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Public Use Forms by Title

Forms Listed by Title

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Form
Number
Title
Revision
Date
Form
Link
 

Health and Human Services (HHS)

   
HHS-690 Assurance of Compliance
05/16
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HHS-568 Procedures for Submission of Final Invention Statement
08/12
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HHS-691 Request for Special Pay for Physicians and Dentists
10/06
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Public Health Service (PHS)

   
N/A PHS Request for Basic Training Contract Memo
01/17
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N/A PHS Sample Memorandum To Request Payment of A Uniform Allowance
08/16
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N/A PHS Training Purposes and Objectives
08/16
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N/A Commissioned Corps of the U.S. Public Health Service – General Instructions for Completing Medical Examination Forms DD-2807-1 “Report of Medical History” and DD-2808 “Report of Medical Examination”
11/16
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PHS-398 Public Health Service – Includes Research Career Awards and Institutional National Research Service Awards
08/12
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PHS-416-1 Application for an Individual National Research Service Award Fellowship
Instructions
08/12
PHS-416-5 Research Fellowship Activation Notice
08/12
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PHS-416-7 Termination Notice NRSA
06/15
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PHS-416-9 Application for PHS Individual National Research Service Continuation Award
Instructions
08/12
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PHS-838 Commissioned Officers Effectiveness Report
08/15
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PHS-1122-1 Application for Training for PHS Commissioned Personnel (Privacy Act) (Also print the cover memo) [PDF]
08/16
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PHS-1881-1 Basic Training Contract
16-Aug
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PHS-1881-2 Order Pursuant to Basic Training Contract
16-Aug
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PHS-2271 Statement of Appointment of Trainee
15-Jun
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PHS-2590 Application for Continuation of a PHS Grant
12-Aug
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PHS-2988 Voucher for Reimbursement for Travel Dependents of PHS COs
16-Nov
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PHS-3734 Official Statement Relinquishing Interest and Rights in a PHS Research Grant
15-Jun
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PHS-4013-1 Application for Shipments of Household Goods (Commissioned Officers) 
16-Aug
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PHS-5141-2 Appointment Affidavit Regular Corps
16-Aug
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PHS-6031-1 Annual National Research Service Award
12-Aug
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PHS-6031 National Research Service Award
12-Aug
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PHS-6315 Assurance of Compliance by Sub-Award Recipients
16-Nov
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PHS-6342-2 Individual Honor Award Nomination Record - Part 1
16-Oct
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PHS-6349 Annual Report on Possible Research Misconduct
16-Nov
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PHS-6355 Report of Dental Examination of Applicants to the Commissioned Corps of the Public Health Service
17-Jun
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PHS-6373 Extramural Training Agreement
16-Aug
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PHS-6374 Intramural Training Agreement
16-Nov
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PHS-6379 Supplemental Medical History Record Required of Applicants to the Public Health Service Commissioned Corps
17-Jun
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PHS-7044 Commissioned Corps Annual Physical Fitness Test (APFT) Readiness Standards Report Form
16-Jan
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PHS-7045 Temporary Lodging Expense (TLE) Computation Worksheet
16-Aug
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PHS-7062 Extramural Training Agreement (Scholarships, Grants, Fellowships)
16-Nov
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PHS-7064 Training Agreement for Officers Assigned as Students to School of Medicine
Also print the cover memo [PDF]
08/16
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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-172 SAMHSA Application for Peer Grant Review  Exp 06/04
 

 

Indian Health Service

   
IHS-810 IHS Authorization for Release of Information 04/16
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IHS-913 Request for an Accounting of Disclosures 04/16
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IHS-963 Request for Confidential Communication by Alternative Means or Alternate Location 04/09
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IHS-917 Request for Correction/Amendment of Protected Health Information 04/16
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IHS-912-1 Request for Restriction(s) 04/16
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IHS-912-2 Request for Revocation of Restriction(s) 04/16
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Content created by Program Support Center (PSC)
Content last reviewed on June 26, 2017