Information Collection Request
Prescription Drop Off/Activation Form
ICR 202309-0720-002 · OMB 0720-0074 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form DHA Form 298 DHA Form 298 Prescription Drop Off/Activation Form |
Form | New | Repair queued |
 0720-PDOA_SSA_2.13.2024.docx |
Supporting Statement A | Uploaded 2024-02-20 | Repair queued |
| TAB A_Draft_DHA_AI XXXX.xx MTF Authorized Pharmacy Forms Guidance (03.23.23).docx |
Supplementary Document | Uploaded 2023-09-14 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 262184 |  DHA Form 298 Prescription Drop Off/Activation Form |
Form | New |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | DOD/DODOASHA |
| OMB Control No | 0720-0074 |
| Type of Information Collection | New collection (Request for a new OMB Control Number) |
| Agency Tracking No | 0720-PDOA |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |