Public Use Forms by Title

Forms Listed by Title

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Form Number	Title	Revision Date	Adobe PDF	MDF (Form Filler)	MS Word
	Health and Human Services (HHS)
HHS-687	Consent to Sterilization	05/10	N/A	N/A	N/A
HHS-687-1	Consent to Sterilization (Spanish Version)	11/03	N/A	N/A	N/A
HHS-568	Procedures for Submission of Final Invention Statement	06/09		N/A
	Public Health Service (PHS)
PHS-6031-1	Annual National Research Service Award	06/09		N/A	N/A
PHS-6349	Annual Report on Possible Research Misconduct	10/12		N/A	N/A
PHS-2590	Application for Continuation of a PHS Grant	06/09		N/A	N/A
PHS-398	Application for PHS Grant	06/09		N/A
PHS-416-1	Application for PHS Individual National Research Service Award Instructions	06/09		N/A
PHS-416-9	Application for PHS Individual National Research Service Continuation Award Instructions	06/09		N/A	N/A
PHS-5161-1	Grant Application for Non-Construction Projects	07/00	*	N/A
PHS-6031	National Research Service Award	06/09		N/A	N/A
PHS-3734	Official Statement Relinquishing Interest and Rights in a PHS Research Grant	06/09			N/A
PHS-1813	Reference Request for Applicants to the U.S. Public Health Service Commissioned Corps	08/10		N/A	N/A
PHS-416-5	Research Fellowship Activation Notice	06/09		N/A	N/A
PHS-2271	Statement of Appointment of Trainee	06/09		N/A	N/A
PHS-416-7	Termination Notice NRSA	06/09		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	or HTML	N/A	N/A
SMA-167	Notification of Intent to Use Opioid Drugs for Maintenance and Treatment	00/00	HTML	N/A	N/A
SMA-171	Prevention Registry	Exp 06/06	HTML	N/A	N/A
SMA-172	SAMHSA Application for Peer Grant Review	Exp 06/04	HTML	N/A	N/A
	Indian Health Service
IHS-810	Authorization for Use or Disclosure of Protected Health Information	04/09		N/A	N/A
IHS-913	Request for an Accounting of Disclosures	04/09		N/A	N/A
IHS-963	Request for Confidential Communication by Alternative Means or Alternate Location	04/09		N/A	N/A
IHS-917	Request for Correction/Amendment of Protected Health Information	04/09		N/A	N/A
IHS-912-1	Request for Restriction(s)	04/09		N/A	N/A
IHS-912-2	Request for Revocation of Restriction(s)	04/09		N/A	N/A