PHS-1662: Request for Personnel Action, Commissioned Officer

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

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

Furnish officer's/applicant's Social Security Number (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; Environmental Health; Therapy; Nurse; Veterinary; Health Services; Engineer; Pharmacy.

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

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

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.

OCCO will make adjustments to CAD orders to include time required for travel to initial duty station. 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 be 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. Enter Concurrence/Release given by, Phone number and Date.

If annual leave en route is approved, so indicate and provide actual dates of annual leave.

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.

Mark YES or NO for Temporary Duty En Route. If no, skip to item 9.

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.

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.

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

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.

Use for any additional necessary remarks.

Submission of this form to the Office of Commissioned Corps Operations (OCCO) by the requesting program certifies that all applicable hiring or assignment restrictions and security clearance requirements for this position have been met.

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.

Division and OPDIV/Program officials requesting action must sign and date form.

For the Budget Official, 1st Requesting Official, 2nd Requesting Official and Agency/OPDIV/Program Liaison Official, enter the Name, Title and Approval Date.

After completing this form, forward the original to the Office of Commissioned Corps Operations, ATTN: Division of Commissioned Corps Assignments, 1101 Wootton Parkway, Suite 100, Rockville, MD 20852, at least 20 calendar days before the effective date of the 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 Office of Commissioned Corps Operations (OCCO).