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Phs commissioned officer

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The document is a form (PHS-1373) used by commissioned officers of the Public Health Service to request separation from active duty. It outlines the necessary information required for separation, including personal details, type of separation (termination, inactivation, retirement), and responsibilities regarding terminal leave and physical examinations. The form must be submitted 30 days prior to the officer's last day at their duty station and includes sections for completion by the separating officer, their supervisor, and fiscal/administrative officers.

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Click ‘Get Form’ to open it in the editor.
Begin with Part A, where you will enter your name, grade, and separation type. Ensure all fields are filled accurately.
Provide your Social Security Number (SSN) and current station details, including email and phone number.
Indicate your reason for separation and last day at duty station. Review the terminal leave options and select accordingly.
Complete the physical examination section by choosing whether to take the exam or waive it.
Fill in travel preferences for yourself and any dependents, specifying modes of travel and destinations.
In Part B, have your immediate supervisor complete their section regarding recommendations for your separation.
Finally, ensure that Parts C and D are completed by the fiscal/administrative officer before submission.

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Versions	Form popularity	Fillable & printable
2005	4.9 Satisfied (45 Votes)
2002	4 Satisfied (21 Votes)

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