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Mission Services Requests

To submit a request for an APHC Product or Service, please complete the form below.

First Name

Last Name

Email address

Phone Number

Subject of Request (subjects with an * require additional customer input)

Request (please include a short description of your request)

By clicking on the checkbox, you affirm that you are a U.S. Military Member, a retired U.S. Military member, a dependent of a U.S. Military member or retired U.S. Military member as recorded in DEERS, a DoD Civilian, or an authorized DoD contractor or an employee of a DoD contractor with official duties in support of Army Public Health. Your request for APHC services will be sent to the responsible POC for a response.

PRIVACY ACT STATEMENT

Authority: 5 U.S.C. 1302, 2951, 3301, 3372, 4118, 8347, and Executive Orders 9830, 12107, and 13478.

Principal Purposes: To verify an individual's eligibility for the request for products/services, authentication of identity and identification of customers.

Routine Uses: Information provided will be used only within APHC and will not be released to any other staff activity.

Disclosure: Information is voluntary, however, failure to provide all the requested information could lead to disapproval of the request for products/services.

SECURITY CLASSIFICATION STATEMENT

It is incumbent upon customers providing information and data to this Program/Institute/Command to ensure that consolidation of that information and data will not result in an increase in security classification. Developers must use the SIPRNET to communicate information and data in situations where a resulting increase in security classification is reasonably foreseeable.