Page 8 of 22

Page 9: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 62-020.9/15

Appraisal - Correlation and Allocation 04/2011 Other RWUMS

TC 62-020B Appraisal - Comparable Sale Data - Non-Rural 04/2011 Other RWUMS

TC 62-020C Comparable Sale Data- Rural 04/2011 Other RWUMS

TC 62-020D Appraisal - Comparable Sale Data 04/2011 Other RWUMS

TC 62-021A Acquisition - Condemnation Pay Statement 04/2011 Other RWUMS

TC 62-022 Appraisal - Certification of Comparable Sales Data 04/2011 Other RWUMS

TC 62-026 Rental Agreement 06/2015 Word SP-External

TC 62-041 Improvement Removal Contract 02/2002 Word SP-External

TC 62-043 Bid Summary 09/2014 Excel SP-External

TC 62-044 Bid Opening Certification 09/2014 Excel SP-External

TC 62-048 Closing Statement 08/2016 Word SP-External

TC 62-050 Mortgage Interest Rates 08/2016 Word SP-External

TC 62-052 Grave Data Sheet 09/2014 Word SP-External

TC 62-054 Daily Disinterment & Reinterment Record 09/2014 Excel SP-External

TC 62-055 Consent & Authorizaton 09/2014 Word SP-External

TC 62-058 Rent Certification 08/2016 Word SP-External

TC 62-059 Mortgage Information 08/2016 Word SP-External

TC 62-063 Comparative Data Sheet 09/2005 Word SP-External

TC 62-064 Reinterment Agreement 09/2014 Word SP-External

TC 62-065 Consent and Release 09/2014 PDF SP-External

TC 62-067 DS&S Inspection Report 09/2005 Word SP-External

TC 62-068 Certified Inventory 07/2011 Word SP-External

TC 62-071 Rent Claim 07/2014 Word SP-External

TC 62-075 Project Report 02/2018 Word SP-External

TC 62-077 Record of Contacts 09/2014 Word SP-External

TC 62-077A Acquisition - Record of Contacts 04/2011 Other RWUMS

TC 62-083 Parcel Summary 04/2011 Other RWUMS

TC 62-083A Memorandum of Understanding 07/2009 Other RWUMS

TC 62-084 Rental Record 07/1998 Word SP-External

TC 62-085 Notice of Excess Purchase 04/2011 Other RWUMS

TC 62-087 Appraisal Review 04/2011 Other RWUMS

TC 62-090 Property Owner Opinion Survey 09/2014 PDF SP-External

TC 62-091 Relocation Assistance Opinion Survey 01/2015 Word SP-External

Page 9 of 22

Page 10: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 62-097 Relocation Project Summary 09/2005 Word SP-External

TC 62-099 Move Claim- Residential 07/2014 Word SP-External

TC 62-101 Appraiser/Review Appraiser Performance Evaluation 09/2014 Word SP-External

TC 62-102 Protective Rental Agreement 06/2015 Word SP-External

TC 62-201 Project Summary of Improvements 07/1998 Word SP-External

TC 62-203 Right of Way Cost Estimate 09/2014 Excel SP-External

TC 62-204 Affidavit of Descent 02/2003 Word SP-Internal

TC 62-205 Affidavit of Personal Representative 02/2003 Word SP-Internal

TC 62-206 Moving Expense Estimate/Bid 08/2010 Word SP-External

TC 62-207 Nonresidential Payment Request 07/2014 Word SP-External

TC 62-208 Non-Residential Worksheet 09/2010 Word SP-External

TC 62-209 Payment Summary 07/2015 Word SP-External

TC 62-210 Relocation Benefits Summary 11/2005 Word SP-External

TC 62-211 Replacement Housing Payment Computation Correlation 07/2011 Word SP-External

TC 62-212 Replacement Housing Payment Computation- Owner 07/2014 Word SP-External

TC 62-213 Replacement Housing Payment Computation- Tenant 07/2014 Word SP-External

TC 62-214 Replacement Housing Payment Worksheet - Residential 07/2014 Word SP-External

TC 62-215 Replacement Housing/Down Payment Assistance Residential Claim

07/2014 Word SP-External

TC 62-216 Request for Relocation Review/Appeal 09/2010 Word SP-External

TC 62-218 Solicitation for Removal of Improvements 09/2014 Word SP-External

TC 62-219 Local Public Agency Right-of-Way Acquisitions 05/2008 Word SP-Internal

TC 62-220 Performance Evaluation - Demolition Services 07/2010 Word SP-External

TC 62-221 Relocation Payment Summary 09/2010 Word SP-External

TC 62-222 District Checklist for Surplus Property Disposal 09/2014 PDF SP-External

TC 62-223 Appraisal Review Recapitulation 04/2011 Word SP-External

TC 62-224 Acquisition - Administrative Settlement 04/2011 Word SP-External

TC 62-225 Acquisition - Minor Acquisition Review 04/2011 Word SP-External

TC 62-226 Right of Way Certification 01/2016 Word SP-External

TC 62-227 Consent and Release - Existing Right of Way 06/2016 Word SP-External

TC 62-228 Miscellaneous/Billboard Move Worksheet 08/2016 Word SP-External

TC 63-010 Cost-Plus Sheet 04/2017 Excel SP-External

TC 63-014 Daily Inspectors Report for Bridge Painting 03/2000 Excel SP-External

TC 63-026 Contract Overtime & Liquidated Damage Review 03/2010 Excel SP-Internal

Page 10 of 22

Page 11: KYTC Forms Registry - Kentucky Transportation Cabinet · KYTC Forms Registry Jul 16, ... TC 12-211 Manual Order Form 08/2017 Excel SP-External ... TC 14-001 Application for Certificate

Number Title Revision Date Format Website

TC 63-028 Daily Inspection Report 03/2000 Excel SP-External

TC 63-032 Notice of Changed Condition/Disagreement 12/2007 Excel SP-External

TC 63-033 Acknowledgment of Notice of Changed Condition/Disagreement

06/2017 Excel SP-Internal

TC 63-035 Subcontract Request 05/2018 Excel SP-External

TC 63-035CO Subcontract Request - Supplemental Change Order Items 04/2007 Excel SP-External

TC 63-043 Rideability Test Report 10/2015 Excel SP-External

TC 63-046 Nuclear Meter Daily Log Sheet 06/2001 Excel SP-Internal

TC 63-047 Moisture-Density Test Report (DGA/CSB) 11/1998 Excel SP-Internal

TC 63-049 In-Place Density Using Control Strip 11/1998 Excel SP-Internal

TC 63-050 Written Narrative Schedule 12/2011 Word SP-External

TC 63-055 Concrete Mixer 04/1987 Word SP-External

TC 63-060 Storm Water Best Management Practice Plan (BMP) 01/2012 Excel SP-External

TC 63-061 Erosion Control Inspection Report 10/2015 Excel SP-External

TC 63-061A Erosion Control Inspection Report - For KPDES Permits in Contractor's Name

10/2015 Excel SP-External

TC 63-064 Pre-Construction Conference Checklist 12/2017 Word SP-External

TC 63-065 Seeding Locations & Areas 12/2011 Excel SP-Internal

TC 63-067 Traffic Control Inspection Report 12/2011 Excel SP-External

TC 63-068 Vehicle Enforcement Request 05/2018 Excel SP-External

TC 63-070 Highway Construction Restriction Notification 05/2013 Word SP-External

TC 63-071 Department Equipment Rental 04/2016 Excel SP-External

TC 63-072 Guardrail Delivery Verfication Sheet 08/2015 Word SP-External

TC 63-073 Record of Test Pile Furnished and Driven 05/2016 Excel SP-Internal

TC 63-074 Contractor Performance Evaluation 07/2016 Excel SP-External

TC 63-075 Appeal Form - Contractor Performance Evaluation 07/2016 Word SP-External

TC 63-076 Department of Highways Performance Evaluation 07/2016 Word SP-External

TC 63-077 Notice of Potential Claim 01/2018 Excel SP-External

TC 63-078 Acknowledgement of Notice of Potential Claim 01/2018 Excel SP-Internal

TC 64-001 Certification of Materials 03/1996 Paper None

TC 64-005 Certification of Materials- Construction 03/1996 Paper None

TC 64-122 Fabricator's Heat Number Identification of Reinforcing Bars 01/2001 PDF SP-External

TC 64-309 Inspection for Prestressed Concrete Members 06/2002 PDF SP-Internal

TC 64-310 Elongation for Prestressed Concrete Members 03/1995 Paper None

Page 11 of 22

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Number Title Revision Date Format Website

TC 64-313 Precast & Prestressed Concrete Mix Design Data 05/2005 PDF SP-Internal

TC 64-316 Scale Report for Concrete Plants 03/1995 PDF SP-External

TC 64-317 Concrete Mobile Calibration Data Sheet 12/1986 Paper None

TC 64-416 Annual Asphalt Mixing Plant Inspection 06/2000 Paper None

TC 64-416A Asphalt Mixing Plant Acceptance 06/2000 Paper None

TC 64-418 Contractor's Quality Control Plan/Checklist 11/2008 PDF SP-External

TC 64-753 Shielded Metal ARC Welders & MIG Welders 08/2007 PDF SP-External

TC 64-759 Concrete Mix Design Approval 04/2006 PDF SP-Internal

TC 64-760 Concrete Trial Batch Approval 04/2006 PDF SP-Internal

TC 64-761 CSB & DGA Mixing Plant Inspection Report 11/2005 PDF SP-Internal

TC 64-762 Concrete Trial Batch Failure 09/2007 PDF SP-Internal

TC 64-763 Certification of Compliance for Polish-Resistant Aggregate 09/2011 Word SP-External

TC 64-764 Certification of Compliance for Freeze-Thaw Resistant Concrete Aggregate

09/2011 Word SP-External

TC 64-765 Individual Pipe Video Inspection Report 05/2014 Excel SP-External

TC 64-766 Pipe Video Inspection Summary Report 05/2014 Excel SP-External

TC 64-767 Individual Pipe Deflection Inspection Report 05/2014 Excel SP-External

TC 64-768 Pipe Deflection Inspection Summary Report 05/2014 Excel SP-External

TC 66-200 Subsurface Log 06/2007 Paper None

TC 66-201 Unit Cost Items for Geotechnical Services 06/2007 Paper None

TC 66-202 Performance Evaluation for Geotechnical Services 06/2007 Paper None

TC 66-203 Notification for Drilling Services 06/2007 Paper None

TC 66-204 Tabulation of Quantities for Invoices 06/2007 Paper None

TC 66-205 Cost Items for Statewide Geotechnical Engineering Services 06/2007 Paper None

TC 66-206 Summary of Cost Items for Statewide Geotechnical Engineering Services

06/2007 Paper None

TC 66-207 Thin-Walled Tube & SPT Sample Log 06/2007 Paper None

TC 66-208 Summary of Rock Quantities 06/2007 Paper None

TC 66-209 Prequalification Requirements for Geotechnical Drilling Services

06/2007 Paper None

TC 66-210 Prequalification Requirements for Geotechnical Engineering Services

06/2007 Paper None

TC 66-211 Prequalification Requirements for Geotechnical Laboratory Testing Services

06/2007 Paper None

TC 66-212 Summary of Rockline Soundings 06/2007 Paper None

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Number Title Revision Date Format Website

TC 69-004 Utility/Rail Agreement Change Order 11/2017 Word SP-External

TC 69-005 Notification of Utility Relocation and/or Adjustment 02/2003 Word SP-Internal

TC 69-007 Utility Progress Report 04/2011 Excel SP-Internal

TC 69-008 Utility/Rail Agreement Statement of Charges 11/2017 Word SP-External

TC 69-009 Summary of Project Costs (Utility Adjustments) 02/1995 Excel SP-Internal

TC 69-011 Summary for KYTC Projects That Involve a Railroad 08/2010 Word SP-Internal

TC 69-012 Request for Utilities Section Involvement for Non-RHP Projects

10/2011 Word SP-Internal

TC 69-013 Project Relocation Delivery Order 08/2016 Word External

TC 71-005 Critical Bridge Maintenance Needs Inspection Report 07/2016 Excel SP-Internal

TC 71-009 Certified Transportation Plan 06/2008 Word SP-External

TC 71-010 Storm Log 01/2013 Excel SP-Internal

TC 71-011 Maintenance & Traffic Contract 08/2008 Word SP-Internal

TC 71-012 Contract Truck Log 07/2016 Word SP-Internal

TC 71-014 Consent & Release 03/2009 Word SP-Internal

TC 71-017 Final Inspection Report of State Construction Projects 12/2008 Excel SP-Internal

TC 71-021 Report for Correcting Private Entrance 07/2008 Word SP-Internal

TC 71-025 Guardrail & End Treatment Installation & Repair Report 01/2009 Word SP-Internal

TC 71-108 Pesticide Field Report 01/2014 Word SP-Internal

TC 71-126 Rest Area Maintenance Inspection Report 03/2017 Excel SP-Internal

TC 71-132 Consultant Bridge Inspection Field Review Report 07/2008 Word SP-Internal

TC 71-201 Industrial Haul Permit: Application 09/2011 Excel SP-External

TC 71-202 Industrial Haul Permit: Performance Bond 06/2008 Excel SP-External

TC 71-203 Industrial Haul Permit: Release from Bond 06/2008 Excel SP-External

TC 71-204 Industrial Haul Permit: Truck Information 06/2008 Excel SP-External

TC 71-205 Industrial Haul Permit: Transportation Plan 06/2008 Excel SP-External

TC 71-206 Industrial Haul Permit: Bridge Weight Limits 06/2008 Excel SP-External

TC 71-214 Daily Report on Use of Rented Equipment 11/2013 Word SP-Internal

TC 71-216 Direct Anti-Icing Application 07/2008 Word SP-Internal

TC 71-219 Regular Overtime Log 07/2008 Word SP-Internal

TC 71-221 Fire Watch Log 04/2010 Excel SP-External

TC 71-222 Estimate for Road Construction or Improvement 06/2008 Excel SP-Internal

TC 71-223 Agreement for Services to Be Performed in Conjunction with Governmental Agencies

11/2012 Excel SP-External

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Number Title Revision Date Format Website

TC 71-224 Industrial Haul Permit: Bridge Analysis Request 06/2008 Excel SP-External

TC 71-225 Daily Materials Usage Report 10/2010 Word SP-Internal

TC 71-226 Noxious Weed Control Request 04/2018 Word SP-External

TC 71-227 Cooperative Agreement 08/2008 Word SP-External

TC 71-228 State-Owned Guardrail Declared Surplus 03/2012 Word SP-Internal

TC 71-229 Sign Details Information 04/2013 Excel SP-External

TC 71-230 Sign Assembly Information 04/2013 Excel SP-External

TC 71-231 Declared Scrap Metal 04/2017 Word SP-Internal

TC 71-232 Snow and Ice Contract Truck Inspection Sheet 06/2017 Word SP-External

TC 71-233 Preseason Checklist for Snow and Ice Contract Trucks 06/2017 Word SP-External

TC 72-003 Motor Vehicle Speed Field Data Sheet - Radar 10/2013 Excel SP-Internal

TC 72-004 Traffic Signal Checklist (Automated) 03/2017 Excel SP-Internal

TC 72-006 Traffic Signal Warrant Analysis 10/2013 Excel SP-Internal

TC 72-010 Collision Diagram 10/2013 Excel SP-Internal

TC 72-101 Traffic Work Order 09/2002 Word SP-Internal

TC 72-103 LED-Enhanced Sign Order 10/2013 Excel SP-Internal

TC 72-104 Advance Warning Flasher Checklist 10/2013 Excel SP-Internal

TC 72-105 Critical Rate Analysis 10/2013 Excel SP-Internal

TC 72-106 Signal Analysis Using Peak Hour/ADT Projections 10/2013 Excel SP-Internal

TC 72-107 School Flasher Request 10/2013 Excel SP-Internal

TC 72-109 Railroad Preemption Worksheet 04/2017 Excel SP-Internal

TC 72-110 Intersection Conflict Warning System Calculations 08/2017 Excel SP-Internal

TC 73-102 Agency Request for Quotation 05/2017 Excel SP-Internal

TC 73-137 RFP Evaluator Acknowledgment 12/2014 Word SP-Internal

TC 73-138 Solicitation Evaluation Procedure and Confidentiality Statement

11/2014 Word SP-Internal

TC 73-139 Vendor Complaint 07/2017 Word SP-Internal

TC 74-005 Portable Diesel Tank Distribution Sheet 11/2013 Excel SP-Internal

TC 74-011 Operators Daily Check Sheet 05/2015 Word SP-Internal

TC 74-012 KY DOT Inspection List 06/1995 Paper None

TC 74-013 Equipment History Sheet 09/2010 Excel SP-Internal

TC 74-023 Daily Labor Report 03/2015 Excel SP-Internal

TC 74-201 Equipment Work Request 09/2004 Word SP-Internal

TC 74-306 Equipment Operators Test 11/2002 Word SP-Internal

Page 14 of 22

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Number Title Revision Date Format Website

TC 74-504 Window Ticket 12/2013 Excel SP-Internal

TC 74-540 Equipment Turn-In Sheet 06/2002 Excel SP-Internal

TC 74-551 Fuel Card User Agreement 11/2013 Word SP-Internal

TC 74-552 Equipment Rental Agreement Information 06/2015 Excel SP-Internal

TC 74-553 Equipment Appraisal Sheet 11/2014 Word SP-Internal

TC 74-555 Tool Insurance Coverage Waiver 01/2015 Word SP-Internal

TC 74-556 Tool Insurance Coverage Acceptance 01/2015 Excel SP-Internal

TC 74-557 Safe Patrol Inspection Worksheet 03/2015 Excel SP-Internal

TC 74-558 Technician Full-Service Checklist 03/2018 Word SP-Internal

TC 74-560 KYTC Used/Demo Equipment Inspection Checklist 12/2017 SP-Internal

TC 77-001 State-Owned Personal Property Declared Surplus 10/2012 Word SP-Internal

TC 77-003 Equipment Transfers- Office, Engineering, & Laboratory 12/2011 Word SP-Internal

TC 77-004 Frame Shop Order 08/2009 Word SP-Internal

TC 77-006 New Office, Engineering, & Laboratory Equipment Assignment

12/2011 Word SP-Internal

TC 77-009 Relocation Request 10/2009 Word SP-Internal

TC 77-010 Requisition 03/2015 Excel SP-Internal

TC 77-023 Conference Center Room Information Request 02/2010 Word SP-Internal

TC 77-024 Room Information & Lease Agreement- State Agencies 03/2018 Word SP-External

TC 77-025 Rental Information & Lease Agreement - Non-State Agencies

03/2018 Word SP-External

TC 77-027 Archibus Access Request 01/2009 Word SP-Internal

TC 77-030 Identification Badge Acknowledgment 10/2016 Word SP-Internal

TC 77-031 Employee Building Security Access 09/2016 Word SP-Internal

TC 77-032 Meeting Confirmation 11/2016 Excel SP-External

TC 90-122 Request for Funding Authorization 01/2015 Excel SP-Internal

TC 90-123 Design Phase Funding Certification 07/2007 Excel SP-Internal

TC 90-124 Programming Document (PR-1) for Federal Project Agreement (FPA-1)

04/2011 PDF None

TC 94-001 Request for Driver Licensing Record That Includes Personal Information

05/2013 Word SP-External

TC 94-014 Voluntarily Surrendered License Affidavit 05/2013 Word SP-External

TC 94-017 Farm-Related Services/Restricted CDL Application 03/2014 Word SP-External

TC 94-029 Application for Renewal or Duplicate License by Mail (Military Personnel and Military Dependents only)

02/2018 PDF SP-External

Page 15 of 22

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Number Title Revision Date Format Website

TC 94-030 Driver License- ID Card Application 09/2008 PDF SP-External

TC 94-032 Commercial Driver License Application 03/2015 Word SP-External

TC 94-037 Test History Card 02/2015 Paper None

TC 94-038 Request for Medical Waiver 12/1996 Paper None

TC 94-038A Medical Report Form- Vision 06/2004 Paper None

TC 94-038B Medical Report Form- Metabolic 06/2004 Paper None

TC 94-038C Medical Report Form- Neurological 06/2004 Paper None

TC 94-038D Medical Report Form- Cardiovascular 06/2004 Paper None

TC 94-038E Medical Report Form- Musculoskeletal 06/2004 Paper None

TC 94-038F Medical Report Form- Alcohol or Drug Dependence 06/2004 Paper None

TC 94-038G Medical Report Form- Mental & Emotional Conditions 06/2004 Paper None

TC 94-039 Transfer Test Card 01/1996 Paper None

TC 94-051 Probation Request 07/2013 Paper None

TC 94-061 Medical Review Board Affidavit 03/2018 Word SP-External

TC 94-062 Graduated License Certification Card 03/1999 Paper None

TC 94-063 State Traffic School Certification Card 08/2001 Paper None

TC 94-064 State Traffic School Roster- Graduated License Course Roster

01/1996 Paper None

TC 94-065 Report on Civil Judgment Involving a Motor Vehicle Accident

05/2013 Word SP-External

TC 94-086 Medical Review Board Examination 03/2018 Word SP-Internal

TC 94-090 Affidavit for Withdraw of Responsibility 12/1992 Paper None

TC 94-148 Non-US Citizen Document Verification 01/2006 Paper None

TC 94-151 Non-Resident Reinstatement Letter 06/2001 Paper None

TC 94-152 Non-US Citizen Application 07/2016 Word SP-External

TC 94-152 Spanish

Non-US Citizen Application- Spanish 07/2016 Word SP-External

TC 94-153 Non-US Citizen Verification Checklist 12/2001 Paper None

TC 94-159 USCIS School Compliance Non-US Citizen Driver Licensing & Personal Identification Application

08/2012 PDF SP-External

TC 94-161 Religious Exemption Affidavit 05/2013 Word SP-External

TC 94-162 Voter Registration Declination Statement 05/2013 Word SP-External

TC 94-163 Application for Valid In-Kentucky-Only License 05/2013 PDF SP-Internal

TC 94-165 Denial Statement & Affidavit for Duplicate License 08/2015 Word SP-Internal

TC 94-167 Military Certification for Skills Test Exemption 09/2015 Word SP-External

Page 16 of 22

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Number Title Revision Date Format Website

TC 94-169 Commercial Driver License Self-Certification 05/2017 Word SP-External

TC 94-171 Medical Review Board Psychiatric Examination 03/2018 Word SP-Internal

TC 94-174 Medical Review Board Visual Acuity and Fields Examination 03/2018 Word SP-Internal

TC 94-175 Ignition Interlock Application 08/2015 Word SP-External

TC 94-176 Breath Alcohol Ignition Interlock Physician Statement 08/2015 Word SP-External

TC 94-177 Certificate of Installation of Ignition Interlock Device 08/2015 Word SP-External

TC 94-178 Certificate of Removal for Ignition Interlock Device 08/2015 Word SP-External

TC 94-179 Non-Resident Violator Compact 03/2016 Word SP-External

TC 94-180 55+ Driving Program Application 12/2017 Word SP-External

TC 95-001 Kentucky Trucking Application 05/2018 PDF SP-External

TC 95-010 Kentucky Overweight/Overdimensional Permit Worksheet 02/2018 PDF SP-External

TC 95-015 Certificate of Motor Vehicle Equipment Lease 12/2007 Word SP-External

TC 95-016 Application for U-Drive-It 06/2017 PDF SP-External

TC 95-018 Application for License to Operate Municipal Solid Waste Transportation Vehicle(s)

05/2018 Word SP-External

TC 95-019 Kentucky Overweight/Overdimensional Permit 04/2006 Paper None

TC 95-025 Application for Annual Overweight or Overdimensional Permit

07/2018 PDF SP-External

TC 95-037 Affidavit for Passenger Plate Transfer 05/2018 PDF SP-External

TC 95-038 Vehicle Additions or Deletions Subject to KY Weight Distance (KYU) Tax

05/2018 PDF SP-External

TC 95-039 Application for Kentucky Passenger Fee Receipt Card for Year

05/2018 PDF SP-External

TC 95-041 Application for Kentucky Solid-Waste Transporter Vehicle ID Card

05/2018 PDF SP-External

TC 95-044 Annual Report 05/2018 Word SP-External

TC 95-053 Application to Register a Motor Vehicle under U-Drive-It Program

12/1998 Excel SP-External

TC 95-070 Application for Extended-Weight Decal 05/2018 Excel SP-External

TC 95-101 Kentucky Weight Distance Tax 03/2010 Paper None

TC 95-103 Highway Quarterly Tax Return 12/2007 Paper None

TC 95-214 Application for Fuel Tax Refund for Use of Power Take-off Equipment

07/2018 Excel SP-External

TC 95-303B Kentucky IRP Apportioned Registration Application- Schedule B

10/2017 Excel SP-External

TC 95-303C Kentucky IRP Apportioned Registration Supplemental Application- Schedule C

11/2017 PDF SP-External

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Number Title Revision Date Format Website

TC 95-308 Charter Bus Authority Application 05/2018 PDF SP-External

TC 95-309 Application for U-Drive-It Renewal 05/2018 PDF SP-External

TC 95-310 House Moving Application 08/2012 Word SP-External

TC 95-567 Kentucky Intrastate For-Hire Authority- Renewal 05/2018 PDF SP-External

TC 95-573 Change of Company Information 05/2018 PDF SP-External

TC 95-586 Authorization Agreement for Preauthorized Payments (OWOD)

02/2018 PDF SP-External

TC 95-589 Disabled Persons Vehicle Qualification 07/2009 Word SP-External

TC 95-590 OW/OD Annual Permit Replacement Request 05/2018 PDF SP-External

TC 95-591 Household Goods Certificate Kentucky Intrastate Qualification Application

05/2018 PDF SP-External

TC 95-592 IRP Notification of Lease Correction/Update 05/2016 Word SP-External

TC 95-594 Disabled Persons Vehicle Authority Application 05/2018 Word SP-External

TC 95-601 Charter Bus and Bus Authority Renewal 05/2018 PDF SP-External

TC 95-605 Motor Carrier Passenger Certificate, Vehicle Qualification and Renewal Application

05/2018 PDF SP-External

TC 95-607 For-Hire Authority Vehicle Add-On 05/2018 PDF SP-External

TC 95-608 Additional KIT/IFTA Decal Request 05/2018 PDF SP-External

TC 95-609 Passenger & Household Goods Change of Company Information

05/2018 PDF SP-External

TC 95-611 U-Drive-It Refund Application 06/2017 PDF SP-External

TC 95-613 Temporary Event-Related Authority Application 05/2018 PDF SP-External

TC 95-616 Cash Bond Refund Application 06/2018 PDF SP-External

TC 95-617 Amendment Questionnaire KYU/KIT/IFTA 05/2018 Word SP-External

TC 95-622 Consumer Complaint 05/2018 Word SP-External

TC 95-623 KIT or IFTA Fuel License Renewal 05/2018 Word SP-External

TC 95-624 IRP or EWD Request for Refund 05/2018 Word SP-External

TC 95-625 Overweight/Overdimensional Proposed Route Survey 05/2018 Word SP-External

TC 95-626 Application for Providers and Courses for Motor Carrier Training

05/2018 Word SP-External

TC 95-627 Transportation Network Company Authority Application 05/2018 Word SP-External

TC 95-628 Affidavit for Replacement of Passenger Credentials 05/2018 Word SP-External

TC 95-629 Household Goods Authority Application 05/2018 Word SP-External

TC 95-630 Passenger Vehicle Inspection 07/2015 Word SP-External

TC 95-631 Bus Authority Application 05/2018 Word SP-External

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Number Title Revision Date Format Website

TC 95-632 Taxicab Authority Application 05/2018 PDF SP-External

TC 95-633 Limousine Authority Application 04/2018 PDF SP-External

TC 95-634 Driveaway Authority Application 05/2018 Word SP-External

TC 95-635 Utility Trailer Authority Application 05/2018 Word SP-External

TC 95-636 Certificate of Assumed Name for Sole Proprietor 05/2018 Word SP-External

TC 95-637 Driveaway Authority Renewal 05/2018 Word SP-External

TC 95-638 Utility Trailer Authority Renewal 05/2018 Word SP-External

TC 95-639 Application for Rental Car Allocation 11/2015 Word SP-External

TC 95-640 Tax Overpayment/Credit Refund Application 05/2018 PDF SP-External

TC 96-003 Affidavit of Incomplete Transfer 06/2015 Word SP-External

TC 96-004 Odometer Disclosure Statement - Leased Vehicle 07/2015 Word SP-External

TC 96-005 Odometer Disclosure Statement 06/2015 Word SP-External

TC 96-010A Kentucky Motor Vehicle Dealer or Manufacturer Temporary Employee Transportation Permit for Dealer Plate Usage

05/2017 Word SP-External

TC 96-010B Motor Vehicle Dealer or Manufacturer's Dealer Plate Usage Authorization Register

03/2015 Word SP-External

TC 96-015 Application for Special License Plate 10/2016 Word SP-External

TC 96-016A Request for Motor Vehicle or Boat Record That Includes Personal Information

03/2016 Word SP-External

TC 96-016B Request for Personal Information Pursuant to KRS 411.402 and 411.406 Theft of Motor Fuel

07/2017 Word SP-External

TC 96-016G Request for Motor Vehicle or Boat Record That includes Personal Information (Gov't Agency Use)

03/2015 Word SP-External

TC 96-016T Request by Towing & Storage Companies & Lien Holders for Motor Vehicle or Boat Records that Include Personal Information

07/2017 Word SP-External

TC 96-150 Application for Commercial Temporary Trailer or Motor Vehicle Placard

07/2016 Word SP-External

TC 96-150TF Transit Tag Application 03/2014 Word SP-External

TC 96-150TP Transit Plate 01/2014 Word Paper

TC 96-153 Affidavit Supporting Application for License Plates for Manufacturers & Dealers

12/2012 Word SP-External

TC 96-155 Temporary Plate 03/2011 Paper None

TC 96-155F Application for Commercial Temporary Trailer or Motor Vehicle Registration

01/2014 Word SP-External

TC 96-155MC

Temporary Tag Motorcycle 04/2011 Paper None

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Number Title Revision Date Format Website

TC 96-155MV

Temporary Tag Motor Vehicle 01/2016 Paper None

TC 96-155T Temporary Transport Tag 03/2011 Paper None

TC 96-159 Affidavit of Motor Vehicle Sale 07/2017 Word SP-External

TC 96-159M Mechanic's Lien 11/2013 Word SP-External

TC 96-159S Affidavit Supporting Title Application by an Insurance Company

04/2018 Word SP-External

TC 96-159T Towing and Storage Lien 11/2013 Word SP-External

TC 96-159VT Voluntary Towing & Storage Lien 07/2017 Word SP-External

TC 96-167 Affidavit for Replacement or Non-Exchange 10/2014 Word SP-External

TC 96-169 Application for Vehicle Identification Number 10/2016 Word SP-External

TC 96-170 Claim for Refund of Truck License Fee 02/2014 Word SP-External

TC 96-171 Claim for Refund of Motor Vehicle License Fee 02/2014 Word SP-External

TC 96-179 Kentucky Self-Service Storage Act 02/2014 PDF SP-External

TC 96-180 Certificate of Title 05/2004 Paper None

TC 96-180A Certificate of Title Reassignment 06/2000 Paper None

TC 96-182 Application for Kentucky Certificate of Title or Registration 10/2015 Word SP-External

TC 96-183 Notice to County Clerk of Vehicle Acquisition 03/2014 Word SP-External

TC 96-184 Motor Boat Transaction Record Application for Title and Registration

03/2016 PDF SP-External

TC 96-187 Title Lien Statement 07/2016 PDF SP External

TC 96-191 Affidavit Supporting Vehicle License Application 02/2014 Word SP-External

TC 96-192 Affidavit Supporting Repossession & Disposition of a Vehicle

01/2014 Word SP-External

TC 96-204 Application for Disabled Persons Special Parking Permit 01/2016 Word SP-External

TC 96-209 Temporary Tag Application 02/2014 Word SP-External

TC 96-210 Temporary Tag Log 07/2010 Word SP-External

TC 96-215 Affidavit of Motor Vehicle Assembled from Wrecked or Salvaged Motor Vehicles

06/2018 Word SP-External

TC 96-217 Application for Disabled Veterans Free Certificate of Registration and License Plates

07/2006 PDF SP-External

TC 96-219 Application for Special Radio Operator License Plate 03/1990 Paper None

TC 96-222 Application for Dealer Demonstrator License Plates 03/2014 Word SP-External

TC 96-228 Application for Disaster and Emergency Services Plate 03/2014 Word SP-External

TC 96-229 Vehicle Inspection Performed in Another State 03/2014 Word SP-External

TC 96-322 Affidavit of Mileage Correction 01/2014 Word SP-External

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Number Title Revision Date Format Website

TC 96-323 Kentucky Mandatory Insurance Reporting Enrollment 04/2014 Word SP-External

TC 96-324 Attestation 07/2017 Word SP-External

TC 96-325 Special Plate Donation Affidavit 05/2009 Paper None

TC 96-327 Certified Motor Vehicle Inspector Designation 03/2017 Word SP-Internal

TC 96-328 Special Event License Plate 02/2012 Word SP-External

TC 96-330 Affidavit to Grant/Revoke Permission for a Person to Pick Up Certificates of Title

07/2016 Word SP-External

TC 96-331 Police Impounded Vehicle 09/2015 PDF SP-External

TC 96-332 Affidavit for Special License Plate Donation 05/2014 Word SP-External

TC 96-333 Organization or Group Application for a Special License Plate

05/2014 Word SP-External

TC 96-334 Outside Agency User ID Security Request 05/2014 Word SP-Internal

TC 96-335 County Clerk and Motor Vehicle Licensing User ID Security Request

08/2016 Word SP-Internal

TC 96-336 Limited Power of Attorney to Transfer Ownership & Disclose Mileage

05/2015 Word SP-External

TC 96-337 Request for Motor Vehicle Inventory due to DUI 05/2016 Word SP-Internal

TC 96-338 Affidavit to Remove Title From Archive 08/2016 Word SP-External

TC 96-339 Application for Vehicle Identification Number (VIN) Removal

06/2015 Word SP-External

TC 96-340 Commercial Trailer Temporary Tag Log 08/2015 Word SP-External

TC 96-341 Affidavit for Motor Vehicle Usage 04/2016 Word SP-External

TC 96-342 Application for Specialized License Plate 07/2017 Word SP-External

TC 96-343 Affidavit for Boat Hull Identification Number 03/2018 Word SP-External

TC 96-344 Military Surplus Vehicle Inspection 05/2017 Word SP-External

TC 96-345 Application for National Guard Plate 07/2017 Word SP-External

TC 98-001 Application for Motor Vehicle Dealer License 04/2017 PDF SP-External

TC 98-002 Application for Motor Vehicle Manufacturer/Distributor License

08/2010 Word SP-External

TC 98-003 Application for Temporary Off-Site Sale or Display Event 07/2014 Word SP-External

TC 98-004 Salesperson License Application 02/2017 Word SP-External

TC 98-005 Vehicle Purchase Complaint 07/2014 Word SP-External

TC 99-001A Application for Encroachment Permit 01/2015 Word SP-External

TC 99-001B Encroachment Permit 01/2012 Paper None

TC 99-007 Encroachment Permit Bond 06/2018 Word SP-External

TC 99-022 Agreement for Services to Be Performed 01/2015 Excel SP-External

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Number Title Revision Date Format Website

TC 99-027 Ownership Disclosure Statement 07/1995 Word SP-Internal

TC 99-028 Categorical Exclusion Checklist 07/1995 PDF SP-External

TC 99-031 Application for Off-Premise Advertising Device 01/2015 Word SP-External

TC 99-032 Advertising Device Permit 05/2013 Paper None

TC 99-056 Application for Recycling Permit & Screening Plan Approval 06/2018 Excel SP-External

TC 99-057 Permit for Automobile, Vehicle, Machinery, or Material Recycling Yard

07/1995 Paper None

TC 99-058 Automobile, Vehicle, Machinery or Material Recycling Yard Permit

04/2015 PDF SP-Internal

TC 99-200 Limited Supplemental Guide Signs Application 11/2013 Word SP-External

TC 99-202 Temporary Agritourism Site Application 04/2010 Excel SP-External

TC 99-203 Attraction Eligibility Information 05/2009 Excel SP-External

TC 99-204 Signing Incentives Program Application 02/2010 Excel SP-External

TC 99-205 Advertising Device Ownership Transfer 01/2015 Word SP-External

TC 99-206 Advertising Device Biennial Certification 01/2015 Word SP-External

TC 99-207 Application for Off-Premise Electronic Advertising Device 01/2015 Word SP-External

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