department of health and human services request …request for title 38 physician and dentist pay...

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DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUEST FOR TITLE 38 PHYSICIAN AND DENTIST PAY (PDP) 1. SPECIAL PAY REQUEST Physician Dentist 2. ACTION REQUESTED New Recruitment Change to Existing PDP Other (Specify) 3. EMPLOYEE INFORMATION Name Position Title / P.D. Number Organization (Agency/Center/Division) Official Tour of Duty Full Time Part Time If part time, regular scheduled hours per pay period: 4. AMOUNT OF PDP TO BE PAID GP or GR Grade / Step Clinical Specialty / Board Certification Pay Table Number Tier Number Type of Incentive Recruitment Retention Relocation GS Base Pay $ Market Pay $ Total Annual PDP $ 3 R’s Pay $ Total Annual Compensation $ 5. NOTES 6. REVIEWS AND APPROVALS Recommending Official (Name and Title) Signature Date Compensation Panel Chair (Name) N/A Signature Date Approving Official (Name and Title) Signature Date Fund Availability (Name and Title) Signature Date Human Resources Review (Name and Title) Signature Date 7. EFFECTIVE DATE HHS-691 (10/06) PSC Publishing Services (301) 443-6740 EF

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Page 1: DEPARTMENT OF HEALTH AND HUMAN SERVICES REQUEST …REQUEST FOR TITLE 38 PHYSICIAN AND DENTIST PAY (PDP) 1. SPECIAL PAY REQUEST. Physician Dentist. 2. ACTION REQUESTED. New Recruitment

DEPARTMENT OF HEALTH AND HUMAN SERVICES

REQUEST FOR TITLE 38 PHYSICIAN AND DENTIST PAY (PDP)

1. SPECIAL PAY REQUEST

Physician

Dentist

2. ACTION REQUESTED

New Recruitment Change to Existing PDP

Other (Specify)

3. EMPLOYEE INFORMATIONName

Position Title / P.D. Number

Organization (Agency/Center/Division)

Official Tour of DutyFull Time Part Time If part time, regular scheduled hours per pay period:

4. AMOUNT OF PDP TO BE PAIDGP or GR Grade / Step

Clinical Specialty / Board Certification

Pay Table Number Tier Number

Type of IncentiveRecruitment Retention Relocation

GS Base Pay $

Market Pay $

Total Annual PDP $

3 R’s Pay $

Total Annual Compensation $

5. NOTES

6. REVIEWS AND APPROVALSRecommending Official (Name and Title) Signature Date

Compensation Panel Chair (Name) N/A Signature Date

Approving Official (Name and Title) Signature Date

Fund Availability (Name and Title) Signature Date

Human Resources Review (Name and Title) Signature Date

7. EFFECTIVE DATE

HHS-691 (10/06) PSC Publishing Services (301) 443-6740 EF

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