• Decrease font size
  • Return font size to normal
  • Increase font size
U.S. Department of Health and Human Services

About FDA

  • Print
  • Share
  • E-mail

Staff Manual Guide 3113.11, Attachment A

Format For FDA Outstanding Achievement Award Nominations

Prepare an information sheet. The instructions in parentheses describe the information to be entered. Do not exceed one page.

(Actual size 8 1/2" x 11")


1. Name and organization of nominee: (Use name exactly as it should appear on certificate. Include any doctoral degree used. Also indicate Miss, Ms., Mrs., Mr., as appropriate.)

2. Title, series, and grade of current position: (Example - Clerk Typist, GS-322-4)

3. Brief statement of current duties:

4. Length of Government service:

Length of HHS service:

Length of FDA service:

5. Listing of previous honors and awards: (Example - Quality Increase 1978)

6. Brief summary of education:

7. Brief summary of work experience:

8. Proposed citation: (Twenty-five [25] words or less summarizing the service or achievement which serves as the basis for this nomination. Begin the citation with, "In recognition of..." --or-- "For..." and do not include personal pronouns such as "her" or "his."

Prepare a narrative justification (single-spaced). The instructions in parentheses describe the information to be entered. Do not exceed three pages.

(Actual size 8 1/2" x 11")


(Describe the employee's achievement or distinguished service, showing clearly the manner in which the nominee has met the award criteria. This statement should include sufficient detail to provide reviewing and advising boards with enough information to e effectively evaluate the nominee's contribution. Some points to include, if applicable, are: impact of the achievement on Agency mission, function, or activity affected; level of effectiveness before and after improvement actions were taken; results obtained by the nominee's actions, including any quantifiable evidence of improvement; and, degree of ingenuity, innovation, or exceptional skill demonstrated by the nominee's attributes, attitudes and job knowledge.)