Loading
Form preview picture

Get cl navy 2005-2024

Signature of Alloter ADMINISTRATIVE ACTION For Payroll Use Only Processed Verified PHS-6173 Rev. 3/05 FRONT PSC Media Arts 301 443-1090 EF Application for Allotment of Pay -- PHS-6173 Privacy Act Notification Statement General The following information about this form and its uses is provided to you as required by the Privacy Act of 1974 5 U.S.C. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Commissioned Corps For Payroll Use Only APPLICATION FOR ALLOTMENT OF PAY Please read Privacy Act Statement on back before completing this form Deliver to Office of Commissioned Corps Support Services ATTN Compensation Branch 5600 Fishers Lane Room 4-50 Rockville MD 20857-0001 1. Name Last First Middle 2. Date 3. Social Security Number Type or Print 4. Address 5. City 6. State 7. Zip Code 9. Purpose 8. Work Phone Number 10. Account Number if applicable Insurance Charity Dependent Support 11. Allotment Recipient 12. Check One Box Initial Authorization Amount Name Increase Allotment To From Cancel Authorization City Zip 13. Effective Date For Action 14. Request and Authorization I hereby request and authorize the above pay allotment to be initiated and to remain in effect until revoked by me in writing. 552a. The form is part of the following system of records 09-40-0010 Pay Leave and Attendance Records HHS/PSC/HRS and 09-40-0001 PHS Commissioned Corps General Personnel Records HHS/PSC/HRS* Authority for Collection of Information Title 37 U*S* Code Section 704 P. L* 87-649 Revision and Codification of Title 37 -- Pay and Allowances of Uniformed Services and Executive Order 9397. Principal Purpose and Routine Uses The information you are requested to supply on this form will be used to process your allotment of pay to a financial organization or other designee. The information may also be used under exceptional circumstances for other purposes including but not limited to the following 1. To respond to court orders for garnishment of an employee s pay for alimony or child support. for Federal income tax purposes. 3. To respond to Federal State or local agencies investigating or prosecuting a violation of law. Effects of Nondisclosure Disclosure of your Social Security Account Number SSAN is mandatory. The SSAN is requested for identification purposes. Failure to supply complete and accurate information may result in delays and/or denial of request. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Commissioned Corps For Payroll Use Only APPLICATION FOR ALLOTMENT OF PAY Please read Privacy Act Statement on back before completing this form Deliver to Office of Commissioned Corps Support Services ATTN Compensation Branch 5600 Fishers Lane Room 4-50 Rockville MD 20857-0001 1. Name Last First Middle 2. Date 3. Social Security Number Type or Print 4. Address 5. City 6. State 7. Name Last First Middle 2. Date 3. Social Security Number Type or Print 4. Address 5. City 6. State 7. Zip Code 9. Purpose 8. Work Phone Number 10. Account Number if applicable Insurance Charity Dependent Support 11. .

How It Works

codification rating
4.8Satisfied
81 votes

Tips on how to fill out, edit and sign Fishers online

How to fill out and sign Allotment online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

Feel all the advantages of completing and submitting legal documents on the internet. Using our service filling out PHS-6173 only takes a matter of minutes. We make that possible by giving you access to our feature-rich editor capable of altering/fixing a document?s original text, inserting special fields, and e-signing.

Execute PHS-6173 in several moments by following the guidelines listed below:

  1. Choose the document template you will need from the collection of legal forms.
  2. Click on the Get form key to open it and begin editing.
  3. Submit the requested boxes (they will be yellowish).
  4. The Signature Wizard will enable you to add your electronic autograph right after you?ve finished imputing information.
  5. Add the relevant date.
  6. Double-check the entire document to ensure you?ve filled in all the data and no changes are required.
  7. Hit Done and save the resulting form to your gadget.

Send your PHS-6173 in a digital form when you finish filling it out. Your information is well-protected, because we adhere to the most up-to-date security requirements. Join numerous satisfied customers who are already filling out legal forms right from their houses.

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Video instructions and help with filling out and completing designee

Avoid legal representative service fees for acquiring and completing your Form. Find all the tricks and tips you need in our video guide to start saving money on official documents.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to PHS-6173

  • 1974
  • Alloter
  • codification
  • 552a
  • designee
  • garnishment
  • Nondisclosure
  • Attn
  • fishers
  • hrs
  • applicable
  • allotment
  • EF
  • allowances
  • revision
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.