1172 2 Instructions – Fill Out and Use This PDF

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.

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

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.

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.

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

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

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.

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.