Urinalysis tactics, techniques, and procedures ttp deputy. While there is no singular records custodian for the dd form 2624, this is an indispensable document for both the upl and the forensic toxicologist. The memo must identify the specimen by base area code, uic, batch number, date collected, specimen number and ssn. Both witnesses must testify about the information recorded on the dd form 2624, the regulatory requirements to generate and maintain the document, and their level of experience with the document. Complete the appropriate form and send it to the appropriate claims processor. This allows us to effect needed changes and updates without waiting for a published change to the manual. Removes a new collection bottle from the box in front of the soldier and replace it with the soldiers military id card. This page lists forms and worksheets referenced in the personnel and pay procedures manual. Dd forms 2795, 2796, 2900 and deployment mental health. Select initial, updated, or after action report and enter the date. Download a form you can access commonly used forms below or browse the menu on the left for more information. Verify that all ssns on the unit ledger, dd form 2624 and bottle labels match. The latest technologies high quality electronic pubs and forms view u. Drawing can be seen in the office during working hrs.
Prepares dd form 2624 chain of custody form listing up to 12 samples on form. Common drug testing discrepancies to correct codes bd and bf, an annotation on dd form 2624, block must be made. Completion of the dd form 2624, specimen custody document drug testing. Soldier prints name first, middle initial, last and payroll. Dd form 2977 instructions, jan 2014 instructions for completing dd form 2977. Fill dd form 2624 fillable, download blank or editable online. Required information entry on front and back of form.
Instructions for form 4506a, request for public inspection or copy of exempt or. Fill free fillable consent for third party contact 2017 form2624. Deployment health assessment dd forms 2795, 2796, 2900 and deployment mental health assessment dd form 2978 prior to deployment returning from. One of the most important aspects of collecting urine specimens is maintaining the specimen custody document drug testing dd form 2624. If the specific date cannot be determined, enter an. Ensure that every bottle listed on the dd form 2624 is in the collection box and in the correct slot. Dd form 2624, specimen custody document drug testing.
Read instructions on last page before completing form. Since many noncommissioned officers are very familiar with the latter. The directives division administers and operates the dod issuances program, the dod information collections program, dod forms management program. Samples mailed to lab by bm2 smith immediately after collection, with no intermediate transfer of custody. Appendix t specimen custody documentdrug testing dd form 2624 1. The upl will then af fix the label to the bottle, in full view of both the soldier and the observer, and. Made a copy of this claim and attachments for your records. Dd form 2624, feb 1998 previous edition may be used. This eight year service requirement is called the military service obligation. Army da administrative publications and forms by the army publishing directorate apd.
It should include batch and specimen number and an explanation. Dd form 11722 instructions september 2018 1 instructions for completion of dd form 11722, application for identification carddeers enrollment the dd form 11722 shall be used to apply for issuance of a dd form 2 reserve, retired, and reserve retired, a dd form 1173, a dd form 11731, a dd form 2764, a dd form 2765, and. The following is a link to a pdf and xfdl versions of the da form 705 army physical training fitness test scorecard leaders use to test the physical fitness of their units. Ensure that all required information, signatures, and initials are on the bottle label, unit ledgers, and dd form 2624. Consent fixing period of limitation on assessment of. Election for alternative to payment of the imputed underpayment irc section 6226 0219 02062019 form 2553. Consent for third party contact 1117 11092017 form 921p.
Agent officers name, grade, ssn, unit address include zip codeapo. If the sponsor and patient are the same enter same. I certify that i am a laboratory certifying official, that the laboratory results indicated on this form were correctly determined by proper laboratory procedures, and that they are correctly annotated. If you dont see any interesting for you, use our search form on bottom v. Dd form 2624, specimen custody document drug testing, november 2014 author.
Directives division washington headquarters services. Recapture of investment credit 1216 01272017 inst 4255. Block is indicated by a green arrow on the next page. Election by a small business corporation 1217 062019 form 9783. On this page you can read or download 2977 army pubs in pdf format. Updated april 2007 participant guide july 2008 32 tricare dd form 2642 dd form 2642 apr 2007 previous edition is obsolete. Tricare health plan enroll tricare health plan disenroll tricare dental program enroll below are helpful links about your tricare eligibility.
For separation requirements and notification of loss of benefitsconsequences see local directives and ar 635200. Sign, fax and printable from pc, ipad, tablet or mobile with pdffiller instantly no software. Specifically, we created an example template of a correctly completed chain of custody and had laboratory personnel available to assist in training or provide clarification. Using this procedure will greatly aid the units with accomplishing the annual requirement of testing 100 percent of the assigned strength and provide minimal disruption to the accomplishment of the recruiting mission during the fy. Tricare claim forms can be downloaded from the tricare website link below. Eftps individual enrollment form 1211 09162017 form 9779. The directives division administers and operates the dod issuances program, the dod information collections program, dod forms management program, gao affairs, and the dod plain language program for the office of the secretary of defense. Instructions for form 4255, recapture of investment credit. Submitting unit required information entry on front and back of form. Mcas yuma drug demand reduction program bd broken seal bf bottle, two seals, no explanation situation service member broke the seal and placed a. Form 2624, see the commanders guide and upl urinalysis collection handbook.
Dec 06, 2015 on this page you can read or download 2977 army pubs in pdf format. Iaw air force manual afman 33363, management of records, and disposed of iaw air. Dd form 2624 download fillable pdf or fill online specimen. Register, dd form 2624, and a urinalysis sample container box are used to ship the io specimens. Does upc sign and date block 12 of dd2624 when collection of all samples is completed. General specification booklet can be seen in the office during working hrs 14. Military construction programmilitary construction program. Army substance abuse program asap maryland military. Does upc sign and date block 12 of dd2624 when collection of all samples is. Use fill to complete blank online irs pdf forms for free. Ensure that every bottle listed on the dd form 2624 is in the. Consent for third party contact 1117 11092017 form 2678. Assign a discrepancy lan only if an attempt was not made to indicate. Ensure that specimens are placed in storage in accordance with ar 60085.
These forms and worksheets are now published independently of the manual. Place each dd forms 2624 into the corresponding specimen containers. Before completing this form, you must first request corrected income statements or written verification of the correct amount of income paid to you from the financial institution, employer. Using this procedure will greatly aid the units with accomplishing the annual requirement of testing 100. Instructions for completion of dd form 11722, application for identification carddeers enrollment the dd form 11722 shall be used to apply for issuance of a dd form 2. Use the following information for completing form 2624. Dec 06, 2015 on this page you can read or download dd form 2977 september 2014 in pdf format. Attached dd form 2527, statement of personal injury possible third party liability defense health agency if accident or work related. Instructions for form 4506a, request for public inspection or copy of exempt or political. Figure 64 dd form 2624 corrections for untested members.
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