If you are a small business owner and you have not yet heard the news, there is a new form that the IRS has released called the "Da 3947." This form is for small businesses to use in order to apply for an Employee Identification Number (EIN). An EIN is essentially like a social security number for your business, and it is required in order to open a business bank account, file taxes, or hire employees. If you are thinking about starting up your own small business, make sure to get started on this process as soon as possible! The sooner you have your EIN in hand, the easier it will be to keep everything organized and streamlined. And don't forget - if you need help filling out this form or any
| Question | Answer |
|---|---|
| Form Name | Da 3947 Form |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | da3947, narsum example, da form 3947 pdf fillable, da 3947 |
MEDICAL EVALUATION BOARD PROCEEDINGS
For use of this form, see AR
MEDICAL TREATMENT FACILITY
DATE
(YYYYMMDD)
1. NAME (Last, First, MI) |
2. GRADE |
3. SSN |
4. COMPONENT |
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5. DEPARTMENT |
6. SEX |
7. DATE OF BIRTH 8. ORGANIZATION |
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9. TOTAL YEARS OF MILITARY SERVICE
a. ACTIVE |
b. INACTIVE |
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10.DATE ENTERED CURRENT TOUR OF ACTIVE DUTY (YYYYMMDD)
11.MILITARY OCCUPATIONAL SPECIALTY (include code)
ACTION BY THE BOARD
BY DIRECTION OF THE APPOINTING AUTHORITY,
THE BOARD CONVENED TO EVALUATE THE PATIENT IDENTIFIED ABOVE
12. The patient |
did |
did not present views in own behalf. (When presented, attach a summary of the patient's comments to the report) |
Click here for initials:
13. DIAGNOSIS
AFTER CONSIDERATION OF CLINICAL RECORDS, LABORATORY FINDINGS, AND PHYSICAL EXAMINATION, THE BOARD FINDS THAT THE PATIENT HAS THE FOLLOWING MEDICAL CONDITIONS/DEFECTS. LIST ALL DIAGNOSIS.
a
APPROXIMATE
DATE OF
ORIGIN
b
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EXISTED |
PERMANENTLY |
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ENTITLED TO |
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BY SERVICE |
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BASE PAY |
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14. The board recommends that the patient be: Returned to duty
Returned to duty with the following limitations:
Referred to a Physical Evaluation Board (PEB)
Other (specify)
DA FORM 3947, SEP 1983 |
PREVIOUS EDITIONS ARE OBSOLETE. |
Page 1 of 2 |
APD PE v3.03ES
15. The patient does
does not desire to continue on active duty under AR
16.Continuance on active duty under provisions of AR
15 is affirmative) Enter assignment limitations in Item 30.
is
is not medically contraindicated. (Complete when answer to item
17. TYPED NAME AND GRADE OF PHYSICIAN
SIGNATURE
18. TYPED NAME AND GRADE OF PHYSICIAN
SIGNATURE
19. TYPED NAME AND GRADE OF PHYSICIAN
SIGNATURE
ACTION BY THE APPROVING AUTHORITY
20.
21.
22.
The findings and recommendation of the board are approved. |
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The report of the board is returned for reconsideration. |
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The report of the board is forwarded to: |
Comments are attached as inclosure |
23. TYPED NAME, GRADE AND TITLE OF APPROVING AUTHORITY
SIGNATURE
DATE (YYYYMMDD)
ACTION BY PATIENT
24.I have been informed of the approved findings and recommendation of the board.
Click here for initials:
I agree with the board's findings and recommendation.
I do not agree with the board's findings and recommendation. My appeal is attached as inclosure
25. TYPED NAME, GRADE AND SSN
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Grade: , SSN:
SIGNATURE
DATE (YYYYMMDD)
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FURTHER ACTION BY APPROVING AUTHORITY |
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26. |
The appeal has been considered and the original findings and recommendation are confirmed. |
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The appeal has been considered and the report of the board is returned for reconsideration. Attach further action as inclosure |
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The appeal has been considered and the report of the board is forwarded to: |
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Comments are attached as Enclosure |
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29. TYPED NAME, GRADE AND TITLE OF APPROVING AUTHORITY |
SIGNATURE |
DATE |
(YYYYMMDD) |
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30.CONTINUATION (Identify by item number)
TRANSITION POINT:
Continuation of Block #24:
I have reviewed the contents of the Medical Evaluation Board (MEB) packet and read the attached DA Form 3947 (Medical Board Proceedings), Narrative Summary (NARSUM), and the Physical Profile (DA Form 3349).
a. In regard to issues relating to fitness for duty and disability compensation, I understand that the PEB will consider and review only those conditions listed on the DA Form 3947.
b. The DA Form 3947 includes all my current medical conditions and whether or not they meet medical retention standards.
c. The conditions which do not meet medical retention standards are properly listed on the following three documents: DA Form 3947; the Narrative Summary; and the Physical Profile (DA Form 3349).
d. All documentation of military medical care in my possession has been provided to the Physical Evaluation Board Liaison Officer for inclusion in this MEB.
e. I agree that this MEB accurately covers all my current medical conditions.
f. If I do not agree with any of these statements and/or I do not agree with the contents of the MEB as reflected in my election at item 24, above, I have provided all my disagreements and concerns in the attached appeal.
DA FORM 3947, SEP 1983 |
Page 2 of 2 |
APD PE v3.03ES
13. DIAGNOSIS (CONT'D.)
AFTER CONSIDERATION OF CLINICAL RECORDS, LABORATORY FINDINGS, |
APPROXIMATE |
INCURRED |
EXISTED |
PERMANENTLY |
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AND PHYSICAL EXAMINATION, THE BOARD FINDS THAT THE PATIENT HAS |
DATE OF |
WHILE |
PRIOR TO |
AGGRAVATED |
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THE FOLLOWING MEDICAL CONDITIONS/DEFECTS. LIST ALL DIAGNOSIS. |
ORIGIN |
ENTITLED TO |
SERVICE |
BY SERVICE |
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DA FORM 3947, SEP 1983 |
APD PE v3.03ES |