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Ds 174 Form: What You Should Know

All dates must be accurately entered. Do not include letters, numbers or symbols on all page edges. All data must  be typed by hand, using correct space between the lines. Do not copy or write on any page. Do not copy the  application form. Do not delete any section on the front or side of the application form. Do not make any  changes to the data entered. Do not delete or do not change the name or social security number. Do not delete or make any changes to the data entered on the Application for Physicians, Dentists, Podiatrists, Optometrists, and  chiropractors. Please list all locations you are applying for appointment to, including phone numbers, addresses,  and dates of employment for all personnel listed. If at all possible, provide information about the individual from whom  you are applying, including full name and current address, the title, and current position number. Please provide  all certifications, licenses, certifications, and titles you hold. If you have any questions about the application for  physician assistant, please contact the Assistant Provider Benefits Division of the National Health Care  Program at or TTY.  VACATION NOTICE. The following VA personnel will provide the following benefits as follows at  their full-time rates for the months listed, and will be reimbursed the appropriate amount. If employed during the period from January 1st through August 15th, 2018, 9,000 annually unless otherwise  provided. From January 1st through August 15th, 2018, 8,800 annually unless otherwise provided. From September 1st through April 8th, 2019, 7,600 annually unless otherwise provided. You are a military training employee (full-time employee with at least 6 months of military  service creditable service from your last appointment if applicable) who is performing on-site  certified and licensed health-related work for the Veterans Health Administration (VA) and who meets the  VA's standards and procedures for certification and licensing. You are required to submit all your  information in the form. Your initial and final evaluations and your annual reports must be signed  by your supervisor and/or supervisor's designee or on his/her behalf. The application form, as listed  below, must be completed on-line.

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