Instructions for the DD Form 1172-2 can be found at http //www. cac.mil/docs/1172-2-Instructions. pdf.. RELATIONSHIP ADDRESS 66. CITY 68. ZIP CODE 67. STATE 69. COUNTRY SECTION VI - RECEIPT Receipt of new card is acknowledged. DD FORM 1172-2 JAN 2014 73. INSTRUCTIONS The instructions for completing the DD Form 1172-2 should be closely followed to ensure accurate data collection and to preclude overcollection of information. Section IV of this form should only be completed if benefits or sponsorship is being requested for/by an eligible sponsor or their dependent. The DD Form 1172-2 currently covers the RUs that would include retirees and dependents. To the Department of Health and Human Services the Department of Veterans Affairs the Social Security Administration and to other Federal state and local government agencies to identify individuals having benefit eligibility in another plan or program. For a complete list of DEERS routine uses visit http //privacy. Chapter 23 E.O. 9397 E.O. 10450 as amended. PRINCIPAL PURPOSE S To apply for and enroll in the Defense Enrollment Eligibility Reporting System DEERS for DoD benefits and privileges. These benefits and privileges include but are not limited to medical coverage DoD Identification Cards access to DoD installations buildings or facilities and access to DoD computer systems and networks. Section 301 10 U.S.C. chapter 147 10 U.S.C. Sections 1061 - 1065 1072 - 1074 1074a - 1074c 1074c 1 1076 1076a 1077 1095 k 2 50 U.S.C. chapter 23 E.O. 9397 E.O. 10450 as amended. PRINCIPAL PURPOSE S To apply for and enroll in the Defense Enrollment Eligibility Reporting System DEERS for DoD benefits and privileges. APPLICATION FOR IDENTIFICATION CARD/DEERS ENROLLMENT Please read Agency Disclosure Notice Privacy Act Statement and Instructions prior to completing this form. OMB No. 0704-0415 OMB approval expires Jan 31 2017 SECTION I - SPONSOR/EMPLOYEE INFORMATION 2. GENDER 1. NAME Last First Middle 6. PAY GRADE 7. GEN. CAT 8. CITIZENSHIP 4. STATUS 12. CITY Permission to use for benefits notifications 5. ORGANIZATION 10. PLACE OF BIRTH 9. DATE OF BIRTH YYYYMMMDD 11. CURRENT HOME ADDRESS 16. PRIMARY E-MAIL ADDRESS 3. GENDER 1. NAME Last First Middle 6. PAY GRADE 7. GEN* CAT 8. CITIZENSHIP 4. STATUS 12. CITY Permission to use for benefits notifications 5. ORGANIZATION 10. PLACE OF BIRTH 9. DATE OF BIRTH YYYYMMMDD 11. CURRENT HOME ADDRESS 16. PRIMARY E-MAIL ADDRESS 3. SSN OR DOD ID NO. 13. STATE 18. CITY OF DUTY LOCATION 17. TELEPHONE NUMBER Include Area Code/DSN 14. ZIP CODE 15. COUNTRY 19. STATE OF DUTY LOCATION 20. COUNTRY OF DUTY 21. REMARKS Cite legal documentation as applicable. NOTARY SIGNATURE AND SEAL I certify the information provided in connection with the eligibility requirements of this form is true and accurate to the best of my knowledge. If not signed in the presence of the authorizing/verifying official the signature must be notarized* 23. DATE SIGNED YYYYMMMDD 22. SPONSOR/EMPLOYEE SIGNATURE SECTION III - AUTHORIZED BY 24. SPONSORING OFFICE NAME 25.
Award-winning PDF software
How to prepare DD 1172-2 2020-2022
DD form 1172-2 instructions
The DD 1172-2 is the application for an identification card for military sponsors, employees or those who are retired and their families. It is filled out when an individual wants to update or add new information about himself or his relatives entitled to such benefits as TRICARE in the DEERS database. Application for ID is easily filled online in PDF format. The current version of the form, as well as detailed instructions for it, can be found in PDFfiller library via search option. The armed forces officer should prthis template as soon as possible to avoid further misunderstandings.
Filling out DD form 1172-2
If the person changes his or her address or type of employment or any other change happened with his family member then DD 1172-2 form should be completed. It is connected with individuals that get help in such directions as insurance, medicine or dental treatment in accordance with TRICARE program. If the applicant or his spouse, or family members are supplied with the Medicare program, prthis data as well. To successfully fill out a sample online keep following tips that are given below:
- Open the template in the editor and read all the given prompts.
- Prall the required information using the text tool or add the fillable fields to the document.
- To include fields, open the right-side green tab and select the type of option you want to use.
- To add a checkmark select the corresponding item in the top tools panel. Place the mark in front of the point you want to agree with.
- Mind, that the sample contains numerous abbreviation. To type in them correctly, apply to the detailed instruction.
- Additionally, the user needs to indicate the sponsor’s or employee pay grade code and Social Security Number or Foreign National Identification Number.
- Sign the application using the signature wizard. The autograph, drawn with a finger, touchpad or mouse is legally binding.
- Once the template completed, the applicant can send it via e-mail, save or download its printable variant.
Every family member, including children under the age of 10 should be registered in the DEERS office and have a personal ID card. To change information in the database, the sample should be supplied by the originals or true copies of the supporting documents.
The document is usually answered within ninety days after the date it was signed by the sponsor and verified by a notary.
Online methods assist you to arrange your document management and strengthen the efficiency of the workflow. Adhere to the short manual to complete DD 1172-2 2014-2022, stay clear of glitches and furnish it inside a well timed manner:
How to finish a dd form 1172?
- On the web site using the sort, click on Get started Now and pass with the editor.
- Use the clues to fill out the pertinent fields.
- Include your individual info and speak to details.
- Make confident that you enter proper material and figures in acceptable fields.
- Carefully check out the content material in the sort also as grammar and spelling.
- Refer to help you part should you have any problems or address our Support staff.
- Put an electronic signature on your own DD 1172-2 2022 – 2022 aided by the help of Sign Instrument.
- Once the form is accomplished, push Performed.
- Distribute the prepared sort by using electronic mail or fax, print it out or help save in your unit.
PDF editor will allow you to make adjustments towards your DD 1172-2 2022 – 2022 from any online world linked machine, personalize it according to your preferences, indicator it electronically and distribute in various approaches.
What people say about us
Access advanced filing opportunities
Common Mistakes
Benefit from
People also search for DD 1172-2 2020 - 2021
dd 1172 - FAQ
Popular DD 1172-2 2020-2022 Forms
More info
Show details