New Request for Physician Special Pay (PSP)
Check Sheet


Name:

IC:

 

Lab/Branch:

Present Position/Level:


Documentation Required for New Request for Physician Special Pay

Please submit in the following order (original plus 25 copies):

  1. Route Slip - Request for Title 38, Physician Special Pay

  2. NIH Medical Executive Committee Title 38 Physician Special Pay Summary Sheet

  3. NIH Request for Payment of Title 38 Physician Special Pay

  4. HHS-691, Request for Special Pay for Physicians and Dentists signed by the IC Director as recommending official.

    NOTE: Do not complete item 3.b. Social Security Number. Create a signature line, 7.a.1. for the signature of the ADCR or DDIR as appropriate.

  5. HHS-691-1, Employee Agreement to Receive Special Pay for Physicians and Dentists Under Title 38.


    NOTE: Complete all items except 3.b. Social Security Number and 15., employee signature.

  6. Current Curriculum Vitae.

  7. Classified Position Description (OF-8 and narrative description of duties).

  8. If applicable - completed request for recruitment bonus or retention allowance.

    1. PHS 6340, Request for Recruitment/Relocation Bonus and Retention Allowance.

    2. PHS 6340A, Recruitment Bonus Service Agreement, when applicable.

      Narrative justification including supporting documentation, e.g., benefits comparison supported by current pay slip, statement of benefits from current employer, employee handbook, written outside job offer, etc.


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