TN 16 (11-92)
RS 01702.529 Contact With PHS
If it is necessary to contact PHS to verify any service of a commissioned officer from 1/1/57 - 6/30/60 and/or to obtain a breakdown of the Reserve Corps and Regular Corps wages, send a letter based on the sample in B., below. This letter will be typed as needed.
B. VERIFICATION OF PUBLIC HEALTH SERVICE RESERVE CORPS SERVICE
Sample Letter of Request for Verification of Public Health Service Reserve Corps Service from 1/1/57 - 6/30/60
Chief, Commissioned Personnel Operations Division
Office of Personnel and Training
Department of Health and Human Services
Parklawn Building, Room 4-36
5600 Fisbers Lane
Rockville, Maryland 20852 Re: Request for Verification of
Public Health Reserve Service from
January 1, 1957, to June 30, 1960
You have previously notified the Social Security Administration that (Name of Officer) , Social Security Account No. , born , performed active service as a Public Health Reserve officer at some time during the period January 1, 1957, to June 30, 1960.
The information below is requested to permit us to determine the effect of this service under the Social Security Act in view of Public Law 86-415.
Was the individual's active commissioned service during the period entirely Reserve Corps service? YES NO
If answer to 1 is "no" answer 2 and 3.
What were the dates of the individual's active service in the Reserve Corps between December 31, 1956, and July 1, 1960?
If the individual was transferred within a calendar quarter from active service in the Reserve Corps to the Regular Corps (or vice versa), please show the remuneration reported for social security purposes, that was attributable to Reserve service and to Regular service for that quarter.
|Quarter of Transfer||Reserve Service||Regular Service|
| ||Signature: || |
| ||Title: || |
Return to: Social Security Administration
One Metro Square
51 Monroe Street
Rockville, Maryland 20850