USAR Form 107-R at a glance
What it is: The Family Information Data Worksheet gathers data that will assist in the development of appropriate Family Programs activities and services to servicemembers' families.
Who signs: Enter PRINTED NAME, mark SOLDIER or FAMILY MEMBER, then SIGN and enter the SIGNATURE DATE (MM/DD/YYYY).
SOLDIER or FAMILY MEMBER: enter PRINTED NAME and SIGN.
A filled-in USAR Form 107-R example: a single soldier fills out page 1
How to fill out USAR Form 107-R, box by box
Soldier Information
Under SECTION I - SOLDIER INFORMATION, enter LAST NAME, FIRST NAME, MI and RANK.
Enter DOB and MOB DATE as (MM/DD/YYYY), and TOUR LENGTH as (# of DAYS).
Mailing Address and Phone and E-mail
Enter the MAILING ADDRESS: STREET, APT. #, CITY, STATE, ZIP CODE and COUNTRY.
Under Section I, enter Primary Phone, Secondary Phone, Primary E-mail and Secondary E-mail.
Primary Unit and Reassigned Unit
Enter PRIMARY UNIT and MAJOR COMMAND, then REASSIGNED UNIT and MAJOR COMMAND.
Marital Status
MARITAL STATUS: Single, Married, Divorced.
Primary Point of Contact
Under SECTION II - PRIMARY POINT OF CONTACT, enter LAST NAME, FIRST NAME, MI, RELATIONSHIP TO SOLDIER and PRIMARY LANGUAGE.
Mailing Address for the Primary Point of Contact: Street, Apt. #, City, State, Zip Code, Country.
For the Primary Point of Contact: Primary Phone, Secondary Phone, Primary E-mail, Secondary E-mail.
Consent
Under SECTION III - CONSENT, your Primary Point of Contact will be contacted by the Family Programs Office staff. Please initial to release this information to FRG volunteers.
Enter PRINTED NAME, mark SOLDIER or FAMILY MEMBER, then SIGN and enter the SIGNATURE DATE (MM/DD/YYYY).
Secondary Point of Contact
Family Information Data Worksheet (continuation): enter SOLDIER'S LAST NAME and FIRST NAME MI.
Section IV, Secondary Point of Contact: Last Name, First Name, MI, Relationship to Soldier, Primary Language.
Mailing Address for the Secondary Point of Contact: Street, Apt. #, City, State, Zip Code, Country.
For the Secondary Point of Contact: Primary Phone, Secondary Phone, Primary E-mail, Secondary E-mail.
Child Information
Under SECTION V - CHILD INFORMATION, enter CHILDREN: Last Name, First Name, MI, Gender, DOB (MM/DD/YYYY) and Mailing Address (If different from family address).
For CHILDREN, mark Yes or No. For GUARDIAN, enter the GUARDIAN, PHONE and E-MAIL.
Family Concerns
Under SECTION VI - FAMILY CONCERNS, mark SPECIAL NEEDS OR FAMILY CONCERNS and DUAL MILITARY: Yes or No. If "Yes," please explain:
More rules for USAR Form 107-R
The information on this worksheet is for official use only within Army Reserve Family Programs and will not be furnished to any commercial enterprise, company, representative, organization or agency outside the Department of Defense, as established by the Privacy Act of 1974 (5 USC 552A and AR 340-21).
Information provided (specifically, name, address, and telephone number) may be listed and distributed to other participants to enable development of a communication and support network. Voluntary disclosure.
Failure to provide information may prevent the Family Programs participants from contacting you, especially during periods of military separation, or being able to provide you updated information on military unit related family activities, programs, and services available.
For use of this form see USAR Reg 608-1; the proponent agency is the USAR Family Programs Directorate.
Section VII, Family Programs Staff Use Only: Soldier's SSN and Date Entered in Portal.
Sources
[1] USAR Form 107-R, Family Information Data Worksheet, 15 May 10, U.S. Army Reserve Family Programs Directorate (the Official source link on this page).
