Public Use Forms by Number

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Form Number	Title	Revision Date	Adobe PDF
	Health and Human Services (HHS)
HHS-419	Clearance of Employees for Separation or Transfer	12/10
HHS-520	Request for Approval of Outside Activity	01/06
HHS-521_508	Annual Report of Outside Activity	01/06
HHS-568	Procedures for Submission of Final Invention Statement	06/09
HHS-687	Consent to Sterilization	05/10
HHS-687-1	Consent to Sterilization (Spanish Version)	11/03
HHS-690	Assurance of Compliance	01/09
HHS-697	Foreign Activities Questionnaire	04/02
HHS-719	Request for Copy of the Record(s) in the Case File	09/05
HHS-720	Request for Copy of Record(s): Third-Party with the Individual Appellant's Consent	08/05
HHS-721	Individual Appellant's Consent to Third-Party for Copies of the Individual Appellant's Record(s)	08/05
HHS-722	Request for Substitution of Party Upon Death of Party	08/05
HHS-723	Waiver of Right to an Administrative Law Judge (ALJ) Hearing	08/05
HHS-724	Request to Correct, Amend, or Delete a Record(s)	08/05
HHS-725	Request for Administrative Law Judge (ALJ) to Review Dismissal by the Qualified Independent Contractor	08/05
HHS-727	Extension Request to File a Request for an Administrative Law Judge (ALJ) Hearing	08/05
HHS-728	Filing of New Evidence	08/05
HHS-729	Response to Notice of Hearing	08/05
HHS-730	Withdrawal of Request for an Administrative Law Judge (ALJ) Hearing	08/05
HHS-731	Withdrawal of Waiver of Right to an Administrative Law Judge (ALJ) Hearing	08/05
HHS-733	Identity Verification	08/05
HHS-734	Payment Information Report	09/05
HHS-T-001	Response to Notice of Hearing	08/05
	Public Health Service (PHS)
PHS-398	Application for PHS Grant	06/09
PHS-416-1	Application for PHS Individual National Research Service Award Instructions	06/09
PHS-416-5	Research Fellowship Activation Notice	06/09
PHS-416-7	Termination Notice NRSA	06/09
PHS-416-9	Application for PHS Individual National Research Service Continuation Award Instructions	06/09
PHS-2590	Application for Continuation of a PHS Grant	06/09
PHS-3734	Official Statement Relinquishing Interest and Rights in a PHS Research Grant	06/09
PHS-6031	National Research Service Award	06/09
PHS-6031-1	Annual National Research Service Award	06/09
PHS-6349	Annual Report on Possible Research Misconduct	12/10
	Program Support Center (PSC)
	Substance Abuse and Mental Health Services Administration (SAMHSA)
SMA-162	Application for Certification to Use Opioid Drugs in a Treatment Center	01/03	or HTML
SMA-167	Notification of Intent to Use Opioid Drugs for Maintenance and Treatment	00/00	HTML
SMA-171	Prevention Registry	Exp 06/06	HTML
SMA-172	SAMHSA Application for Peer Grant Review	Exp 06/04	HTML
	Indian Health Service
IHS-810	Authorization for Use or Disclosure of Protected Health Information	04/09
IHS-912-1	Request for Restriction(s)	04/09
IHS-912-2	Request for Revocation of Restriction(s)	04/09
IHS-913	Request for an Accounting of Disclosures	04/09
IHS-917	Request for Correction/Amendment of Protected Health Information	04/09
IHS-963	Request for Confidential Communication by Alternative Means or Alternate Location	04/09