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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-568Procedures for Submission of Final Invention Statement
06/15
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HHS-691Request for Title 38 Physician, Dentist and Podiatrist Pay (PDP)
01/21
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HHS-990-1 (NTEU)HHS Workplace Flexibilities Agreement (NTEU Employees Only)
05/23
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HHS-990-2HHS Telework Agreement Form (New Form)

03/25

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Public Health Service (PHS)

  
N/ACommissioned 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"
07/18
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N/APHS Request for Basic Training Contract Memo
01/23
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N/APHS Sample Memorandum to Request Payment of A Uniform Allowance
09/20
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N/APHS Service Award, Campaign Medal, and Training Ribbons Nomination Record
01/23
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N/APHS LTT Forms Checklist

PHS Training Purposes and Objectives
01/23

01/23
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PHS-398Public Health Service – Includes Research Career Awards and Institutional National Research Service Awards
03/20
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PHS-416-1Application for an Individual National Research Service Award Fellowship
Instructions
01/21
Online
PHS-416-5Research Fellowship Activation Notice
04/20
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PHS-416-7Termination Notice NRSA
06/15
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PHS-416-9Application for PHS Individual National Research Service Continuation Award
Instructions
08/12
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PHS-488Claim for Temporary Lodging Allowance
09/20
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PHS-838Commissioned Officers Effectiveness Report
08/15
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PHS-1122-1Application for Training for PHS Commissioned Personnel (Privacy Act) (Also print the cover memo)
01/23
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PHS-1345Request and Authority for Leave of Absence (Commissioned Officers)
09/05
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PHS-1373Separation of Commissioned Officer

05/24

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PHS-1637-1Public Health Service - Commissioned Officer's Request for Dependency Determination
11/20
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PHS-1662Request for Personnel Action - Commissioned Officer
10/04
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PHS-1881-1Basic Training Contract
01/23
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PHS-1881-2Order Pursuant to Basic Training Contract
01/23
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PHS-2271Information and Instructions for Completing Statement of Appointment (Form PHS-2271) (Includes Application)
04/24
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PHS-2590Application for Continuation of a PHS Grant
03/16
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PHS-2874Notice of Arrival
04/24
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PHS-2977Quarters Allowance Certificate
05/90
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PHS-2988Voucher for Reimbursement for Travel Dependents of PHS COs
03/24
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PHS-3734Official Statement Relinquishing Interests and Rights in a Public Health Service Research Grant
06/15
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PHS-4013-1Application for Shipments of Household Goods (Commissioned Officers) 
11/24
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PHS-4392Billet Description
02/24
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PHS-5141-2Appointment Affidavit Regular Corps
12/24
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PHS-6031National Research Service Award
08/18
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PHS-6031-1Annual National Research Service Award
06/15
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PHS-6051Merit Promotion Program Certificate for Eligibles
01/90
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PHS-6051-1AHCPR Certificates for Eligibles
05/90
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PHS-6059Request for Overseas Allowances
09/20
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PHS-6106Agreement - To Receive an Allowance under the Federal Physicians Comparability Allowance Program
09/88
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PHS-6173Application for Allotment of Pay (NON-GI BILL: use PHS-7039 for GI BILL)
09/20
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PHS-6189-1Retention Bonus (RB) Agreement Request
12/18
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PHS-6231Certification for Intermittent Tours of Duty
09/20
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PHS-6310-1Incentive Pay (IP) Agreement
12/18
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PHS-6315Assurance of Compliance by Sub-Award Recipients
02/24
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PHS-6342-1Unit Honor Award Nomination Record - Part 1
12/24
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PHS-6342-2Individual Honor Award Nomination Record - Part 1
12/24
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PHS-6349Annual Report on Possible Research Misconduct
10/24
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PHS-6353PHS Commissioned Officer State Tax Withholding Allowance Certificate
09/20
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PHS-6355Report of Dental Examination of Applicants to the Commissioned Corps of the Public Health Service
05/17
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PHS-6363Request to Establish/Change Mailing Address
11/20
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PHS-6364PHS Employee Invention Report
01/93
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PHS-6367Active-Duty Certification (Short Tours of Less Than 30 Days)
09/20
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PHS-6373Extramural Training Agreement
02/24
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PHS-6374Intramural Training Agreement
02/24
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PHS-6380Request for Uniformed Services Medical Records
01/05
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PHS-7015-1Board Certification Incentive Pay (BCIP) Agreement Request
02/25
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PHS-7033Special Pay Contract - Accession Bonus
11/18
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PHS-7036Reimbursement Request Expenses for Adoption
09/20
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PHS-7044Annual Physical Fitness Test (APFT) Report
11/24
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PHS-7044-1Verified Weight Report
11/24
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PHS-7045Temporary Lodging Expense (TLE) Computation Worksheet
09/16
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PHS-7062Extramural Training Agreement (Scholarships, Grants, Fellowships)
01/23
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PHS-7064Training Agreement for Officers Assigned as Students to School of Medicine Form
01/23
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PHS-7082-2Post-9/11 GI Bill Educational Benefits Transferability Commitment and Statement of Understanding
04/20
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PHS-7083Behavioral Health Survey
02/24
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PHS-7088Practice Hours Waiver Request

03/24

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PHS-7089Special Duty Pay (SDP) Agreement

01/25

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PHS-7090

Opt Out Request

01/25

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Substance Abuse and Mental Health Services Administration (SAMHSA)

  
SMA-162Application for Certification to Use Opioid Drugs in a Treatment Center
02/18
Online
 

 

Indian Health Service

  
N/AIHS Child Care & Indian Child Care Worker Positions Form
08/23
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N/AIHS Individual Overtime, Compensatory Time and Credit Hours Request Form
03/23
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IHS-515Authorization for Administration of Anesthesia and for Performance of Operations or Other Procedures*
11/94
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IHS-810IHS Authorization for Release of Information
05/24
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IHS-912-1Request for Restriction(s)
01/24
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IHS-912-2Request for Revocation of Restriction(s)
01/24
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IHS-913Request for Accounting of Disclosures
01/24
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IHS-917Request for Correction/Amendment of Protected Health Information
01/24
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IHS-961*IHS Agreement to Assign Claim Upon Request Form*
11/21
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IHS-963IHS Request for Confidential Communication by Alternative Means or Alternate Location
01/24
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IHS-969IHS Certificate of Records Destruction Form
09/21
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IHS-975Request for Ratification of Unauthorized Commitment (UAC)
05/19
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IHS-976Purchased/Referred Care Proof of Residency
10/17
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IHS-978Records Contact Designation
08/21
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IHS-982IHS Acknowledgement of Receipt of IHS Notice of Privacy Practices
01/24
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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 April 3, 2025
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