U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Realty Forms & Document Templates

Software may be required to open content on this page:

IHS Plug-in Page      "PDF"  Link to Adobe Acrobat Plug-in Acrobat       "DOC"  Link to MicroSoft Word Plug-in MS Word       "XLS"  Link to MicroSoft Excel Plug-in Excel

Please Note: Using fillable PDF forms requires Adobe Acrobat Professional in order to save form data.

Section Links
General    Acquisitions    Disposal    Leasing    Quarters
General
Title & Description/Current Revision Date Download
GSA 1583 - Permit for Use of Real Property by Federal Agency
09/1998 		Download (12/16/2008 - PDF - 52KB)
GSA 2957 - Reimbursable Work Authorization
  		Link Exit Disclaimer – You Are Leaving www.ihs.gov
HEW 507 - Property Review Record and Certification Statement
Utilization of Government-owned and DHEW Leased Real Property - 10/1972 		Download  (04/02/2009 - PDF - 70KB)
HEW 507 - Property Review Record and Certification Statement
(1 Page) Utilization of Government-owned and DHEW Leased Real Property - 10/1972 		Download (12/04/2008 - PDF - 97KB)
HHS 588 - USE Permit - Federal Agency  
03/1985
 (Available upon request by email to Felicia.Snowden@ihs.gov)
PHS 88 - Real Property Voucher
05/1990 		Download (12/04/2008 - PDF - 75KB)
Joint Inspection Report - (Template/Example)
  		(Available upon request by email to Felicia.Snowden@ihs.gov)
Purchase Assembly - List of Exhibits - (Template/Example)
  		(Available upon request by email to Felicia.Snowden@ihs.gov)
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Acquisitions
Title & Description/Current Revision Date Download
GSA 3517B - General Clauses
Acquisition of Leasehold Interests in Real Property - 12/2003		 Download (12/04/2008 - PDF - 119KB)
Agreement of Sale for transfers of Real Property - (Template/Example)
 		 Available upon request by email to Felicia.Snowden@ihs.gov
Warranty Deed - (Template/Example)
 		 Available upon request by email to Felicia.Snowden@ihs.gov
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Disposal
Title & Description/Current Revision Date Download
HHS 342 - Report of Survey - (Only for Personal Property)
08/2001
 Download (12/04/2008 - PDF - 90KB)
Real Property Survey Report
03/2004
 Download (07/27/2009 - PDF - 324KB)
SF118 - Report of Excess Real Property
05/1996
 Link Exit Disclaimer – You Are Leaving www.ihs.gov
SF118A - Buildings, Structures, Utilities, and Miscellaneous Facilities
Schedule A Supplement to Report of Excess Real Property - 05/1996
 Link Exit Disclaimer – You Are Leaving www.ihs.gov
SF118B - Land Schedule B
Supplement to Report of Excess Real Property - 05/1996
 Link Exit Disclaimer – You Are Leaving www.ihs.gov
SF118C - Related Personal Property Schedule C
Supplement to Report of Excess Real Property - 05/1996
 Link Exit Disclaimer – You Are Leaving www.ihs.gov
Excess Real Property Disposal Checklist
Supplement to Report of Excess
 Available upon request by email to Felicia.Snowden@ihs.gov
ASTM Standard E1527-05
Standard Practice for Environmental Site Assessments
 Available upon request by email to Felicia.Snowden@ihs.gov
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Leasing
Title & Description/Current Revision Date Download
GSA 1166 - Annual Report
Real Property Owned by or Leased to the United States - 10/1997
 Link Exit Disclaimer – You Are Leaving www.ihs.gov
GSA 1217 - Lessors Statement of Cost
07/1994
 Link Exit Disclaimer – You Are Leaving www.ihs.gov
GSA - Space Specifications
8/2002
 Download (06/13/2005 - DOC - 82KB)
SF81 - Request for Space
02/1989
 Available upon request by email to Felicia.Snowden@ihs.gov
SF81
Back Of Document
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SF81A - Space Requirements Worksheet
10/1983
 Link Exit Disclaimer – You Are Leaving www.ihs.gov
Revocable License For Use of Real Property - (Template/Example)
 		 Available upon request by email to Felicia.Snowden@ihs.gov
Addendum, Indian Health Service, Health Facilities Planning Manual, Planning Space for IHS and Tribal Leased Facilities
 Download (12/17/2008 - PDF - 302KB)
Present Value Worksheet Available upon request by email to Felicia.Snowden@ihs.gov
Capital Lease Analysis Worksheet Available upon request by email to Felicia.Snowden@ihs.gov
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Quarters
Title & Description/Current Revision Date Download
Quarters Tenant Guide
 Download (11/08/2011 - PDF - 406KB)
Guide to the Quarters Management Program
 Download (08/05/2009 - PDF - 285KB)
IHS 6070A - Quarters Acceptance and Agreement Assignment
11/1999
 Available upon request by email to Felicia.Snowden@ihs.gov
IHS 6070B - Quarters Termination Record
11/2000
 Available upon request by email to Felicia.Snowden@ihs.gov
Transient Quarters Rental Agreement - (Template/Example)
 		 Available upon request by email to Felicia.Snowden@ihs.gov
Quarters Return Funds Processes
12/2007
 PDF (701KB)
Quarters and Subsistence Allowances
Commissioned Corps Personnel Manual CC22.4
 Link Exit Disclaimer – You Are Leaving www.ihs.gov
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