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**Forms Listed by Title****Accessibility Tools for PDF Documents:**Access.adobe.com provides a set of free tools that allow visually disabled users to read documents in Adobe PDF format. These tools convert PDF documents into either HTML or ASCII text which can then be read by many screen reading programs.**Accelio Capture Classic Filler Forms:** Intelligent Forms! Forms you can fill out and print! To properly view forms embedded with logos*, JetForm Filler 4.3 or higher is required. (All versions of Jetform Filler are supported.)**MS Word:** Download the file first, then open in Microsoft Word.**Form Number****Title****Revision Date****Form Link****Health and Human Services (HHS)**HHS-568Procedures for Submission of Final Invention Statement06/15HHS-691Request for Title 38 Physician, Dentist and Podiatrist Pay (PDP)01/21HHS-990-1HHS Workplace Flexibilities Agreement04/24HHS-990-1 (NTEU)HHS Workplace Flexibilities Agreement (NTEU Employees Only)05/23**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"07/18N/APHS Request for Basic Training Contract Memo01/23N/APHS Sample Memorandum to Request Payment of A Uniform Allowance09/20N/APHS Service Award, Campaign Medal, and Training Ribbons Nomination Record01/23N/APHS LTT Forms ChecklistPHS Training Purposes and Objectives01/2301/23PHS-398Public Health Service – Includes Research Career Awards and Institutional National Research Service Awards03/20PHS-416-1Application for an Individual National Research Service Award FellowshipInstructions01/21OnlinePHS-416-5Research Fellowship Activation Notice04/20PHS-416-7Termination Notice NRSA06/15PHS-416-9Application for PHS Individual National Research Service Continuation AwardInstructions08/12PHS-488Claim for Temporary Lodging Allowance09/20PHS-838Commissioned Officers Effectiveness Report08/15PHS-1122-1Application for Training for PHS Commissioned Personnel (Privacy Act) (Also print the cover memo)01/23PHS-1345Request and Authority for Leave of Absence (Commissioned Officers)09/05PHS-1373Separation of Commissioned Officer05/24PHS-1637-1Public Health Service - Commissioned Officer's Request for Dependency Determination11/20PHS-1662Request for Personnel Action - Commissioned Officer10/04PHS-1881-1Basic Training Contract01/23PHS-1881-2Order Pursuant to Basic Training Contract01/23PHS-2271Information and Instructions for Completing Statement of Appointment (Form PHS-2271) (Includes Application)04/24PHS-2590Application for Continuation of a PHS Grant03/16PHS-2874Notice of Arrival09/20PHS-2977Quarters Allowance Certificate05/90PHS-2988Voucher for Reimbursement for Travel Dependents of PHS COs03/24PHS-3734Official Statement Relinquishing Interests and Rights in a Public Health Service Research Grant06/15PHS-4013-1Application for Shipments of Household Goods (Commissioned Officers)08/16PHS-4392Billet Description02/24PHS-5141-2Appointment Affidavit Regular Corps08/16PHS-6031National Research Service Award08/18PHS-6031-1Annual National Research Service Award06/15PHS-6051Merit Promotion Program Certificate for Eligibles01/90PHS-6051-1AHCPR Certificates for Eligibles05/90PHS-6059Request for Overseas Allowances09/20PHS-6106Agreement - To Receive an Allowance under the Federal Physicians Comparability Allowance Program09/88PHS-6173Application for Allotment of Pay (NON-GI BILL: use PHS-7039 for GI BILL)09/20PHS-6189-1Retention Bonus (RB) Agreement Request12/18PHS-6231Certification for Intermittent Tours of Duty09/20PHS-6310-1Incentive Pay (IP) Agreement12/18PHS-6315Assurance of Compliance by Sub-Award Recipients02/24PHS-6342-2Individual Honor Award Nomination Record - Part 110/16PHS-6349Annual Report on Possible Research Misconduct02/24PHS-6353PHS Commissioned Officer State Tax Withholding Allowance Certificate09/20PHS-6355Report of Dental Examination of Applicants to the Commissioned Corps of the Public Health Service05/17PHS-6363Request to Establish/Change Mailing Address11/20PHS-6364PHS Employee Invention Report01/93PHS-6367Active-Duty Certification (Short Tours of Less Than 30 Days)09/20PHS-6373Extramural Training Agreement02/24PHS-6374Intramural Training Agreement02/24PHS-6379Supplemental Medical History Record Required of Applicants to the Public Health Service Commissioned Corps05/17PHS-6380Request for Uniformed Services Medical Records01/05PHS-7015-1Board Certification Incentive Pay (BCIP) Agreement Request12/18PHS-7033Special Pay Contract - Accession Bonus11/18PHS-7036Reimbursement Request Expenses for Adoption09/20PHS-7044Commissioned Corps Annual Physical Fitness Test (APFT) Readiness Standards Report07/19PHS-7044-1Verified Weight Report09/18PHS-7045Temporary Lodging Expense (TLE) Computation Worksheet09/16PHS-7062Extramural Training Agreement (Scholarships, Grants, Fellowships)01/23PHS-7064Training Agreement for Officers Assigned as Students to School of Medicine Form01/23PHS-7082-2Post-9/11 GI Bill Educational Benefits Transferability Commitment and Statement of Understanding04/20PHS-7083Behavioral Health Survey02/24**Substance Abuse and Mental Health Services Administration (SAMHSA)**SMA-162Application for Certification to Use Opioid Drugs in a Treatment Center02/18Online**Indian Health Service**N/AIHS Child Care & Indian Child Care Worker Positions Form08/23N/AIHS Individual Overtime, Compensatory Time and Credit Hours Request Form03/23IHS-515Authorization for Administration of Anesthesia and for Performance of Operations or Other Procedures*11/94IHS-810IHS Authorization for Release of Information05/24IHS-912-1Request for Restriction(s)01/24IHS-912-2Request for Revocation of Restriction(s)01/24IHS-913Request for Accounting of Disclosures01/24IHS-917Request for Correction/Amendment of Protected Health Information01/24IHS-961*IHS Agreement to Assign Claim Upon Request Form*11/21IHS-963IHS Request for Confidential Communication by Alternative Means or Alternate Location01/24IHS-969IHS Certificate of Records Destruction Form09/21IHS-975Request for Ratification of Unauthorized Commitment (UAC)05/19IHS-976Purchased/Referred Care Proof of Residency10/17IHS-978Records Contact Designation08/21IHS-982IHS Acknowledgement of Receipt of IHS Notice of Privacy Practices01/24The 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 August 12, 2024 Back to top
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