Request For APHC Health Hazard Assessment

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Requester InformationInstructions

Use Tab or click to focus on a field, instead of Enter to advance through the form.
You must select/enter one, and only one, Headquarters.

Financial (Comptroller) Information

Acquisition Information

Note: We require at least 90 days after all the data has been provided to the APHC, to compile and staff the HHA Report for all systems except for REF, RFI, JIEDDO, AWSSRB, and UMR-related items.

System Information

Provide Report No. and/or completed
Provide Report No. and/or completed
Provide Report No. and/or completed
Provide Report No. and/or completed
Provide Report No. and/or completed

Medical Cost Avoidance Information

MOS(s) Example: 11B Infantryman

Other Information

Document Upload

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