Indian Health Service The Federal Health Program for American Indians and Alaska Natives
The following forms are due to your Program Analyst during your final year of academic or post-graduate clinical training.
Preferred Placement (IHS-856-12)
You must submit a Preferred Placement (IHS-856-12) [PDF - 44 KB] form to your Program Analyst at the beginning of your final year of academic/post-graduate clinical training (for example, August/September for spring graduates) indicating your preferred IHS Areas and Indian health facilities to fulfill your service commitment.
Placement Update (IHS-856-15)
You must send a Placement Update (IHS-856-15) [PDF - 39 KB] form to your Program Analyst if you are unable to secure employment prior to completion of your academic or post-graduate clinical training. You also must attach documentation outlining your attempts to secure employment (for example, your letter of application receipt, interview dates, denial letters, etc.). This form may also be used to express any dissatisfaction or note any problems encountered while seeking a position.
This form and documentation is due every 30 days from the time you complete your training until you either accept a position or reach the 90-day limit. If after 90 days you have not secured employment, you will be subject to involuntary placement according to the needs and priorities of IHS and each Tribe.
Verification of Employment
You must send the following documentation after you have accepted an IHS-approved position:
- Federal civil service — Notification of Personnel Action (SF-50) form. The program will also accept a hire letter from the facility indicating your start date, position title and position description.
- Tribal/Urban Indian program — A hire letter from the facility indicating your start date, position title and position description.
- USPHS Commissioned Corps — Call-To-Active-Duty (CAD) notice.
- Private practice — A contract, work agreement or hire letter from the facility indicating your start date, position title, position description and terms of employment and benefits.
Your reporting responsibilities do not end once you have begun your career as a health professional. The IHS Scholarship Program requires its former recipients currently fulfilling their service commitment to provide annual updates confirming their status in full-time clinical practice.
Annual Status Report
You must submit an Annual Status Report (IHS-856-16) [PDF - 53 KB] form annually along with a leave report summary, provided by your local Human Resources Department, to your Program Analyst until your service commitment is complete. This is required to monitor your employment activity and document that you have worked in an approved full-time clinical position in the health profession for which you received funding while not exceeding the maximum five weeks or 35 days of leave.
You must also notify the IHS Scholarship Program if there are any interruptions in employment, such as maternity leave; extended sick, disability or family-friendly leave; outside training exceeding 10 days per each 12-month period; breaks in service related to a change of work site; or any other extended time away from work so that your service end-date may be recalculated.