Personnel Action Form PDF Details

In the dynamic environment of the Department of Health and Human Services, the Personnel Action form, specifically the PHS-1662 for Commissioned Officers, serves as a crucial administrative tool designed to streamline various personnel actions. This comprehensive form, updated periodically to reflect the current needs, encapsulates necessary details starting from basic identification, including names and contact information, to more intricate details such as type of action requested, assignment specifics, duty station changes, and travel arrangements. Unique to commissioned officers, it covers an array of requests such as transfers, amendments, reassignments, and training details, emphasizing the flexibility and specificity required in managing personnel within the Public Health Service. Approval processes and security clearances are meticulously outlined to ensure compliance and integrity in handling personnel actions. Instructions accompanying the form guide users through each step, ensuring clarity and accuracy in submissions. By requiring signatures from multiple officials, the form not only validates the request but also ensures a collaborative review process. Ultimately, the Personnel Action form embodies the structured yet adaptable approach needed to manage the diverse and dynamic roles of commissioned officers in the Public Health Service.

QuestionAnswer
Form NamePersonnel Action Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namespesonnel action form paf, personnel action form template, new hire personnel action form, personnel forms

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHS-1662

 

 

 

Public Health Service

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

REQUEST FOR PERSONNEL ACTION - COMMISSIONED OFFICER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(5/01)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PHS-1662

 

 

 

(Read instructions on reverse before completing this form.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. NAME (LAST, FIRST, MIDDLE INITIAL)

 

 

 

2. PHONE NUMBERS (Include area code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work (

)

 

 

Home (

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3A. SSAN

 

 

3b. PHS SERIAL NUMBER

3c. CATEGORY

 

 

 

3d. GRADE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

T

 

 

 

P

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4A. OPDIV / PROGRAM CONTACT

 

 

 

 

 

 

4B. OPDIV / PROGRAM CONTACT PHONE NUMBER

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

EXT.

5. TYPE OF ACTION REQUESTED

 

OTHER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CAD - GENERAL DUTY

CAD - JRCOSTEP

CAD - SRCOSTEP

TRANSFER AMEND PO # DETAIL

BILLET UPDATE

REASSIGNMENT

TRAINING: IN OUT

LIMITED TOUR

 

YEARS

LIMIT:

REMOVE

EXTEND

RECALL FROM: INACTIVE

RETIRED

6a. ASSIGNMENT INFORMATION/DATES (MUST provide EFFECTIVE Date. Provide

other data if applicable to type of order. Use mm/dd/yy for dates.)

1.

EFFECTIVE DATE

4.

Scholarship Obligation - Number of Years

 

 

 

 

2.

Date Released From Old Duty Station

5.

Training Obligation End Date

 

 

 

 

3.

Reporting Date

6.

Short Tour/COSTEP End Date

 

 

 

 

6b. CONCURRENCE INFORMATION

1.

Concurrence/Release given by:

 

 

 

 

 

 

 

 

 

2.

Phone number: (

)

 

3. Date:

 

 

 

 

 

 

 

 

 

6c. APPROVED LEAVE EN ROUTE

YES

NO

 

 

 

 

 

 

 

 

DATES (mm/dd/yy)

From:

 

To:

 

6d. TRAINING OR DETAIL CODES (Provide only if needed)

7. DUTY STATIONS

a. FROM (Current Duty Station)

b. TO (New Duty Station)

ADMINISTRATIVE CODE:

BILLET NUMBER / TITLE:

OPDIV / AGENCY / BUREAU:

DIV / BRANCH / SECTION:

MAILSTOP / ROOM NUMBER:

COMPLETE ADDRESS:

(Building, Street,

City, State, ZIP Code)

8. TEMPORARY DUTY EN ROUTE

YES

NO (If no, skip to item 9)

 

 

DATES (mm/dd/yy)

From:

 

Through:

 

 

 

 

LOCATION:

 

 

 

 

 

 

 

REASON:

 

 

 

 

 

 

 

9a. MODE OF TRAVEL:

(Air, POV, Common Carrier)

9b. SPECIFIC SCHEDULE / ITINERARY (If needed)

10.SPECIAL TRAVEL ALLOWANCES OR INSTRUCTIONS

11.NEW ACCOUNTING INFORMATION

a. CAN (PAY) #:

b. Acct. Pt. (PAY) #:

c. DA/Timekeeper #:

d. CAN (TVL) #:

e. Acct. Pt. (TVL) #:

12.REMARKS (If applicable, include training preceptor name/phone number)

13.DIVISION AND OPDIV / PROGRAM CLEARANCE AND APPROVAL -- Submission of this form to DCP by the requesting program certifies that all applicable hiring or assignment restrictions and security clearance requirements for this position have been met. (Check as appropriate)

a. SECURITY INFORMATION

Non-Sensitive Position

Sensitive Position

Date Individual

Cleared (mm/dd/yy):

b. TDP

Yes

No

c. WORKS WITH CHILDREN

Yes

No

d. ROG (Research Officer Group)

Yes

Change

No

e. ROG TENURE STATUS

A (Assoc/Untenured)

F (Fellow)

K (Tenured Track)

N(NonROG) R (Tenured)

14. APPROVAL (Print or type Name (First - M.I. - Last), Title and Date.)

BUDGET OFFICIAL - NAME

TITLE

SIGNATURE

DATE

1ST REQUESTING OFFICIAL - NAME

TITLE

SIGNATURE

DATE

2ND REQUESTING OFFICIAL - NAME

TITLE

SIGNATURE

DATE

AGENCY/OPDIV/PROGRAM LIAISON OFFICIAL - NAME

TITLE

SIGNATURE

DATE

15. DIVISION OF COMMISSIONED PERSONNEL (DCP) CLEARANCE

Comments, if any:

SIGNATURE OF DCP OFFICIAL

DATE

 

 

 

FOR DCP USE ONLY

Mileage:

Number of Days Travel:

OD

TAS

ODB

PSB

CB

MAB

Created by: PSC Media Arts (301) 443-2454 EF

PHS-1662

INSTRUCTIONS FOR COMPLETING FORM PHS-1662 (REV. 6/97)

(5/01)

 

An additional sheet of plain paper may be added to complete answers, if necessary.

Be sure to put officer’s/applicant’s name and Social Security Number (SSAN) on additional sheets.

See INSTRUCTION 2, Subchapter CC23.6 of the Commissioned Corps Personnel Manual (CCPM), for additional information.

PLEASE TYPE OR PRINT LEGIBLY

After completing this form, forward original to the Division of Commissioned Personnel/HRS/PSC, ATTN: TAS, Room 4-20, 5600 Fishers Lane, Rockville, MD 20857-0001, AT LEAST 20 CALENDAR DAYS BEFORE EFFECTIVE DATE OF REQUESTED ACTION OR 30 CALENDAR DAYS IN THE CASE OF TRAINING. For Calls to Active Duty (CAD) allow additional time, as the 20-day rule does not begin until all of the application materials and the acceptance response have been received in the Division of Commissioned Personnel (DCP).

1.Show the officer’s/applicant’s full name (last name, first name, middle initial) as it appears on official documents.

2.Furnish officer’s duty station/work phone number and applicant’s work and home phone numbers (include area code).

3.Furnish officer’s/applicant’s SSAN, PHS Serial Number (SERNO) (if applicable), Category, and Temporary and Permanent grades (if applicable). Category response should be one of the following:

Medical

Scientist

Dietetics

Dental

Sanitarian

Therapy

Nurse

Veterinary

Health Services

Engineer

Pharmacy

 

4.Furnish name and phone number of Operating Division (OPDIV)/Program official to be contacted if further information or clarification is necessary.

5.Indicate nature of action requested. See INSTRUCTION 2, Subchapter CC23.6 of the CCPM for definitions of types of actions.

6.Effective date should be the date you want the personnel order to be effective. For orders with travel, this is the day travel begins. Indicate date officer/applicant is to report to his/her new assignment or the last day officer will be at the releasing station. DCP will make adjustments to CAD orders to include time required for travel to initial duty station. [NOTE: Reporting date should not be on a nonwork day such as a holiday or weekend unless the OPDIV/Program specifically wants the officer to report on such a day, and in the case of a CAD the reporting date should not on the 31st of any month.] Show obligation end date and training obligation end date, if applicable. Name and phone number of official concurring in release date must be furnished. If annual leave en route is approved, so indicate and provide actual dates of annual leave.

7.Furnish officer’s current duty station information and "NEW" duty station information. If a CAD order, furnish officer/applicant’s home address in Item 7(a) "Current Duty Station" and furnish "New" duty station information.

8.If temporary duty en route to new permanent duty station is requested, furnish the specific dates and place at which temporary duty will be performed and the purpose of such request.

9.Show mode of travel and the officer’s/applicant’s specific schedule if travel is by means other than privately owned vehicle (POV), e.g., air, train, bus, etc.

10.Indicate whether there are any special travel allowances or instructions about travel expenses, e.g., extra baggage, mixed mode, ferry system, etc.

11.Furnish the Common Accounting Number (CAN) for Pay, Accounting Point (Pay) number, Designated Agent/Timekeeper number, CAN for Travel number, and Accounting Point (Travel/Transportation) number of the office to which the officer will be assigned.

12.Use for any additional necessary remarks.

13.It is mandatory to answer all questions concerning required clearances. Authority for:

Testing Designated Position (TDP): See HHS Personnel Manuel Instruction 792-5 (INTERIM);

Child Care Services (CCS): See 42 USC 13041E; and

Research Officer Group (ROG): See INSTRUCTION 1, Subchapter CC23.6, of the CCPM.

14.Division and OPDIV/Program officials requesting action must sign and date form. If you have any questions, contact your OPDIV / Program Commissioned Corps Liaison.

15. DCP will sign off and issue a personnel order only after all required documentation is furnished.