Skip to main content


U.S. flag
      An official website of the United States government
              Here’s how you know
        Here’s how you knowDot gov**Official websites use .gov**
                 A **.gov** website belongs to an official government organization in the United States.
                  HTTPS**Secure .gov websites use HTTPS**
                 A **lock** (A locked padlock) or **https://** means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites. 
  Menu Close
          HHS Search block
    Search
        








  
  
    

  
      

                                      About HHS
    
                        
                              
      
      
      Programs & Services
    
                        
                              
      
      
      Grants & Contracts
    
                        
                              
      
      
      Laws & Regulations Breadcrumb
    Home
                              HHS Forms
                              Public Use Forms by Number
 Text resize icon

                    




Public Use Forms by Number








  
  
    

  
      





We are committed to ensuring that all HHS forms on this Web site are fully accessible to individuals with disabilities in accordance with Section 508 of the Rehabilitation Act. If you have any difficulty viewing any page with adaptive technology, please contact the webmaster for this site, or the **HHS Forms Coordinator**.Documents on the HHS Web sites are available in PDF format. These forms are accessible to users using Microsoft Active Accessibility (MSAA), JAWs for Windows screen reading software as well as Dragon Naturally Speaking Voice Recognition Software. Adobe provides their Acrobat Reader software as a free download.**Health and Human Services (HHS)****Form Number****Title****Revision Date****Form Link**HHS-520Request for Approval of Outside Activity01/06HHS-521Annual Report of Outside Activity01/06HHS-568Procedures for Submission of Final Invention Statement06/15HHS-691Request for Title 38 Physician, Dentist and Podiatrist Pay (PDP)01/21HHS-697*Foreign Activities Questionnaire*10/20HHS-719Request for Copy of the Record(s) in the Case File09/05HHS-720Request for Copy of Record(s): Third –Party With the Individual Appellant's Consent08/05HHS-721Individual Appellant's Consent to Third-Party for Copies for the Individual Appellant's Record(s)08/05HHS-724Request to Correct, Amend, or Delete a Record (s)08/05HHS-733Identity Verification08/05HHS-734Payment Information Report09/05HHS-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 Fellowship**Instructions**01/21PHS-416-5Research Fellowship Activation Notice04/20PHS-416-7Termination Notice NRSA06/15PHS-416-9Application for PHS Individual National Research Service Continuation Award**Instructions**08/12PHS-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-515*Authorization 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
    Contact HHS
    
                        
                                            
      
      
      Careers
    
                        
                                            
      
      
      HHS FAQs
    
                        
                                            
      
      
      Nondiscrimination NoticeHHS Archive
    
                        
                                            
      
      
      Accessibility Statement
    
                        
                                            
      
      
      Privacy Policy
    
                        
                                            
      
      
      Viewers & PlayersBudget/Performance
    
                        
                                            
      
      
      Inspector General
    
                        
                                            
      
      
      Web Site Disclaimers
    
                        
                                            
      
      
      EEO/No Fear ActFOIA
    
                        
                                            
      
      
      The White House
    
                        
                                            
      
      
      USA.gov
    
                        
                                            
      
      
      Vulnerability Disclosure Policy
        Sign Up for Email Updates

Receive the latest updates from the Secretary, Blogs, and News Releases.

Sign Up
  HHS Headquarters
          200 Independence Avenue, S.W.
                  Washington, D.C. 20201
                  Toll Free Call Center: 1-877-696-6775​ Disclaimer Policy: Links with this icon () mean that you are leaving the HHS website. The Department of Health and Human Services (HHS) cannot guarantee the accuracy of a non-federal website.
                  Linking to a non-federal website does not mean that HHS or its employees endorse the sponsors, information, or products presented on the website. HHS links outside of itself to provide you with further information.
                  You will be bound by the destination website's privacy policy and/or terms of service when you follow the link.
                  HHS is not responsible for Section 508 compliance (accessibility) on private websites. For more information on HHS's web notification policies, see Website Disclaimers.
 Continue
                  Go back