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Form/Template
May 2, 2023

AFHSD 501 Request Form

.PDF | 311.80 KB

Armed Forces Health Surveillance Division (AFHSD) Epidemiology and Analysis AFHSD 501 Request Form

Form/Template
Jan 25, 2023

TRICARE Retail Refund NDC Transfer Form

.PDF | 345.00 KB

Use this form to transfer Products or NDCs between Manufacturer Labelers, for billing purposes, in the TRICARE Retail Refund Program.

Form/Template
Jan 13, 2023

DSA Extension Request - Data Sharing Agreements

.PDF | 161.28 KB

This template shall be used to request a 30 day extension in order to continue to use the data in accordance to the executed Data Sharing Agreement (DSA).

Form/Template
Jan 13, 2023

DHA DSAA Prerequisite Checklist - Data Sharing Agreements

.PDF | 1.06 MB

This checklist is designed to ensure you have completed the Data Sharing Agreement Application (DSAA) pre-submission reviews and have the necessary documentation to submit a DSAA. You must complete and submit this Prerequisite Checklist (PRC) to the Defense Health Agency (DHA) Privacy and Civil Liberties Office (PCLO) before you submit a DSAA or it ...

Form/Template
Jan 5, 2023

DHA Renewal Request - Data Sharing Agreement

.PDF | 307.35 KB

This template shall be used to renew an executed Data Sharing Agreement (DSA) that incorporates an approved Data Sharing Agreement Application (DSAA). Submit this completed request or questions to the DHA Privacy and Civil Liberties Office (Privacy Office) at dha.ncr.j-6.mbx.dsa-mail@health.mil.

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