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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
06/15
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HHS-691 Request for Special Pay for Physicians and Dentists
01/19
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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
01/18
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PHS-416-1 Application for an Individual National Research Service Award Fellowship
Instructions
01/18
PHS-416-5 Research Fellowship Activation Notice
06/15
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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-1345 Request and Authority for Leave of Absence (Commissioned Officers)
09/05
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PHS-1662 Request for Personnel Action - Commissioned Officer
10/04
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PHS-1881-1 Basic Training Contract
08/16
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PHS-1881-2 Order Pursuant to Basic Training Contract
08/16
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PHS-2271 Information and Instructions for Completing Statement of Appointment (Form PHS-2271) (Includes Application)
06/15
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PHS-2590 Application for Continuation of a PHS Grant
03/16
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PHS-2988 Voucher for Reimbursement for Travel Dependents of PHS COs
11/16
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PHS-3734 Official Statement Relinquishing Interests and Rights in a Public Health Service Research Grant
06/15
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PHS-4013-1 Application for Shipments of Household Goods (Commissioned Officers) 
08/16
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PHS-4392 Billet Description
04/06
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PHS-5141-2 Appointment Affidavit Regular Corps
08/16
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PHS-6031 National Research Service Award
06/15
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PHS-6031-1 Annual National Research Service Award
06/15
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PHS-6051 Merit Promotion Program Certificate for Eligibles
01/90
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PHS-6051-1 AHCPR Certificates for Eligibles
05/90
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PHS-6106 Agreement - To Receive an Allowance under the Federal Physicians Comparability Allowance Program
09/88
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PHS-6189-1 Retention Bonus (RB) Agreement Request
12/18
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PHS-6300-1 Medical Special Pay (MSP) Contract Request
04/98
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PHS-6310-1 Incentive Pay (IP) Agreement
12/18
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PHS-6315 Assurance of Compliance by Sub-Award Recipients
01/18
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PHS-6342-2 Individual Honor Award Nomination Record - Part 1
10/16
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PHS-6349 Annual Report on Possible Research Misconduct
11/18
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PHS-6353-1 Request for Voluntary State Income Tax Withholding from Retired Pay
03/05
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PHS-6355 Report of Dental Examination of Applicants to the Commissioned Corps of the Public Health Service
05/17
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PHS-6364 PHS Employee Invention Report
01/93
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PHS-6373 Extramural Training Agreement
08/16
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PHS-6374 Intramural Training Agreement
08/16
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PHS-6379 Supplemental Medical History Record Required of Applicants to the Public Health Service Commissioned Corps
05/17
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PHS-7015 Engineering and Scientific Career Continuation Pay (ESCCP) Contract Request
09/01
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PHS-7015-1 Board Certification Incentive Pay (BCIP) Agreement Request
12/18
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PHS-7033 Special Pay Contract - Accession Bonus
12/18
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PHS-7044 Commissioned Corps Annual Physical Fitness Test (APFT) Readiness Standards Report*
07/19
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PHS-7044-1 Verified Weight Report
09/18
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PHS-7045 Temporary Lodging Expense (TLE) Computation Worksheet
09/16
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PHS-7047 Certification of Clinical Practice Hours*
06/19
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PHS-7062 Extramural Training Agreement (Scholarships, Grants, Fellowships)
08/16
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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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PHS-7082 Post-9/11 GI Bill Educational Benefits Transferability Commitment and Statement of Understanding*
06/19
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PHS-7083 Behavorial Health Survey*
04/19
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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
02/18
SMA-167 Notification of Intent to Use Opioid Drugs for Maintenance and Treatment
00/00
SMA-172 SAMHSA Application for Peer Grant Review
 Exp 09/17
 

 

Indian Health Service

   
IHS-810 IHS Authorization for Release of Information
04/16
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IHS-912-1 Request for Restriction(s)
04/09
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IHS-912-2 Request for Revocation of Restriction(s)
04/09
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IHS-913 Request for an Accounting of Disclosures
04/09
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IHS-917 Request for Correction/Amendment of Protected Health Information
04/09
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IHS-963 Request for Confidential Communication by Alternative Means or Alternate Location
04/09
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IHS-975 Request for Ratification of Unauthorized Commitment (UAC)
06/19
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The contents on this site noted with “*” are in the process of Section 508 review. If you need immediate assistance accessing the content, please submit a request to Cheryllyn Bachelor (PSC) at Cheryllyn.Bachelor@psc.hhs.gov. Content will be updated pending the outcome of the Section 508 review.

Content created by Program Support Center (PSC)
Content last reviewed on September 3, 2019