DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service Commissioned Corps
INSTRUCTIONS FOR COMPLETING THE COMMISSIONED CORPS
INDIVIDUAL HONOR AWARD NOMINATION RECORD
PART I -
OFFICER’S NAME:
Officer’s full name.
ENTRY ON DUTY
DATE:
Include only service as a commissioned officer.
PHS RANK:
Rank as a pay grade (i.e., O-1 through O-10).
PROFESSIONAL
CATEGORY:
Medical, Dental, Nurse, Engineer, Scientist, Environmental Health, Veterinary, Pharmacy, Dietetics, Therapy,
Health Services.
EMPLOYEE ID NO.
List Employee ID Number.
CURRENT
ORGANIZATION:
Self-explanatory.
ORGANIZATIONAL
TITLE OR POSITION:
Self-explanatory.
PROPOSED AWARD:
Award Recommended: Distinguished Service Medal With Valor (DSM/V) Distinguished Service Medal (DSM)
Meritorious Service Medal With Valor (MSM/V) Meritorious Service Medal (MSM) Outstanding Service Medal
With Valor (OSM/V) Outstanding Service Medal (OSM) Commendation Medal (CM) Achievement Medal (AM)
PHS Citation (CIT)
PERIOD COVERED:
The beginning and ending dates (month, day, and year) covering the period of the accomplishment. Do not put
"present" as an ending date. This part must have a month and year (e.g., 03/30/2016).
CITED FOR:
Specific achievement for which the officer is being nominated (150 characters) .
CERTIFICATION:
Self-explanatory.
ENDORSEMENTS:
Endorsers must provide their signatures, titles, and dates. In the space provided for AWARD ENDORSED,
enter the award recommended (i.e., the proposed award or a different award than proposed). Nominations that
have a lower level award endorsed than the proposed award should be forwarded to the next level of review
until there is concurrence at a level that oversees at least 25 officers. NOTE: This may require the submission
of the nomination to a higher level for review than would have originally been necessary for approval of the
award.
COMMENT:
For nominations that have a lower level award endorsed, provide relevant useful comments. Also, use this
section to document external agency concurrence as needed.
CCAB & SG:
Commissioned Corps Awards Board and the Surgeon General.
NARRATIVE:
The narrative should focus on the officer’s contributions, their significance, and how the officer’s actions have
compared to or exceeded what is expected of an officer of this grade and experience. Routine responsibilities
and career progression should be included only to establish the context for the actions cited. The cited actions,
their impact and significance are important and should be stated clearly. If the use of technical terms is
required, the nomination should contain clarifying statements that are understandable to a multidisciplinary
Board. The actions cited must fall within the period covered by the nomination. If the officer has received an
honor award in the period cited or for earlier actions that may seem similar or overlapping with those in the
current nomination, the nomination should clarify the basis for the prior award(s) and the relevance or
nonrelevance to the present nomination. The narrative shall not exceed two single spaced typed pages with 1”
margins. Times News Roman 12pt type style is preferred, but a comparable font that would provide no less
than 12pt and no more than 12 characters per inch can be used. Ask your OPDIV or Non-HHS Organization
Awards Coordinator for guidance in preparing award nominations.
PHS-6342-2 (Rev. 10/16)
INSTRUCTIONS
