DHA Form 298 Prescription Drop Off/Activation Form

Prescription Drop Off/Activation Form

Documents and Forms

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

Information Collection (IC) Details

IC Title:	DHA Form 298 Prescription Drop Off/Activation Form	Agency IC Tracking Number:	0720-PDOA

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.