DOC Forms Price List Report

Department of Corrections FORMS PRICE LIST General Distribution

Wednesday, September 6, 2023

All items with Check Marks are stored at the Moberly Warehouse

All items without Prices shown are more than 5 years since last ordered from the Print Shop, Call For Availability

F/G Form No.

Form Name

Pkg

Price

Revision

Qty

Per Pkg

Date

300-0162 300-0294 300-0966 300-1249 931-0012 931-0013 931-0014 931-0022 931-0086 931-0110 931-0113 931-0134 931-0227 931-0229 931-0259 931-0260 931-0262 931-0263 931-0276 931-0289

931-0322 931-0325 931-0356 931-0358 931-0395 931-0408 931-0478 931-0490 931-0688 931-0730 931-0740 931-0751 931-0752 931-0775 931-0813 931-0872 931-0925 931-1002 931-1029 931-1054 931-1213

Local PO Bid Record Employee Performance Note Monthly Expense Report Report of State Owned Surplus Property Warrant (P&P) Property Pick-Up/Inventory Contact Lens Request #10 Envelope-WERDCC Corrective Action Report Energy Consumption Report #11 Confiscated Money Envelope Report Of Escape #10 Envelope-ACC Chronological Data Sheet Witness Request Visiting Application Inmate Time Card Cooks Worksheet Special Visit Request Offender's Request for Disposition of Indictments, Informations or Complaints (Missouri Only) Out Guide Schedule Inquiry-Basic Information Classification Analysis - Educational Needs Classification Analysis-Medical Needs Conduct Violation Report Classification Hearing Enemy Waiver Visiting List - Change Removals Emergency Drill Classification Analysis-Mental Health Needs X-RAY Requisition Canteen Purchase List Extra Duty Assignment Record Waiver Of Hearing Notification Close Observation- Log Offender Restriction Notification Money Order, Cash, Cash Return Physical Inventory Department Revenue Transmittal Notice Of Detainer Housing Unit Count

100/Pkg 100/Pd 100/Pkg 100/Pkg 100/Pkg 200/Pkg 100/Pd 1000/M 300/Pkg 100/Pkg 500/Pkg 100/Pkg 1000/M 100/Pkg 200/Pkg 300/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg

100/Pkg 100/Pkg 100/Pd 100/Pd 100/Pkg 300/Pkg 300/Pkg 100/Pkg 100/Pkg 100/Pd 100/Pkg 100/Pkg 200/Pkg 300/Pkg 100/Pkg 500/Pkg 100/Pkg 100/Pd 100/Pkg 100/Pkg 100/Pd

$19.80 $0.00 $0.00

$44.00 $0.00 $8.80 $0.00

$54.00 $36.25

$0.00 $75.00 $13.10 $54.00

$4.70 $8.30 $12.20 $13.10 $7.50 $4.70 $32.75

$0.00 $0.00 $0.00 $0.00 $13.10 $37.25 $37.25 $4.70 $0.00 $0.00 $4.70 $4.60 $19.80 $37.25 $4.90 $17.50 $10.90 $4.70 $19.80 $0.00 $4.70

8-01 4-86 4-06 8-10 6-11 2/22 8-94 9-10 7/19 10-97 1-87 5-06 5-06 1-15 5/19 12/17 02/21 5-01 9-12 10-09

12-89 11-14 4-14 5/19 3-00 6-13 6-13 06/23 6-14 11-12 11-95 2-90 5/19 7-16 9-04 4-90 3-96 3-02 5-11 1-95

Page 1 of 14

F/G Form No.

931-1294 931-1318 931-1319 931-1324 931-1410 931-1413 931-1431 931-1435 931-1477 931-1508 931-1569 931-1572 931-1604 931-1628 931-1637 931-1680 931-1696 931-1697 931-1706 931-1709 931-1719 931-1745 931-1767 931-1782 931-1809 931-1814 931-1832 931-1842 931-1894 931-1945 931-2111 931-2112 931-2190 931-2200 931-2202 931-2203 931-2245 931-2266 931-2284 931-2285 931-2288 931-2299 931-2327 931-2338 931-2376 931-2384 931-2387 931-2417 931-2430

Form Name

Offender Safety Rules-Machine Equipment Monthly Vehicle Operator Log Health Services Request Division of Probation and Parole #10 Envelope Inventory Record Request for Withdrawal of Offender's Personal Funds Temporary Ad. Seg. Confinement BIN Card Certificate Of Release Interdisciplinary Program Notes #10 Envelope-CCC Referral and Screening Note - Health Services Recycling Revenue and Expenditures Inventory Tagging Instructions Refusal, Reversal of Refusal to Participate Request for Urinalysis - Chain of Evidence-Institution Dispensation & Release Personal Property Storeroom Requisition #10 Window Envelope-Fiscal Management Unit Deposit Slip Receiving Report Industry Admittance/Discharge Slip Supply Request Offender Field Transfer Count Report #10 Envelope-FCC Refusal Of Treatment - No Show Medical Appointment #10 Envelope-OCC Daily Food Service Report Institutional Count Worksheet - JCCC Institutional Entry/Exit Log Visiting Room Log Vehicle Entry Exit Log MOSOP Chronological Sheet MOSOP Face Sheet Return To Stores Radio Log MOSOP Communication MOSOP Orientation Pre & Post Survey Institutional Count Count-MCC Delivery Ticket Offender Movement Pass Laundry Count Sheet Weight Slip-MVE Laundry Vehicle Pass Shift Supervisor - Control Center Chronological Log-MECC Visitors Pass

Pkg Qty

100/Pkg 200/Pkg 500/Pkg 1000/M 200/Pkg 600/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pd 1000/M 100/Pkg 100/Pkg 100/Pkg 100/Pkg 200/Pkg 100/Pkg 100/Pkg 1000/M 300/Pkg 100/Pkg 100/Pkg 300/Pkg 100/Pd 100/Pd 1000/M 500/Pkg 100/Pkg 1000/M 100/Pkg 100/Pd 200/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pd 100/Pkg 100/Pd 100/Pd 300/Pkg 100/Pkg 100/Pkg 100/Pd

Price Per Pkg

$4.70 $46.50 $18.40 $54.00 $48.50 $43.25 $41.75

$9.60 $0.00 $0.00 $54.00 $4.70 $0.00 $0.00 $41.75 $44.00 $0.00 $13.10 $0.00 $6.70 $32.75 $10.90 $37.25 $4.30 $4.70 $54.00 $18.40 $7.20 $54.00 $0.00 $0.00 $13.00 $4.90 $4.70 $4.70 $4.70 $10.90 $4.70 $17.10 $0.00 $0.00 $2.90 $0.00 $1.40 $0.86 $19.20 $7.20 $0.00 $0.86

Revision Date

8-13 11-01 02/19 11/18 6-90 9-01 4-11 6-00 11-11 2-93 4-09 8-13 12-01 12-01 9-90 8-07 4-00 6-97 4-02 1-11 4-96 7-94 5-95 7-99 11/17 1-05 9-12 10-93 4-02 10-11 12-04 1-90 4-89 12-94 6-89 6-89 11-94 7-13 6-89 12-89 8-88 9-01 5-90 10-11 8-96 9-96 6-95 12-05 3-95

Page 2 of 14

F/G Form No.

931-2508 931-2539 931-2590 931-2591 931-2706 931-2750 931-2853 931-2889 931-2902 931-2924 931-2966 931-3006 931-3035 931-3049 931-3062 931-3078 931-3098 931-3149 931-3154 931-3155 931-3186 931-3201 931-3212 931-3214 931-3227 931-3235 931-3240 931-3241 931-3243 931-3244 931-3245 931-3247 931-3264 931-3274 931-3281 931-3298 931-3299 931-3315 931-3320 931-3324 931-3325 931-3360 931-3363 931-3364 931-3376 931-3377 931-3378 931-3379 931-3381

Form Name

Shipping Transcript Statement Of Your Rights Sexual Offender Program Information (Phase I) Sexual Offender Program Information (PHASE II) Posted Orders Notification Medication-Diet Card Traffic Placement Center Sheet-MECC Department Purchase Order - Inmate Canteen Offender I.D. Back-Up Card Armory Log Segregation Unit Roster Control Center Count Report-MCC Laundry Checklist Firearms Certification Job Report Offender I.D. Card Administrative Segregation Confinement Record-PCC #10 Envelope-FRDC #10 Window Envelope-ACC #10 Envelope-MCC MOSOP Orientation Sessions General Attendance Testing Vehicle Inspection Sheet Vehicle Security Check #10 Window Envelope-FCC Regular Performance Approval Summary Notice Certificate Defense Tactical Instructor #10 Envelope-DOC Box 236 Room Inspection Checklist #10 Envelope-DOC Personnel Unit Offender Urine Sample Label (Min Order 1400 Labels) Steam Heating Plant-Water Chemistry & Water Treatment Log Steam Heating Plant Log #10 Window Envelope-BCC #10 Window Envelope-JCCC Master Count Sheet Laundry List Dry Cleaning Ticket #10 Envelope-JCCC Promissory Note #10 Envelope-BCC Sign Out-Offender Monthly Vehicle Travel Log #10 Envelope-TCC #10 Envelope-TCSTL Informal Resolution Request Offender Grievance Offender Grievance Appeal #10 Envelope-DOC Offender Finance Office Consumable Inventory Summary

Pkg Qty

100/Pkg 300/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pd 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 1000/M 1000/M 1000/M 100/Pkg 100/Pkg 100/Pkg 1000/M 100/Pd 100/Pkg 1000/M 500/Pkg 1000/M 1400/Pkg 100/Pkg 100/Pkg 1000/M 1000/M 100/Pkg 100/Pkg 100/Pkg 1000/M 100/Pkg 1000/M 500/Pkg 200/Pkg 1000/M 1000/M 500/Pkg 200/Pkg 200/Pkg 1000/M 100/Pkg

Price Per Pkg

$38.50 $37.25 $19.80 $19.80

$0.00 $3.00 $0.00 $0.00 $0.00 $0.00 $4.70 $4.90 $13.10 $4.90 $7.20 $4.50 $0.00 $54.00 $76.50 $54.00 $0.00 $2.90 $4.70 $0.00 $0.00 $0.00 $54.00 $18.40 $0.00 $35.00 $7.50 $0.00 $76.50 $76.50 $0.00 $0.00 $10.90 $54.00 $0.00 $54.00 $19.50 $46.50 $54.00 $0.00 $18.40 $8.30 $8.30 $0.00 $4.70

Revision Date

5-03 5/19 6-91 4-93 8-14 5-87 2-95 6-97 9-97 5-91 4-04 9-01 9-96 10-99 3-96 7-97 9-00 11/18

11-07 6-89 10-90 8-15 1-05 7-88 9-05 4-02 1-00 4-02 9-03 8-97 3-97 10-02 4-09 9-87 4-90 7-13 4-09 5-91 10-02 12-97 11-01 4-02 12/18 09/22 12-04 5-03 4-02 6-02

Page 3 of 14

F/G Form No.

931-3389 931-3391 931-3397 931-3399 931-3405 931-3407 931-3435 931-3440 931-3450 931-3461 931-3463 931-3464 931-3465 931-3466 931-3469 931-3476 931-3477 931-3485 931-3488 931-3489 931-3496 931-3504 931-3507 931-3508 931-3509 931-3511 931-3512 931-3516 931-3517 931-3527 931-3533 931-3534 931-3535 931-3536 931-3537 931-3543 931-3549 931-3550 931-3556 931-3563 931-3564 931-3567 931-3570 931-3583 931-3588 931-3597 931-3600 931-3601 931-3623

Form Name

Operational Housing Unit Count-ERDCC #10 Envelope-MECC Wanted Persons Check MULES NCIC Suicide Intervention Report Educational/Vocational Evaluation #10 Envelope-WMCC Offender Clothing-Male/ Female Offender Clearance Offender Assets Disclosure Availability Letter W/Application Interview Call Letter W/Application Interview Call Letter Without Application Institutional Count Report Institutional Count Record-PCC Administrative Procedure Warning Mailroom Package Control Log #10 Envelope-KCCRC Censorship Notification Shift Supervisor Control Center Chronological Log-PCC Operational H.U. Count Medication Administration Record Daily Shift Report-OCC State House Preoccupation Agreement Treatment Progress Report MOSOP Part & Exam Report PH II Cont. Enemy Listing - Protective Custody Declaration MOSOP Prop Loan Receipt #10 Window Envelope-MVE Central Office Key and Lock Requisition Count Sheet Monthly Cost & Recap Sheet Personal Property Inventory-Male Legal Material Inventory Property Transaction Property Disposition Employee Emergency Data Individual Confinement Record Offender Appointment Schedule H.U. Traffic Sheet MOSOP Participation - Appellant Information PC Custody Needs Assessment/Waiver Institutional Security Inspection Report MOSOP Phase II Treatment Plan Report Personal Property Inventory-Female Computer Criminal History Inquiry Basic Hygiene Issue Log HIV AIDS Information Pre Test (Staff) Issue Log Prescription

Pkg Qty

100/Pkg 1000/M 100/Pkg 100/Pkg 100/Pkg 1000/M 200/Pkg 200/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 1000/M 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 300/Pkg 100/Pkg 1000/M 100/Pd 100/Pkg 100/Pkg 100/Pkg 100/Pkg 300/Pkg 100/Pkg 100/Pkg 300/Pkg 100/Pkg 100/Pkg 100/Pkg 300/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pd 100/Pkg 100/Pkg 100/Pkg 100/Pkg

Price Per Pkg

$4.70 $54.00

$4.70 $41.75

$0.00 $54.00 $46.50 $44.00 $13.10

$0.00 $0.00 $0.00 $4.70 $0.00 $0.00 $4.70 $54.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $11.90 $0.00 $0.00 $2.90 $2.90 $4.70 $10.20 $0.00 $37.25 $0.00 $0.00 $12.60 $4.60 $0.00 $0.00 $37.25 $4.70 $0.00 $10.20 $0.00 $0.00 $0.00 $4.90 $2.90

Revision Date

5-03 12-03 8-13 5-00 10-14 4-02 8-03 7-99 12-08 1-90 1-90 1-90 12-88 5-09 1-89 3-95 11/21 12-12 11-96 2-89 5-93 5-10 5-89 3-91 6-89 9-07 6-89 7-89 6-97 4-99 12-97 8-03 4-92 02/22 1-04 10-89 07/23 7-12 1-90 11-89 4-15 8-11 12-89 8-03 5-95 12-90 7-90 7-13 1-97

Page 4 of 14

F/G Form No.

931-3627 931-3631 931-3637 931-3642 931-3647 931-3654 931-3686 931-3688 931-3692 931-3694 931-3695 931-3699 931-3711 931-3713 931-3715 931-3719 931-3723 931-3726 931-3727 931-3729 931-3730 931-3732 931-3737 931-3737-B 931-3738 931-3741 931-3746 931-3749 931-3751 931-3755 931-3756 931-3760 931-3761 931-3762 931-3763 931-3774 931-3776 931-3777 931-3778 931-3779 931-3780 931-3781 931-3782 931-3783 931-3784 931-3785 931-3786 931-3787 931-3788

Form Name

Career and Technical Education Job Order Invoice Informed Consent For Mental Health Medication Classification Action Sheet Laundry Checklist Control Center Master Count Sheet-ACC Classification Analysis - Vocational Needs Diagnostic Personal Property Inventory-Male Diagnostic Personal Property-Female Marriage Application Sign-In Offender Sign In Nurses Administrational Record Optometry Exam Re-Entry File Checklist Firearms Instructor Certification Appliance Repair/Return Conduct Violation Log Shift Supervisor/Control Center Chronological Log-BCC Response Team Report Dining Room Staff & Guest Register Receipt Receipt Of Information on Tuberculosis Screening #10 Envelope-MVE 12 x 15? Kraft Envelope-MVE Daily Count-OCC Physical Statement on Tuberculosis Screening #10 Envelope-FTC Optical Products Lab Psychiatric Consultation Patient Information Confidential Medical Fax Sheet Intake Health Screening R/O Medical Negative HIV Test Results Segregation Medical Documentation Screen Instrument-OCC Drug Treatment Program Open Visiting Request H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC H.U. Count Sheet-MCC

Pkg Qty

100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pd 100/Pkg 100/Pkg 100/Pd 200/Pkg 500/Pkg 100/Pkg 100/Pd 100/Pd 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pkg 100/Pd 100/Pkg 1000/M 1000/M 100/Pkg 100/Pkg 1000/M 100/Pkg 100/Pd 100/Pkg 100/Pd 100/Pd 100/Pd 100/Pkg 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd 100/Pd

Price Per Pkg

$0.00 $0.00 $4.90 $0.00 $0.00 $0.00 $19.80 $0.00 $4.70 $8.30 $18.40 $4.70 $0.00 $0.00 $0.00 $10.90 $4.70 $0.00 $0.00 $4.70 $2.90 $0.00 $0.00 $0.00 $4.70 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $2.90 $0.00 $0.00 $0.00 $4.70 $4.70 $4.70 $4.70 $4.70 $4.70 $4.70 $4.70 $4.70 $4.70 $4.70 $4.70 $4.70

Revision Date

10-08 4-09 5-91 5-91 11-09 4-14 10/22 10/22 9-14 7-12 8/20 7-94 3-93 5-93 9-05 11-96 2-97 5-10 3-13 8-93 11-94 2-11 4-02 4-02 10-01 2-11 1-05 11-93 4-94 8-98 9-99 4-94 8-99 2-97 6-94 8-94 6-94 6-94 6-94 6-94 6-94 6-94 6-94 6-94 6-94 6-94 6-94 6-94 6-94

Page 5 of 14

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