Prescription Drop Off/Activation Form

ICR 202309-0720-002

OMB: 0720-0074

Federal Form Document

Forms and Documents

Document Name	Status
Form DHA Form 298 DHA Form 298 Prescription Drop Off/Activation Form Form	New
0720-PDOA_SSA_2.13.2024.docx Supporting Statement A	2024-02-20
TAB A_Draft_DHA_AI XXXX.xx MTF Authorized Pharmacy Forms Guidance (03.23.23).docx Supplementary Document	2023-09-14

IC Document Collections

IC ID	Document Title	Status
262184	DHA Form 298 Prescription Drop Off/Activation Form Form	New