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DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Commissioned CorpsAPPLICATION FOR ALLOTMENT OF PAY Please read Privacy Act Statement on back before completing this form For Payroll Use
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Form PHS-6173 is an application used to request specific health services and funding from the Public Health Service.
Entities or individuals seeking funding or services from the Public Health Service are required to file Form PHS-6173.
To fill out Form PHS-6173, provide accurate personal and organizational information, detail the requested services or funding, and submit any required documentation.
The purpose of Form PHS-6173 is to apply for health-related services and funding, ensuring that applicants meet eligibility criteria set forth by the Public Health Service.
Information that must be reported includes applicant details, specific services or funds requested, justification for the request, and any relevant organizational or personal qualifications.
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