ROUTE DIRECTLY TO ASSISTANCE DIVISION

ROUTE DIRECTLY TO ASSISTANCE DIVISION

AGENCY NAME: __________________________________________________

AGENCY CONTACT PERSON AND PHONE: ___________________________

Agencies: Please Note

THIS COVER SHEET SHOULD BE USED ONLY FOR ITEMS BEING SENT TO THE ASSISTANCE DIVISION, SUCH AS:

Request for 4.1(d)1 or 4.1(d)2

Layoff Plan

Layoff Report

Request for detail in excess of 1 year

Requests to rescind actions

Any other request requiring pre-approval by DSCS

Any other documents requested by the Assistance Division

DO NOT USE THIS COVER SHEET FOR RETURNING ANY
OTHER ITEMS TO CIVIL SERVICE OR ASSISTANCE DIVISION