Your Command's Letterhead 5355 Ser (yours) Date (your command's name and City) From: Commanding Officer, To: Commanding Officer, Navy Drug Screening Laboratory, Jacksonville Subj: REQUEST FOR COPY OF DD FORM 2624 1. Please provide a copy of DD Form 2624 for the following UIC RUC): batch(s) for (your or your Batch/Specimen No. SSN/DOD ID NO. LAN (Lab Accession Number) (This information is taken from the results you received from us.) *** Social Security Numbers (SSNs) will be redacted in accordance with Personal Identifiable Information (PII) guidelines. To receive an unredacted copy, you must specifically request that SSNs not be redacted. If your mailing address is different from your letterhead, 2. please include it. name) number) 3. Point of contact is at or (POC's (DSN number, including extension number, if applicable) (commercial (e-mail address). and SIGNATURE be signed by the Commanding (Must Officer or someone with "By direction" authority.)
Your Command's Letterhead 5355 Ser (yours) Date From: Commanding Officer, (your command's name and City) To: Commanding Officer, Navy Drug Screening Laboratory, Jacksonville Subj: REQUEST FOR COPY OF DD FORM 2624 1. Please provide a copy of DD Form 2624 for the following batch(s) for (your UIC or your RUC): Batch/Specimen No. SSN/DOD ID NO. LAN (Lab Accession Number) (This information is taken from the results you received from us.) *** Social Security Numbers (SSNs) will be redacted in accordance with Personal Identifiable Information (PII) guidelines. To receive an unredacted copy, you must specifically request that SSNs not be redacted. 2. If your mailing address is different from your letterhead, please include it. 3. Point of contact is (POC's name) at (DSN number) or (commercial number, including extension number, if applicable) and (e-mail address). SIGNATURE (Must be signed by the Commanding Officer or someone with "By direction" authority.)
COPY%20OF%20DD%20FORM%202624%20REQUEST.docx