Information Collection

DHA Form 298 Prescription Drop Off/Activation Form

IC 262184 under ICR 202309-0720-002 · OMB 0720-0074.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form DHA Form 298 DHA Form 298 Prescription Drop Off/Activation Form	Form
DHA Form 298 DHA Form 298 Prescription Drop Off/Activation Form DHA 298_9.8.2023.pdf	Form
DHA Form 298 DHA Form 298 Prescription Drop Off/Activation Form DHA 298_9.8.2023.pdf	Form

IC Title:

Agency IC Tracking Number:

0720-PDOA

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	DHA Form 298	DHA Form 298 Prescription Drop Off/Activation Form	DHA 298_9.8.2023.pdf		Yes	Yes	Fillable Printable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	5,000	5,000
Annual IC Cost Burden (Dollars)	168,800	168,800

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.