DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service Commissioned Corps
ACCESSION BONUS (AB) or CRITICAL WARTIME SKILLS ACCESSION BONUS (CWS-AB) AGREEMENT REQUEST
(Privacy Act Notice is on the Second Page)
IDENTIFICATION
NAME (Last, First, Middle Initial)
GRADE/RANK
PHS SERIAL NUMBER ORGANIZATION
DUTY PHONE NUMBER E MAIL
DCCPR USE ONLY
DATE REC’D.
SPECIAL PAY REQUESTED
ACCESSION BONUS (AB) or CRITICAL WARTIME SKILLS ACCESSION BONUS (CWS-AB)
4 year agreement
CONDITIONS OF AGREEMENT
In consideration of payment of the
AB or CWS-AB
for which I qualify in accordance with 37 U.S.C. 335; Commissioned Corps Directive
(CCD) 151.05; and Commissioned Corps Instruction (CCI) 633.01, I hereby agree to the following:
A. To remain on active duty in the Corps for the agreement period specified above, commencing on the following date:
B.
That I will be paid AB or CWS-AB in the amount specified for my category of with a specialty in
for each year of obligation.
C.
That I hold a current, valid and unrestricted license as directed for my category under CCI 251.01 "Professional Licensure and
Certification" or certification as required by CCI 231.01, "General Appointment Standards." I agree to remain certified in the
specialty referenced in section B, above, during the period I receive
AB or CWS-AB
.
D.
That I will receive the AB in a one-time lump sum payment or CWS-AB in equal annual installments.
E.
That if I fail to complete the period of service for which AB or CWS-AB is paid:
(1) Under the provisions contained in Section 6-7.e. of CCI 633.01, I will be required to refund a pro rata portion of the payment
received which represents the unearned portion of that annual payment of a terminated agreement in accordance with 37
U.S.C. 373.
(2) I will be required to refund a pro rata portion of any payment received pursuant to this agreement. The amount of the
repayment shall be that portion of the payment not earned (1/1440th of the 4-year agreement for each day of the agreed-to
period not earned for AB and 1/360th of the annual payment for each day of the year not earned for CWS-AB);
(3) Any amount I am obligated to refund because of the termination of this agreement will be a debt due to the United States
which I hereby agree to pay in full as directed by the appropriate collections officials in accordance with CCI 654.02; and
(4) That I may not be eligible for recommissioning in the Corps.
F.
That I will serve in a clinical position that is in the specialty for which the pay is received and that I may not transfer out of the
agency that paid the bonus until I have fulfilled my service obligation.
G.
If I am not eligible to receive base pay because of a period of Absence Without Leave (AWOL), then I am not eligible for AB or
CWS-AB for
the duration of the AWOL, and I am required to repay the prorated portion of any amount paid during the period of
AWOL and my obligation will be extended for an equal period of time as the AWOL.
H.
That I am not serving a training-related service obligation; scholarship or other financial assistance received from the Department
of Health and Human Services (HHS) or the Department of Defense (DoD) to pursue a course of study in exchange for an
agreement to accept an appointment as a commissioned officer or have an existing training-related service obligation as a result
of financial assistance received from HHS, DoD, or another Federal organization.
I.
That the effective date of this agreement will be the date of call to active duty (CAD), if the signed agreement is received in the
Compensation Branch (CB), Division of Commissioned Corps Personnel and Readiness (DCCPR), within 60 days of the CAD,
otherwise the effective date will be the date determined by procedures set forth by the SG in Personnel Operations Memorandum
(POM).
J.
Payment of AB and CWS-AB will normally commence within 90 days after receipt of the completed agreement in DCCPR or
within 90 days after DCCPR receives all necessary supporting documention.
PHS-7033 (Rev. 12/18)
PSC Publishing Services (301) 443-6740
EF
