Fillable Phs-1122-1-memo FORM PHS-1122-1 Memo

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Phs-1122-1-memo FORM PHS-1122-1 Memo

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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Office of the Director
Public Health Service Commissioned Corps
1101 Wootton Parkway, Plaza Level, Suite 100
Rockville, MD 20852
Supplement to Form PHS-1122-1
Application for Training for PHS Commissioned Personnel
This addendum must be attached to form PHS-1122-1, Application for Training for PHS Commissioned Personnel,
when an officer decides to apply for long-term training offered by a Department of Health and Human Services (HHS)
Operating Division (OPDIV), Staff Division (STAFFDIV), or by a non-HHS organization to which he/she is currently
detailed.
Notice to Supervisors and Line Managers
Any officer of the Public Health Service Commissioned Corps (Corps) selected for long-term training by an OPDIV,
STAFFDIV, or non-HHS organization, other than for one to which he/she is currently detailed, must be provisionally
released by the losing OPDIV, STAFFDIV, or non-HHS organization through the completion of this 'Supplement to
Form PHS-1122-1.'
If selected for the specific training, the current supervisor and Bureau/Institute/Center/Division Director understand
that the affected officer will be transferred to the OPDIV, STAFFDIV, or non-HHS organization paying for the training
for the duration of the training program as well as for the payback obligation. An applicant's immediate supervisor
should consider this information when completing Section III, Item 22, of form PHS-1122-1.
Section III, items 23, 24, and 25, are to be completed by the gaining OPDIV, STAFFDIV, or non-HHS organization - the
entity paying for the training.
When the immediate supervisor has completed Section III, item 22, of form PHS-1122-1, this supplement is to be
attached to the front of form PHS-1122-1 and submitted to the applicant's Bureau/Institute/Center/ Division Director
for review as shown below:
Concurrence Non-concurrence
Reasons for concurrence/non-concurrence
Printed name Title
OPDIV, STAFFDIV or non-HHS organization
Signature Date
(Rev. 11/16)
PSC Publishing Services (301) 443-6740
EF
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Completed 27 February 2020

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