Dd1172 2 Instructions Details

Have you ever wondered what the 1172 2 instructions are on your tax return? Well, wonder no more! Below we will outline what these instructions are and what they mean for you. Keep in mind that this is general information and you should speak with a tax professional to determine how these instructions specifically apply to your tax situation.

If you wish to first learn how much time you will need to prepare the 1172 2 instructions and how many pages it has, here is some general data that might be useful.

QuestionAnswer
Form Name1172 2 Instructions
Form Length13 pages
Fillable?No
Fillable fields0
Avg. time to fill out3 min 15 sec
Other names1172 2 instructions, d1172 form, 1172 2 identification, dd form 1172 2 instructions

Form Preview Example

INSTRUCTIONS FOR COMPLETION OF DD FORM 1172-2, “APPLICATION FOR

IDENTIFICATION CARD/DEERS ENROLLMENT”

The DD Form 1172-2 shall be used to apply for issuance of a DD Form 2 (Reserve, Retired, and Reserve Retired), a DD Form 1173, a DD Form 1173-1, a DD Form 2764, a DD Form 2765, and a Common Access Card (CAC) for eligible individuals who are not enrolled in the Defense Enrollment Eligibility Reporting System (DEERS). The DD Form 1172-2 shall also be used to enroll eligible individuals in DEERS or to update an eligible individual’s DEERS record by submitting the form to a Verifying Official (VO) at any Real-time Automated Personnel Identification System (RAPIDS) Site. Retention and disposition of the DD Form 1172-2 shall be in accordance with uniformed services' regulatory instructions.

Notes:

DoD sponsors enrolling their dependents in DEERS should complete Sections I, II, and V. O For dependents already enrolled in DEERS, CAC-enabled sponsors may logon to the

RAPIDS Self-Service (RSS) Portal to verify their dependents online and digitally create and sign DD Form 1172-2. Once the CAC-enabled sponsor verifies the dependent via RSS portal, the DD Form 1172-2 is saved under the dependent’s DEERS record, and must be printed and submitted to a VO at a RAPIDS Site to support card issuance.

DoD sponsors updating their own status or adding a personnel condition impacting benefits (e.g., overseas assignment) should complete Sections I and II.

Eligible employees applying for a CAC should complete Sections I and II (and Section IV if a Foreign Affiliate on orders to the U.S. with authorized dependents). The DD Form 1172-2 should then be provided to a DoD sponsor for authorization and completion of Section III.

DoD personnel sponsoring an eligible individual for a CAC should complete Section III.

For certain populations, a paper form will not be required (e.g., populations entered into RAPIDS via the Trusted Associate Sponsorship System (TASS)).

A DD Form 577 (signature card) for DoD personnel completing Section III must be on file at the issuing site for CAC applicants using the DD Form 1172-2 for enrollment. The DD Form 577 may be completed with either a wet or digital signature, selecting the format which will be used to sign the DD Form 1172-2. If both signature formats will be used, a DD Form 577 for each format must be completed and on file at the issuing site.

SECTION I – SPONSOR/EMPLOYEE INFORMATION

Block 1. Name. Enter the sponsor/employee’s LAST name first, enter the FIRST name, and then enter the MIDDLE initial or the full MIDDLE name. Use no more than 51 characters.

The name field can include a designation of JR, SR, ESQ, or the Roman numerals I through X. To include that designation, enter the appropriate data after the middle initial.

The name cannot contain any special characters nor is any punctuation permitted.

DD Form 1172-2 Instructions (September 2018)

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Block 2. Gender. Enter the sponsor/employee’s gender from the valid codes listed in Table 1. Use one character.

Table 1. Gender Abbreviations

CODE

GENDER

MMale

F Female

Block 3. Social Security Number (SSN) or DoD Identification (ID) Number. Enter the sponsor/employee’s SSN or DoD ID Number.

In cases where an employee has not been issued an SSN or DoD ID Number, an ITIN or Foreign National Identification Number (FNIN) can be provided.

If neither number is available, a Foreign Identification Number (FIN) will be generated by the system. A FIN (assigned as 900-00-0000F and up) will be assigned and automatically generated for eligible foreign nationals who do not have an SSN.

An SSN or ITIN is the preferred identifier for initial enrollment. Only in cases where neither is available should an alternate be used.

For Verifying Officials (VOs): If an SSN or DoD ID Number is already registered in DEERS for another individual, STOP processing and verify the number. If verification confirms duplication of the SSN by the Social Security Administration, continue processing and the system shall automatically generate a duplicate control number for the additional sponsor/employee.

Block 4. Status. Enter the sponsor/employee’s status from the valid codes listed in Table 2. If unsure of status, leave blank. Use no more than six characters.

 

Table 2.

Status Codes

 

 

 

CODE

 

STATUS

 

 

ACADMY

Academy or Navy Officer Candidate School (OCS) Student

AD

Active duty (excluding Guard and Reserve on extended active duty for more than 30 days)

AD-DEC

Active duty deceased

 

CIV

Civilian

 

CONTR

Contractor

 

DAVDEC

100-percent disabled veteran deceased (either temporary (TMP) or permanent (PRM)

DAVPRM

100-percent disabled veteran, permanent disability

DAVTMP

100-percent disabled veteran, temporary disability

FP

Foreign military personnel

 

FMRMR

Former member who is in receipt of retired pay for non-regular service but who has been

discharged from the Service and maintains no military affiliation

 

FMRDEC

A former member who qualified for retired pay for non-regular service at his or her sixtieth

birthday, before his or her discharge from the Service, but died while in receipt of retired pay

 

GRD

National Guard (all categories)

 

GRDDEC

National Guard deceased

 

DD Form 1172-2 Instructions (September 2018)

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CODE

STATUS

 

 

GRD-AD

Guard on extended active duty for more than 30 days

MH

Medal of Honor recipient

MH-DEC

Medal of Honor recipient deceased

OTHER

Non-DoD eligible beneficiaries (including credit union employees, and other civilians employed in

support of U.S. forces overseas, who are authorized benefits and privileges)

 

PDRL

Retired member, on the Permanent Disability Retired List (PDRL)

PR-APL

Prisoner or Appellate leave

RCL-AD

Recalled to active duty

RES

Reserve (all categories)

RES-AD

Reserve members on extended active duty for more than 30 days

RESDEC

Reserve deceased

RESRET

National Guard and Reserve members who retire, but are not entitled to retired pay until age 60

RET

Retired member entitled to retired pay

RETDEC

Deceased retired member entitled to retired pay. Code applies to active duty retired, Retired

Reserve beginning on their 60th birthday, the TDRL, and the PDRL.

 

SSB

Special Separation Benefits (SSB) recipient member with 120 days medical benefits

(CHAMPUS/TRICARE and MTF)

 

TDRL

Retired member, on the TDRL

TA-RES

Selected Reserve Transition Assistance Management Program members and their eligible

 

dependents

TA-30

Involuntarily separated member of Reserve or Guard Component entitled to 30 days medical

 

benefits (CHAMPUS/TRICARE and MTF)

TA-60

Involuntarily separated member with 60 days medical benefits (CHAMPUS/TRICARE and MTF)

TA-120

Involuntarily separated member with 120 days medical benefits (CHAMPUS/TRICARE and MTF)

TA-180

Involuntarily separated member with 180 days medical benefits (CHAMPUS/TRICARE and MTF).

VSI

Voluntary Separation Incentive (VSI) recipient with 120 days medical benefits

 

(CHAMPUS/TRICARE and MTF)

Block 5. Organization. Enter the sponsor/employee’s organization, branch, or service from the valid codes listed in Table 3. Use no more than five characters.

Table 3. Organization/Branch/Service Codes

CODE

ORGANIZATION/BRANCH/SERVICE

 

 

USA

U.S. Army

USAF

U.S. Air Force

USN

U.S. Navy

USMC

U.S. Marine Corps

USCG

U.S. Coast Guard

USPHS

U.S. Public Health Service

NOAA

National Oceanic and Atmospheric

 

Administration

DoD

Department of Defense

FED

Employee of an Agency other than DoD

OTHER

Used when the sponsor/employee is not

 

affiliated with one of the uniformed services

 

listed above

Block 6. Pay Grade. Enter the sponsor/employee’s pay grade from the valid codes listed in Table 4. Use no more than four characters.

DD Form 1172-2 Instructions (September 2018)

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Table 4. Pay Grade Codes

 

 

CODE

PAY GRADE

 

 

El-E9

Enlisted pay grades 1 through 9

W1-W5

Warrant officer pay grades 1 through 5

STDT

Academy and/or Navy OCS student (ENTER PAY GRADE IF

 

STDT RECEIVING PAY)

001-011

Officer pay grades 1 through 11 (011 is reserved)

GS01-GS18

Federal employees with General Schedule pay grades

NF1-NF6

Federal employees with Nonappropriated Fund pay grades

OTHER

Other (non-uniformed service) pay grades not defined above,

 

to include all contractors

N/A

Not applicable. Use this code with the Block 4 status codes of

 

“FMRMR” or FMRDEC”

Block 7. GEN. CAT (Geneva Convention Category). Leave this block blank. This block is automatically generated by DEERS/RAPIDS with the valid codes listed in Table 5.

 

Table 5. GEN CAT

 

 

CODE

GEN CAT

 

 

I

Category I (pay grades E1 through E4)

II

Category II (pay grades E5 through E9)

III

Category III (pay grades W1 through 003 and/or

 

Cadets and/or Midshipmen)

IV

Category IV (pay grades 004 through 006)

V

Category V (pay grades 007 through 011)

N/A

Not applicable (non-protected personnel)

Block 8. Citizenship. Enter the sponsor/employee's appropriate country of citizenship from the valid codes listed in Table 6. Use three characters.

Table 6. Country Abbreviations

Afghanistan

AFG

 

Aruba

ABW

 

Belarus

BLR

Akrotiri

XQZ

 

Ashmore and Cartier

XAC

 

Belgium

BEL

 

 

 

Islands

 

 

 

Albania

ALB

 

 

Belize

BLZ

 

 

 

 

Australia

AUS

 

Algeria

DZA

 

 

Benin

BEN

 

Austria

AUT

 

American Samoa

ASM

 

 

Bermuda

BMU

 

Azerbaijan

AZE

 

Andorra

AND

 

 

Bhutan

BTN

 

Bahamas, The

BHS

 

Angola

AGO

 

 

Bolivia

BOL

 

Bahrain

BHR

 

Anguilla

AIA

 

 

Bonaire, Sint

BES

 

Baker Island

XBK

 

 

 

 

 

Eustatius, and Saba

Antarctica

ATA

 

 

 

 

 

 

Bangladesh

BGD

 

Bosnia and

BIH

Antigua and Barbuda

ATG

 

 

 

 

 

 

Herzegovina

 

Barbados

BRB

 

Argentina

ARG

 

 

 

 

 

 

Botswana

BWA

 

Bassas da India

XBI

 

Armenia

ARM

 

 

 

 

 

 

Bouvet Island

BVT

 

 

 

 

 

 

 

 

 

 

 

 

DD Form 1172-2 Instructions (September 2018)

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Brazil

BRA

British Indian Ocean

IOT

Territory

 

Brunei

BRN

Bulgaria

BGR

Burkina Faso

BFA

Burma

MMR

Burundi

BDI

Cambodia

KHM

Cameroon

CMR

Canada

CAN

Cape Verde

CPV

Cayman Islands

CYM

Central African

CAF

Republic

 

Chad

TCD

Chile

CHL

China

CHN

Christmas Island

CXR

Clipperton Island

CPT

Cocos (Keeling)

CCK

Islands

 

Colombia

COL

Comoros

COM

Congo (Brazzaville)

COG

Congo (Kinshasa)

COD

Cook Islands

COK

Coral Sea Islands

XCS

Costa Rica

CRI

Cote DIvoire

CIV

Croatia

HRV

Cuba

CUB

Curacao

CUW

Cyprus

CYP

Czech Republic

CZE

Denmark

DNK

Dhekelia

XXD

Diego Garcia

DGA

Djibouti

DJI

Dominica

DMA

Dominican Republic

DOM

Ecuador

ECU

Egypt

EGY

El Salvador

SLV

Equatorial Guinea

GNQ

Eritrea

ERI

Estonia

EST

Ethiopia

ETH

Etorofu Habomai

 

Kunashiri and

XQP

Shikotan Islands

 

Europa Island

XEU

Falkland Islands (Islas

FLK

Malvinas)

 

Faroe Islands

FRO

Fiji

FJI

Finland

FIN

France

FRA

French Guiana

GUF

French Polynesia

PYF

French Southern and

ATF

Antarctic Lands

 

Gabon

GAB

Gambia The

GMB

Gaza Strip

XGZ

Georgia

GEO

Germany

DEU

Ghana

GHA

Gibraltar

GIB

Glorioso Islands

XGL

Greece

GRC

Greenland

GRL

Grenada

GRD

Guadeloupe

GLP

Guam

GUM

Guantanamo Bay

AX2

Naval Base

 

Guatemala

GTM

Guernsey

GGY

Guinea

GIN

Guinea-Bissau

GNB

Guyana

GUY

Haiti

HTI

Heard Island and

HMD

McDonald Islands

 

Honduras

HND

Hong Kong

HKG

Howland Island

XHO

Hungary

HUN

Iceland

ISL

India

IND

Indonesia

IDN

Iran

IRN

Iraq

IRQ

Ireland

IRL

Isle of Man

IMN

Israel

ISR

Italy

ITA

Jamaica

JAM

Jan Mayen

XJM

Japan

JPN

Jarvis Island

XJV

Jersey

JEY

Johnston Atoll

XJA

Jordan

JOR

Juan de Nova Island

XJN

Kazakhstan

KAZ

Kenya

KEN

Kingman Reef

XKR

Kiribati

KIR

Korea, North

PRK

Korea, South

KOR

Kosovo

XKS

Kuwait

KWT

Kyrgyzstan

KGZ

Laos

LAO

Latvia

LVA

Lebanon

LBN

Lesotho

LSO

Liberia

LBR

Libya

LBY

Liechtenstein

LIE

Lithuania

LTU

Luxembourg

LUX

Macau

MAC

Macedonia

MKD

Madagascar

MDG

Malawi

MWI

Malaysia

MYS

DD Form 1172-2 Instructions (September 2018)

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Maldives

MDV

Mali

MLI

Malta

MLT

Marshall Islands

MHL

Martinique

MTQ

Mauritania

MRT

Mauritius

MUS

Mayotte

MYT

Mexico

MEX

Micronesia, Federated

FSM

States of

 

Midway Islands

XMW

Moldova

MDA

Monaco

MCO

Mongolia

MNG

Montenegro

MNE

Montserrat

MSR

Morocco

MAR

Mozambique

MOZ

Namibia

NAM

Nauru

NRU

Navassa Island

XNV

Nepal

NPL

Netherlands

NLD

New Caledonia

NCL

New Zealand

NZL

Nicaragua

NIC

Niger

NER

Nigeria

NGA

Niue

NIU

Norfolk Island

NFK

Northern Mariana

MNP

Islands

 

Norway

NOR

Oman

OMN

Pakistan

PAK

Palau

PLW

Palestinian Territory

PSE

Palmyra Atoll

XPL

Panama

PAN

Papua New Guinea

PNG

Paracel Islands

XPR

Paraguay

PRY

Peru

PER

Philippines

PHL

Pitcairn Islands

PCN

Poland

POL

Portugal

PRT

Puerto Rico

PRI

Qatar

QAT

Reunion

REU

Romania

ROU

Russia

RUS

Rwanda

RWA

Saint Barthelemy

BLM

Saint Helena,

 

Ascension, and Tristan

SHN

da Cunha

 

Saint Kitts and Nevis

KNA

Saint Lucia

LCA

Saint Martin

MAF

Saint Pierre and

SPM

Miquelon

 

Saint Vincent and the

VCT

Grenadines

 

Samoa

WSM

San Marino

SMR

Sao Tome and

STP

Principe

 

Saudi Arabia

SAU

Senegal

SEN

Serbia

SRB

Seychelles

SYC

Sierra Leone

SLE

Singapore

SGP

Sint Maarten

SXM

Slovakia

SVK

Slovenia

SVN

Solomon Islands

SLB

Somalia

SOM

South Africa

ZAF

South Georgia and

 

South Sandwich

SGS

Islands

 

South Sudan

SSD

Spain

ESP

Spratly Islands

XSP

Sri Lanka

LKA

Sudan

SDN

Suriname

SUR

Svalbard

XSV

Swaziland

SWZ

Sweden

SWE

Switzerland

CHE

Syria

SYR

Taiwan

TWN

Tajikistan

TJK

Tanzania

TZA

Thailand

THA

Timor-Leste

TLS

Togo

TGO

Tokelau

TKL

Tonga

TON

Trinidad and Tobago

TTO

Tromelin Island

XTR

Tunisia

TUN

Turkey

TUR

Turkmenistan

TKM

Turks and Caicos

TCA

Islands

 

Tuvalu

TUV

Uganda

UGA

Ukraine

UKR

United Arab Emirates

ARE

United Kingdom

GBR

United States

USA

Unknown

AX1

Uruguay

URY

Uzbekistan

UZB

Vanuatu

VUT

Vatican City

VAT

Venezuela

VEN

Vietnam

VNM

Virgin Islands. British

VGB

Virgin Islands, U.S.

VIR

Wake Island

XWK

Wallis and Futuna

WLF

West Bank

XWB

Western Sahara

ESH

Yemen

YEM

DD Form 1172-2 Instructions (September 2018)

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Zambia

Zimbabwe

ZMB

ZWE

Block 9. Date of Birth. Enter the sponsor/employee's date of birth, four-digit year, three alpha-character month, and two-digit day format (YYYYMMMDD). Use nine characters.

Block 10. Place of Birth. Enter the sponsor/employee's place of birth, including city, state, and country, if outside the United States.

Enter the state of the sponsor/employee’s place of birth from the valid codes listed in Table 7.

If place of birth is a foreign country, enter the country from the valid codes listed in Table 6.

Table 7. State Abbreviations

Alabama

AL

 

Kentucky

KY

 

Oklahoma

OK

Alaska

AK

 

Louisiana

LA

 

Oregon

OR

American Samoa

AS

 

Maine

ME

 

Pennsylvania

PA

Arizona

AZ

 

Maryland

MD

 

Puerto Rico

PR

Arkansas

AR

 

Massachusetts

MA

 

Rhode Island

RI

California

CA

 

Michigan

MI

 

South Carolina

SC

Colorado

CO

 

Minnesota

MN

 

South Dakota

SD

Connecticut

CT

 

Mississippi

MS

 

Tennessee

TN

Delaware

DE

 

Missouri

MO

 

Texas

TX

District of Columbia

DC

 

Montana

MT

 

Utah

UT

Florida

FL

 

Nebraska

NE

 

Vermont

VT

Georgia

GA

 

Nevada

NV

 

Virginia

VA

Guam

GU

 

New Hampshire

NH

 

Virgin Islands

VI

Hawaii

HI

 

New Jersey

NJ

 

Washington

WA

Idaho

ID

 

New Mexico

NM

 

West Virginia

WV

Illinois

IL

 

New York

NY

 

Wisconsin

WI

Indiana

IN

 

North Carolina

NC

 

Wyoming

WY

Iowa

IA

 

North Dakota

ND

 

 

 

Kansas

KS

 

Ohio

OH

 

 

 

Block 11. Current Home Address. Enter the number and street of the sponsor/employee's current home address. Use no more than 27 characters.

If sponsor is deceased or if address is unknown, leave blank.

Block 12. City. Enter the sponsor/employee's current city of residence. Use no more than 18 characters.

If the sponsor/employee's address is an Army Post Office (APO) or a Fleet Post Office (FPO), enter the designation APO or FPO.

If the sponsor is deceased or city is unknown, leave blank.

DD Form 1172-2 Instructions (September 2018)

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Block 13. State. Enter the correct U.S. postal code for the state of the sponsor/employee’s residence from the valid codes listed in Table 7. Use two characters.

If the sponsor/employee's address is an APO or FPO, enter the correct APO or FPO State.

If the sponsor/employee lives outside of the 50 United States, the District of Columbia, or one of the listed territories and possessions, leave blank.

If the sponsor is deceased or if the state is unknown, leave blank.

Block 14. ZIP Code. Enter the correct nine-digit ZIP code of the sponsor/employee's current residence address in the following format: “123456789.” Use no more than nine characters.

If the last four digits are unknown, enter four zeros (0000); e.g., “123450000.”

If the sponsor/employee does not reside in one of the 50 states, the District of Columbia, or one of the territories or possessions, enter the applicable foreign ZIP code, or APO or FPO number.

If the sponsor is deceased or if the ZIP code is unknown, leave blank.

Block 15. Country. Enter the sponsor/employee’s correct country of residence from the valid abbreviations listed in Table 6. Use three characters.

If the sponsor/employee’s address is an APO or FPO, the country must be “US.”

If country is unknown, enter AXI.

Block 16. Primary E-mail Address. Enter the sponsor/employee's home/personal e-mail address as applicable.

This block may be left blank.

The “Permission to use for benefits notifications” checkbox can be checked to verify permission for DoD to contact the included email address with DoD- and Department of Veterans Affairs (VA)-related benefits notifications.

Block 17. Telephone Number. Enter the sponsor/employee's current residence, duty, or business telephone number beginning with the area code. Use no more than 10 characters.

Do not use punctuation to separate area code, prefix, and basic number.

This block may be left blank.

Block 18. City of Duty Location. Enter the city of the sponsor/employee's duty location.

Block 19. State of Duty Location. Enter the correct U.S. postal code for the state of the sponsor/employee’s duty location from the valid codes listed in Table 7. Use two characters.

If the sponsor/employee's address is an APO or FPO, enter the correct APO or FPO State.

If the sponsor/employee lives outside of the 50 United States, the District of Columbia, or one of the listed trust territories, leave blank.

If the sponsor is deceased or if the state is unknown, leave blank.

Block 20. Country of Duty Location. Enter the correct country of the sponsor/employee’s duty location from the valid codes listed in Table 6. Use three characters.

If the country is not listed, enter AXI.

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SECTION II – SPONSOR/EMPLOYEE DECLARATION AND REMARKS

Block 21. Remarks. Enter the method of verification and further explanation of qualifying status.

Qualifying status may include SF 52, sponsoring agency, and period of DEERS enrollment, or other appropriate comments, such as particular work assignment.

This section may be left blank, or prepopulated by the VO.

Block 22. Sponsor/Employee Signature. Block must contain the sponsor/employee’s signature.

When the DD Form 1172-2 is not signed in the presence of the VO at the time of DEERS enrollment, the signature must be notarized. The notary seal and signature should be placed in the right margin of Block 21.

The following exceptions to this requirement are authorized:

1.Unremarried or unmarried former spouses shall sign for themselves.

2.When the sponsor is deceased, the survivors shall sign for themselves.

3.When the sponsor is unavailable for signature, the VO shall ensure that the dependency between the sponsor and family member exists. The VO shall follow the guidance provided in the applicable Uniformed Service regulation.

Block 23. Date Signed. Enter the date, four-digit year, three alpha-character month, and two-digit day format (YYYYMMMDD), that the DD Form 1172-2 Block 22 was signed.

SECTION III – AUTHORIZED BY (DoD CAC Sponsors Only)

Block 24. Sponsoring Office Name. Enter the name of the organization the employee works for or is assigned to.

The sponsoring official shall be a uniformed service member or civilian employee working for the sponsoring organization.

Block 25. Contract Number. Enter the contract number for the purposes of entry into the TASS.

Block 26. Sponsoring Office Address. Enter the number and street, city, state, and zip code of the employee's sponsoring office address. See Table 7 for state abbreviations.

Block 27. Sponsoring Office Telephone Number. Enter the sponsoring office telephone number beginning with the area code. Use no more than 14 characters.

Do not use punctuation to separate area code, prefix, and basic number.

Block 28. Office Email Address. Enter the employee's office e-mail address, as applicable.

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Block 29. Overseas Assignment. Enter the employee’s country of assignment. See Table 6 for country codes.

Obtain this information from the employee’s Travel Authorization.

Block 30. Overseas Assignment Begin Date. Enter the employee’s effective begin date, four-digit year, three alpha-character month, and two-digit day format (YYYYMMMDD), for the overseas assignment.

Obtain this information from the employee’s Travel Authorization.

Block 31. Overseas Assignment End Date. Enter the employee’s effective end date, four- digit year, three alpha-character month, and two-digit day format (YYYYMMMDD), of the overseas assignment.

The period of employment may be obtained from the employee’s Travel Authorization.

Block 32. Eligibility Effective Date. Enter the date, four-digit year, three alpha-character month, and two-digit day format (YYYYMMMDD), the employee’s qualifying status begins.

Block 33. Eligibility Expiration Date. Enter the date, four-digit year, three alpha-character month, and two-digit day format (YYYMMMDD), the employee’s qualifying status ends, not to exceed three years.

Block 34. Sponsoring Official Name. Enter the name of the sponsoring official. Use no more than 51 characters.

Block 35. Unit/Organization Name. Enter the unit and/or command name for the sponsoring official. Use no more than 26 characters.

Block 36. Title. Enter the sponsoring official's title. Use no more than 24 characters.

Block 37. Pay Grade. Enter the sponsoring official’s pay grade. Use no more than four characters.

Block 38. Signature. The sponsoring official must sign in that block.

Block 39. Date Verified. Enter the date, four-digit year, three alpha-character month, and two-digit day format (YYYYMMMDD), that the DD Form 1172-2 Block 38 was signed.

SECTION IV – VERIFIED BY

Block 40. Verifying Official Name (Last, First, Middle Initial). Enter the VO’s LAST name first, enter the FIRST name, and then enter the MIDDLE initial or the full MIDDLE name. Use no more than 51 characters.

Block 41. Site Identification. Enter the VO’s 6-digit site ID.

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Block 42. Telephone Number (Include Area Code/DSN). Enter the VO’s duty-station or business telephone number beginning with the area code. Use no more than 10 characters.

Do not use punctuation to separate area code, prefix, and basic number. Block 43. Signature. VO must sign in the block.

SECTION V – DEPENDENT INFORMATION

Section A (Blocks 40-51)

Block 44. Name. Enter the dependent’s LAST name first, enter the FIRST name, and then enter the MIDDLE initial or the full MIDDLE name. Use no more than 51 characters.

The name field can include a designation of JR, SR, ESQ, or the Roman numerals I through X. To include that designation, enter the appropriate data after the middle initial.

The name cannot contain any special characters nor is any punctuation permitted.

Block 45. Gender. Enter the dependent’s gender from the valid codes listed in Table 1. Use one character.

Block 46. Date of Birth. Enter the dependent’s date of birth, four-digit year, three alpha character month, and two-digit day format (YYYYMMMDD).

Block 47. Relationship. Enter the dependent’s relationship to the sponsor from the valid abbreviations listed in Table 9.

 

Table 9.

Relationship Codes

 

 

 

CODE

 

RELATIONSHIP

 

 

 

CH

 

Child

DB

 

DoD Beneficiary

FC

 

Foster Child

PAR

 

Parent

PL

 

Parent-in-law

PACH

 

Pre-adoptive Child

SP

 

Spouse

SC

 

Stepchild

STP

 

Stepparent

SPL

 

Stepparent-in-law

UMW

 

Unmarried Widow(er)

URW

 

Unremarried Widow(er)

WARD

 

Ward

Block 48. SSN or DoD ID Number. Enter the dependent’s SSN, DoD ID number, ITIN or temporary identification number (TIN).

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A TIN will be automatically generated by RAPIDS and assigned for categories of beneficiaries who do not yet have SSNs, such as newborns and foreign spouses, awaiting an SSN, or for those who do not have and are not eligible for an SSN. Direct care at military treatment facilities will be suspended if an SSN is not provided within 270 days.

For initial enrollment an SSN, ITIN or TIN is preferred, and an alternate should not be used unless the SSN, ITIN or TIN is unavailable.

Block 49. Current Home Address. Enter the number and street of the dependent’s current home address.

Block 50. Primary E-mail Address. Enter the dependent’s preferred e-mail address as applicable.

This block may be left blank.

For dependents aged 18 and older, check “Permission to use for benefits notifications (18 and above)” to verify permission for DoD to contact the included email address with DoD- and Department of Veterans Affairs (VA)-related benefits notifications.

Block 51. Telephone Number. Enter the dependent’s primary telephone number beginning with the area code. Use no more than 10 characters.

Do not use punctuation to separate area code, prefix, and basic number.

This block may be left blank.

Block 52. City. Enter the dependent’s current city of residence.

If the dependent's address is an APO or FPO, enter the designation APO or FPO.

Block 53. State. Enter the correct U.S. postal code for the state of the dependent’s residence from the valid codes listed in Table 7. Use two characters.

Block 54. Zip Code. Enter the correct nine-digit ZIP Code of the dependent's current residence address in the following format: “123456789.”

If the last four digits are unknown, enter four zeros (0000); e.g., “123450000.”

If the dependent does not reside in one of the 50 United States, the District of Columbia, or one of the listed trust territories, enter the applicable foreign ZIP Code, or APO or FPO number.

Block 55. Country. Enter the dependent’s correct country of residence from the valid abbreviations listed in Table 6. Use three characters.

If the dependent’s address is an APO or FPO, the country must be “US.”

If country is unknown, enter AXI.

Block 56. Eligibility Effective Date. Enter the date, four-digit year, three alpha-character month, and two-digit day format (YYYYMMMDD), the when the dependent’s qualifying status began.

Block 57. Eligibility Expiration Date. Leave blank.

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Sections B (Blocks 58-71). Enter information following the instructions in Section A.

SECTION VI - RECEIPT

Block 72. Signature. Card recipient must sign in the block. If the recipient is incapable of signing, the condition must be indicated in that block.

Block 73. Date Issued. Enter the date, four-digit year, three alpha-character month, and two- digit day format (YYYYMMMDD), the recipient acknowledged receipt of the ID card. Use nine characters.

DD Form 1172-2 Instructions (February 2014)

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