Form PFPA Form 55 PFPA Form 55 Request for U.S. Flag to be flown over the Pentagon

PENTAGON FORCE PROTECTION AGENCY
REQUEST FOR UNITED STATES FLAG(S) TO BE FLOWN OVER THE PENTAGON
Hours of Operation are 9:00am-12:30pm and 2:00 pm - 4:00 pm

OMB CONTROL NO.:
0704-FLAG
OMB EXPIRATION
DATE: XX/XX/XXXX

The public reporting burden for this collection of information, 0704-FLAG, is estimated to average three minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters
Services, at [email protected]. Respondents should be aware that notwithstanding any other provision of
law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control
number.
Privacy Act Advisory
Authority: DoDD 5105.68
Disclosure of PII is voluntary: However, failure to provide requested information will result in your flag request being denied.
Routine Use of PII: Your PII will be used to contact you about updates to your flag request. It will not be shared with anyone outside of the Pentagon
Force Protection Agency (PFPA).
This data collection will not become part of any Privacy Act System of Records.

1.

DATE: ___________________________________

2.

NAME OF PERSON FLAG WILL BE FLOWN FOR: _____________________________________

3.

OCCASION FLAG WILL BE FLOWN: (ex., retirement, anniversary, birthday, etc.) ______________

4.

DEDICATION ON CERTIFICATE: (ex. In Honor of Your 20 Years of Service)

_______________________________________________________________________________________
(Message is limited to 32 characters including spaces)
5. SPECIFIC DATE FLAG TO BE FLOWN: ________________________________________________

(Request must be at least 5 business days from date of receipt. If no date is specified, the flag will be flown no later than 15 business days from
date of receipt)

6. POINT OF CONTACT FOR PICK-UP:
NAME: ___________________________________________

PHONE NUMBER: ________________

EMAIL ADDRESS: __________________________________________________________________
(The Flag Coordinator will send an email to the above email address when the flag is ready for pick-up)

7. SUBMITTED BY:

________________________________________________________________________________

Flag Size:

Material:

Distinguished Markings:

8. RECEIVED BY PFPA REPRESENTATIVE:

In Person

Mail

_____________________

PFPA Representative

Flag(s) will be held no longer than 30 days from the date of fly over
PFPA FORM 55, JUL 2022

PREVIOUS EDITIONS ARE OBSOLETE

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