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PHS-1637-1 REV. 8/05 DEPARTMENT OF HEALTH AND HUMAN SERVICES PAYROLL USE ONLY PUBLIC HEALTH SERVICE COMMISSIONED OFFICER'S REQUEST FOR DEPENDENCY DETERMINATION NAME (LAST, FIRST, MIDDLE INITIAL) DATE
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PHS 1637 1 form is a document used by individuals or entities to report certain financial transactions to the Public Health Service (PHS).
Any individual or entity who has engaged in financial transactions that meet the reporting requirements set by the PHS is required to file PHS 1637 1 form.
To fill out PHS 1637 1 form, you need to provide the required information such as your name, contact details, description of the financial transaction, and any other relevant details as specified in the form instructions. Make sure to accurately complete all the fields and submit the form by the deadline.
The purpose of PHS 1637 1 form is to collect and report financial transaction information to the Public Health Service. This information is used for various purposes, including tracking and monitoring financial activities related to healthcare and public health research.
The specific information that must be reported on PHS 1637 1 form may vary depending on the nature of the financial transaction. Generally, it includes details such as the date of the transaction, the parties involved, the amount of money or value involved, and any other relevant information specified by the instructions of the form.
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