Form
Number |
Title |
Revision
Date |
Adobe
PDF |
MDF
(Form Filler) |
MS
Word |
| |
Health
and Human Services (HHS) |
|
|
|
|
| HHS-687 |
Consent to
Sterilization |
11/06 |
|
N/A |
N/A |
| HHS-687-1 |
Consent to
Sterilization (Spanish Version) |
11/06 |
|
N/A |
N/A |
| HHS-568 |
Procedures
for Submission of Final Invention Statement |
05/01 |
|
N/A |
|
| HHS-719 |
Request for Copy of The Record(S) in the Case File |
9/05 |
|
N/A |
N/A |
| HHS-720 |
Request For Copy Of Record(S): Third-Party With The Individual Appellant’S Consent |
8/05 |
|
N/A |
N/A |
| HHS-721 |
Individual Appellant’S Consent To Third-Party For Copies Of The Individual Appellant’S Record(S) |
8/05 |
|
N/A |
N/A |
| HHS-722 |
Request For Substitution Of Party Upon Death Of Party |
8/05 |
|
N/A |
N/A |
| HHS-723 |
Waiver Of Right To An Administrative Law Judge (ALJ) Hearing |
8/05 |
|
N/A |
N/A |
| HHS-724 |
Request To Correct, Amend, Or Delete A Record(S) |
8/05 |
|
N/A |
N/A |
| HHS-725 |
Request For Administrative Law Judge (ALJ) To Review Dismissal By The Qualified Independent Contractor |
8/05 |
|
N/A |
N/A |
| HHS-727 |
Extension Request To File A Request For An Administrative Law Judge (ALJ) Hearing |
8/05 |
|
N/A |
N/A |
| HHS-728 |
Filing Of New Evidence |
8/05 |
|
N/A |
N/A |
| HHS-729 |
Response To Notice Of Hearing |
8/05 |
|
N/A |
N/A |
| HHS-730 |
Withdrawal Of Request For An Administrative Law Judge (ALJ) Hearing |
8/05 |
|
N/A |
N/A |
| HHS-731 |
Withdrawal Of Waiver Of Right To An Administrative Law Judge (ALJ) Hearing |
8/05 |
|
N/A |
N/A |
| HHS-732 |
Centers For Medicare And Medicaid Services (CMS) Or CMS Contractor Participation As A Non-Party Or As A Party To An Administrative Law Judge (ALJ) Hearing |
8/05 |
|
N/A |
N/A |
| HHS-733 |
Identity Verification |
8/05 |
|
N/A |
N/A |
| HHS-734 |
Payment Information Report |
8/05 |
|
N/A |
N/A |
| HHS-752 |
Waiver Of 20-Day Advance Written Notice Of Hearing |
9/07 |
|
N/A |
N/A |
| |
Public
Health Service (PHS) |
|
|
|
|
| PHS-6031-1 |
Annual National
Research Service Award |
07/00 |
|
N/A |
N/A |
| PHS-6349 |
Annual Report
on Possible Research Misconduct |
01/04 |
|
N/A |
|
| PHS-50 |
Application
for Appointment as a Commissioned Officer in the US Public Health Service
Commissioned Corps |
10/03 |
|
N/A |
N/A |
| PHS-2590 |
Application
for Continuation of a PHS Grant |
04/98 |
|
N/A |
N/A |
| PHS-398 |
Application
for PHS Grant |
04/98 |
|
N/A |
|
| PHS-416-1 |
Application
for PHS Individual National Research Service Award
Instructions
|
08/98 |
|
N/A |
|
| PHS-416-9 |
Application
for PHS Individual National Research Service Continuation Award
Instructions
|
06/02 |
|
N/A |
N/A |
| PHS-5161-1 |
Grant Application
for Non-Construction Projects |
07/00 |
 * |
N/A |
|
| PHS-6031 |
National Research
Service Award |
06/02 |
|
N/A |
N/A |
| PHS-3734 |
Official Statement
Relinquishing Interest and Rights in a PHS Research Grant |
05/81 |
|
|
N/A |
| PHS-1813 |
Reference
Request for Applicants to the U.S. Public Health Service Commissioned Corps
|
10/03 |
|
N/A |
N/A |
| PHS-416-5 |
Research Fellowship
Activation Notice |
06/02 |
|
N/A |
N/A |
| PHS-2271 |
Statement
of Appointment of Trainee |
05/01 |
|
N/A |
N/A |
| PHS-416-7 |
Termination
Notice NRSA |
06/02 |
|
N/A |
N/A |
| |
Program
Support Center (PSC) |
|
|
|
|
| PSC-54 |
PSC
Application to the Board for Correction of Public Health Service |
11/02 |
|
N/A |
N/A |
| PSC-270 |
Request
for Advance or Reimbursement |
05/85 |
|
N/A |
N/A |
| |
Substance
Abuse and Mental Health Services Administration (SAMHSA) |
|
|
|
|
| SMA-162 |
Application
for Certification to Use Opioid Drugs in a Treatment Center |
01/03 |
|
N/A |
N/A |
| SMA-167 |
Notification
of Intent to Use Opioid Drugs for Maintenance and Treatment |
00/00 |
|
N/A |
N/A |
| SMA-172 |
SAMHSA Application
for Peer Grant Review |
Exp
06/04 |
|
N/A |
N/A |
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