The Department of Defense has released a new form, Da Form 3903, which will allow service members to request a transfer of their health care benefits to a family member. This form can be used by service members who are transitioning out of the military or retiring, and is designed to help make the transition process easier for families. The Department of Defense encourages all service members who are eligible to use this form to take advantage of the health care benefits that are available to them.
| Question | Answer |
|---|---|
| Form Name | Da Form 3903 |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | da form 3903, da3903, how to form da 3903, da form 3903 pdf |
For use of this form, see AR
SECTION I - REQUIREMENT
1.WORK ORDER NUMBER
2.SECURITY CLASSIFICATION
3.TO (M/VI Activity Name)
4.FROM (Customer Address)
5.CUSTOMER ACCOUNT NUMBER
6a. REQUESTOR'S NAME
6b. GRADE
6c. REQUESTOR'S ORGANIZATION OR APO
6d. REQUESTOR'S EMAIL ADDRESS
6e. PHONE NUMBER
7. DATE REQUESTED (YYYYMMDD)
8a. ALTERNATE POC NAME
8b. GRADE
8c. ALTERNATE'S ORGANIZATION OR APO
8d. ALTERNATE'S EMAIL ADDRESS
8e. PHONE NUMBER
9. DATE REQUIRED (YYYYMMDD)
10. FUNCTIONAL AREA OF SUPPORT (Check One)
a. Combat Readiness |
b. Education & Training |
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c. Garrison/Theater Support |
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d. Intel, Recon, CI, Comm Security |
e. Internal Information |
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f. Recruitment |
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g. Medical & Dental |
h. Public Information |
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i. RDT&E |
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11a. TYPE OF WORK (Check Applicable Box(s)) 11b. DESCRIPTION OF WORK REQUESTED (Attach diagrams, etc., and list enclosure(s)) |
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IMAGING
(1)Imaging - Photo
(2)Imaging - Graphic
(3)Other Imaging
MULTIMEDIA
SERVICES
(1)Services - Presentation Support
(2)Services - Consultation
(3)Other Services
AUDIO
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VIDEO |
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(1) |
Video - Documentation |
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(2) |
Video - Local Production |
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(3) |
Video - |
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(4) |
Video - Video Report |
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(5) |
Other Video |
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OTHER - SPECIFY |
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12. JUSTIFICATION FOR REQUESTED SERVICE |
Requested service is for official purposes and is required by stated deadline. |
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13. VALIDATION SIGNATURE |
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14. M/VI APPROVAL |
SECTION II - WORK RECEIPT (Sections II Through V for M/VI Activity Use Only)
15. SPECIAL PROJECT CODE: |
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16. ITEM/SERVICE |
17. SIZE |
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18. COST |
19. DATE COMPLETED (YYYYMMDD) |
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a. BASELINE |
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b. ABOVE BASELINE |
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20. CUSTOMER NOTIFIED (YYYYMMDD)
21a. RECEIVED BY (Signature)
21b. DATE RECEIVED (YYYYMMDD)
DA FORM 3903, JUL 2005
APD V1.00
SECTION III - MANHOURS (In Quarter Hours)
22. PERSONNEL ID |
23. GRADE |
24. PRODUCT ID |
25. |
26. HOURLY RATE |
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27. MANHOURS |
28. OVERTIME |
29. COMPTIME |
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30. COSTS |
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SECTION IV - CONTRACT |
DATA |
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31. VENDOR NAME |
32. PRODUCT OR SERVICE ID |
33. |
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34. TOTAL NO. ITEMS OR SERVICE |
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35. CONTRACT COST |
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SECTION V - BILL OF MATERIAL(S) |
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36. ITEM |
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37. QUANTITY |
38. SIZE |
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39. |
40. |
ITEM |
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41. QUANTITY |
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42. SIZE |
43. |
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PAGE 2 , DA FORM 3903, JUL 2005 |
APD V1.00 |
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