If you have been separated more than 30 days and want a refund of your total deductions, use form SF 3106; otherwise, forward this application to the Office of Personnel Management, Federal Employees Retirement System, P.O. Box 45, Boyers, PA 16017-0045.

Browse and download your choice of form(s) issued by the Office of Personnel Management

You are not required to use this form. You may draft your own form or use forms available at legal stationery stores. 2. The Department of State recommends that all documents be prepared under the guidance of an attorney. 3. The certificate must be submitted with a $20 filing fee.

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PRINCIPAL PURPOSE(S): To evaluate each practitioner’s formal education, training, clinical experience, and evidence of physical, moral and ethical capacities and to assist the Credentials Committee in making recommendations with regard to the practitioner’s competence to treat certain conditions and perform certain medical procedures.

Applicants currently in training programs are required to supply updated DHA Form 367 and Clinical Privilege Lists no more than 45 days prior to completion of a training program.

Submit JST Corrections Requests and legible copies of certificates through your ESO. Retired/Separated/Spouses /Auxiliary. Submit your correction request via: Email: . [email protected]. Fax.