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Hhs-691 0 FORM HHS-691

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File type: PDF

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DEPARTMENT OF HEALTH AND HUMAN SERVICES
REQUEST FOR TITLE 38 PHYSICIAN AND DENTIST PAY (PDP)
1. EMPLOYEE INFORMATION
Full Name
Organization (Agency/Center/Division)
Position Title P.D. Number
Official Tour of Duty
Full Time
Less than full-time. Number of regularly scheduled hours per pay period
2. MARKET PAY REQUEST
Physician
Dentist
3. ACTION REQUESTED
New Hire
Change to Existing PDP
Other
4. CURRENT PAY INFORMATION (for non-federal employees, provide total annual compenstation information.)
Grade Step Title
Table Tier Clinical Specialty/Board Certification
Notes
Recruitment
$
Relocation
$
Retention
$
Total 3Rs Incentive
$
GS Base Pay
Locality or Current Market Pay
+
Total Annual Pay
=
3Rs Incentive
+
Total Annual Compensation
$
5. PROPOSED PAY INFORMATION
Grade Step Title
Table Tier
Clinical Specialty/Board Certification
Notes
Recruitment
$
Relocation
$
Retention
$
Total 3Rs Incentive
$
Proposed GS Base Pay
Proposed Market Pay
+
Proposed Total Annual Pay
=
3Rs Incentive
+
Proposed Total Annual Compensation
$
6. REVIEWS AND APPROVALS
Recommending Official (Name and Title)
Signature
Date
Compensation Panel Chair (Name)
Signature Date
Approving Official (Name and Title)
Signature Date
Fund Availability (Name and Title)
Signature
Date
Human Resources Review (Name and Title)
Signature Date
Attachments: Justification memorandum; current CV; salary surveys; medical license; board certification, position description (not all may be
applicable to the individual physician or dentist). Documents requested by operating division:
7. EFFECTIVE DATE
HHS-691 (01/19)
PSC Publishing Services (301) 443-6740
EF
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Completed 27 February 2020

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