Forms
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Form
Number |
Title |
Revision
Date |
Adobe
PDF |
| |
Health
and Human Services (HHS) |
|
|
| HHS-568 |
Procedures
for Submission of Final Invention Statement |
9/04 |
|
| HHS-687 |
Consent to
Sterilization |
11/06 |
|
| HHS-687-1 |
Consent to
Sterilization (Spanish Version) |
11/06 |
|
| HHS-690 |
Assurance of Compliance |
08/05 |
|
| HHS-719 |
Request for Copy of the
Record(s) in the Case File |
09/05 |
|
| HHS-720 |
Request for Copy of Record(s): Third-Party with the Individual Appellant's Consent |
08/05 |
|
| HHS-721 |
Individual Appellant's Consent to Third-Party for Copies of the Individual Appellant's Record(s) |
08/05 |
|
| HHS-722 |
Request for Substitution of Party Upon Death of Party |
08/05 |
|
| HHS-723 |
Waiver of Right to an
Administrative Law Judge (ALJ) Hearing |
10/05 |
|
| HHS-724 |
Request to Correct, Amend, or Delete a Record(s) |
08/05 |
|
| HHS-725 |
Request for Administrative Law Judge (ALJ) to Review Dismissal by the Qualified Independent Contractor |
08/05 |
|
| HHS-727 |
Extension Request to File a Request for an Administrative Law Judge (ALJ) Hearing |
08/05 |
|
| HHS-728 |
Filing of New Evidence |
08/05 |
|
| HHS-729 |
Response to Notice of Hearing |
08/05 |
|
| HHS-730 |
Withdrawal of Request for an Administrative Law Judge (ALJ) Hearing |
08/05 |
|
| HHS-731 |
Withdrawal of Waiver of Right to an Administrative Law Judge (ALJ) Hearing |
08/05 |
|
| HHS-733 |
Identity Verification |
08/05 |
|
| HHS-734 |
Payment Information Report |
09/05 |
|
| HHS-752 |
20-Day Advanced Written Notice of Hearing |
09/05 |
|
| HHS-T-001 |
Response to Notice of Hearing |
08/05 |
|
| |
Public
Health Service (PHS) |
|
|
| PHS-50 |
Application
for Appointment as a Commissioned Officer in the US Public Health Service
Commissioned Corps |
10/08 |
|
| PHS-398 |
Application
for PHS Grant |
04/08 |
|
| PHS-416-1 |
Application
for PHS Individual National Research Service Award
Instructions
|
10/05 |
|
| PHS-416-5 |
Research Fellowship
Activation Notice |
10/05 |
|
| PHS-416-7 |
Termination
Notice NRSA |
10/05 |
|
| PHS-416-9 |
Application
for PHS Individual National Research Service Continuation Award
Instructions
|
10/05 |
|
| PHS-1813 |
Reference
Request for Applicants to the U.S. Public Health Service Commissioned Corps
|
10/03 |
|
| PHS-2590 |
Application
for Continuation of a PHS Grant |
05/01 |
|
| PHS-3734 |
Official Statement
Relinquishing Interest and Rights in a PHS Research Grant |
09/08 |
|
| PHS-5161-1 |
Grant Application
for Non-Construction Projects |
07/00 |
 * |
| PHS-6031 |
National Research
Service Award |
06/02 |
|
| PHS-6031-1 |
Annual
National Research Service Award |
06/02 |
|
| PHS-6349 |
Annual
Report on Possible Research Misconduct |
12/06 |
|
| |
Program
Support Center (PSC) |
|
|
| PSC-270 |
Student Loan Repayment Plan (Program Support Center (PSC) and PSC-Serviced HHS Components) |
11/08 |
|
| |
Substance
Abuse and Mental Health Services Administration (SAMHSA) |
|
|
| SMA-162 |
Application
for Certification to Use Opioid Drugs in a Treatment Center |
01/03 |
|
| SMA-167 |
Notification
of Intent to Use Opioid Drugs for Maintenance and Treatment |
00/00 |
|
| SMA-171 |
Prevention
Registry |
Exp
06/06 |
|
| SMA-172 |
SAMHSA Application
for Peer Grant Review |
Exp
06/04 |
|
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