SAMPLE TERMINATION/RENEGOTIATION OF
DENTAL INCENTIVE SPECIAL PAY REQUEST (ISP)
From: LCDR John L. Doe, MC, USN, 123-45-6789/2200
To: Chief, BUMED (M1C1)
Via: Commanding Officer, USS EVERSAIL (CV-35)
Subj: TERMINATION AND RENEGOTIATION OF ACTIVE DUTY AGREEMENT
FOR DENTAL INCENTIVE SPECIAL PAY (ISP)
Ref: (a) OPNAVINST 7220.17A
(b) NAVADMIN (current FY Special Pay Plan)
1. I hereby apply for Dental ISP effective ______________
per references (a) and (b). My current ISP contract dated
___________ will be terminated as of _______________. I
must repay the unearned portion of this ISP contract
incident to award of ISP for the new contract.
2. Condition of the agreement. I understand that:
a. The year of continuous active duty that I agree to
serve will be effective on __________________.
b. Dental ISP in the amount of $________ for the
specialty of _____________ and with an effective date of
____________, may not be paid before approval of this
agreement by CO, NAVMED MPT&E.
c. CO, NAVMED MPT&E may terminate this agreement for
any reason enumerated in paragraph 343 of reference (a).
d. In the event of termination, I must repay unearned ISP
on a pro rata basis per paragraph 344 of reference (a).
e. Termination of ISP does not, in itself, relieve me of
requirements to complete statutory and educational service
f. Point of contact for special pays is ______________,
at _____________ or DSN_____________.
JOHN L. DOE