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All Forms

Form Title: Travel Request Form

This is the form to be filled out when requesting travel outside the District of New York Northern.

Form Title: Monthly Report - En Español

The montly supervision report form Spanish/En Español version.

Form Title: Monthly Report

The monthly supervision report English version

Form Title: Travel Request Form

This is the form to be filled out when requesting travel outside the District of New York Northern.

Form Title: Supplemental Supervision Report

This is the supplemental supervision report form for offenders charged with or convicted of sex offenses.

Form Title: Location Monitoring Schedule Change Request

This is form for requesting a change in your set schedule for location monitoring. This MUST be approved by your designated Probation Officer before any such change is made.

Form Title: Location Monitoring Schedule Change Request

This is form for requesting a change in your set schedule for location monitoring. This MUST be approved by your designated Probation Officer before any such change is made.

Form Title: Self Help Attendance Form

This form is for keeping track of your hours and atendence to self-help events.

Form Title: Job Search Log

This form is for tracking information for offender job searches.

Form Title: Community Service Log

Form for recording community service performed.

Form Title: Modified Financial Form

A form for disclosing financial information.

Form Title: Monthly Cash Flow Statement

A file for describing your monthly cash inflows and outflows.

Form Title: Amendment to Monthly Cash Flow Statement

A local form for adding additional cash outflows.

Form Title: Pretrial Services Supervision Report
Form Title: Daily Treatment Log
Form Number:
Attachment J.6

Log for tracking treatment of clients. Complete one form per client per month.

Form Title: Treatment Services Invoice
Form Number:
Attachment J.8

The Administrative Offices of the United States Courts treatment services invoice. Part A & Part B.

Form Title: Additional Treatment Logs
Form Number:
Attachment J.9

Includes Breathalyzer Instrument Log, Breathalyzer Log, Sweat Patch Testing Log, and Urinalysis Testing Log.

Form Title: Authorization to Release Confidential Information (Drug Abuse Programs)
Form Number:
PROB 11B

United States Probation system authorization to release confidential information from drug abuse programs.

Form Title: Authorization to Release Confidential Information (Substance Abuse & Mental Health)
Form Number:
Prob 11E

United States Probation system authorization to release confidential information from substance abuse and mental health treatment programs.

Form Title: Authorization to Release Confidential Information (Mental Health Treatment)
Form Number:
Prob 11I

United States Probation system authorization to release confidential information from mental health treatment programs.

Form Title: Travel Log
Form Number:
Prob 17

Unites States Probation and Pretrail services travel log.

Form Title: Monthly Treatment Report
Form Number:
Prob 46

Form to be completed and submitted with each monthly billing. Additional information may be included.

Form Title: Authorization to Release Confidential Information (Drug & Alchohol Programs)
Form Number:
PS 6B

Authorization to release confidential information for drug and alchohol abuse programs.

Form Title: Authorization to Release Confidential Information (PS) (Mental Health Treatment)
Form Number:
PS 6D

United States Pretrial services system authorization to release confidential information from mental health treatment programs.