The DA Form 3975 1, also known as the "Individual Unemployability Worksheet" is a self-reported form used by veterans to document their eligibility for VA disability benefits. The form is used to determine whether or not a veteran is unable to maintain gainful employment due to military service-related injuries or illnesses. In order to be eligible for Individual Unemployability benefits, a veteran must meet all of the following criteria: be unable to work in any occupation; have a disability rating of at least 60%; and have an income below the poverty line. Complete instructions on how to fill out the DA Form 3975 1 can be found in the footnotes of the form itself. If you are a veteran who meets all of the
| Question | Answer |
|---|---|
| Form Name | Da Form 3975 1 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | da 3975 military police report, da form 3975 fillable, form 3975 military police report, da 3975 |
MILITARY POLICE REPORT - ADDITIONAL OFFENSES
For use of this form, see AR
This form is a continuation of SECTION II, DA Form 3975. Please attach it to DA Form 3975 when completed.
MILITARY POLICE REPORT NUMBER
DATE (YYYYMMDD)
ORI NUMBER
USACRC CONTROL NUMBER
THRU
TO
FROM
SECTION II - OFFENSE
1a. |
OFFENSE NO. |
1b. SUBJECT NO. |
1c. VICTIM NO. |
1d. NIBRS |
1e. |
1f. SAME OFFENSE DATA FOR ALL |
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INVOLVEMENT |
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INVOLVEMENT |
LOCATION CODE |
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ATTEMPTED |
OFFENSE CODES |
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COMPLETED |
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YES |
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NO |
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1g. |
OFFENSE |
1h. OFFENSE DESCRIPTION(s) |
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1i. OFFENSE LOCATION ADDRESS |
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CODE(s) |
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2a. |
BEGIN DATE |
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3. TYPE OF CRIMINAL ACTIVITY |
4. OFFENSE STATUTORY |
5. OFFENDER USED |
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(Check up to three) |
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BASIS |
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(Check up to three) |
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B Buying/Receiving |
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A UCMJ |
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A Alcohol |
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2b. |
BEGIN TIME (24 Hour) |
C Cultivating/Manufacturing/Publishing |
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C Computer Equipment |
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D Distributing/Selling |
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C State |
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D Drugs/Narcotics |
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2c. |
END DATE |
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E Exploiting Children |
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D Local |
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N Not Applicable |
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(YYYYMMDD) |
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O Operating/Promoting/Assisting |
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E Foreign |
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P Possessing/Concealing |
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F Federal, |
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2d. |
END TIME (24 Hour) |
T Transporting/Importing |
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UUsing/Consuming
6.TYPE OF WEAPON/FORCE. Check up to three and indicate in the second block next to the item whether:
F - Fully Automatic S -
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11 |
Firearm (Unk Type) |
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35 |
Motor Vehicle |
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90 OTHER |
(Specify) |
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12 |
Handgun |
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50 |
Poison |
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13 |
Rifle |
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60 |
Explosives |
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Shotgun |
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Fire/Incendiary |
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99 None |
7. |
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NUMBER OF PREMISES ENTERED (For |
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40 |
Personal Weapons |
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Burglary/Housebreaking only) |
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70 |
Narcotics/Drugs |
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20 |
Knife/Cutting Instrument |
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85 |
Asphyxiation |
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30 |
Blunt Object |
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95 |
Unknown |
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Forcible Entry |
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No Forcible Entry |
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8. AGGRAVATED ASSAULT/HOMICIDE CIRCUMSTANCES (Check up to two) |
9. ADDITIONAL JUSTIFIABLE HOMICIDE CIRCUMSTANCES |
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1 |
Argument |
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20 |
Criminal Killed by Private Citizen |
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A Criminal attacked police officer and that police officer |
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Assault on Law officer |
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Criminal Killed by Law Enforcement |
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killed the criminal |
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3 |
Drug Dealing |
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Child Playing With Weapon |
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B Criminal attacked police officer and was killed by |
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Gangland |
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31 |
Gun Cleaning Accident |
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another police officer |
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5 |
Juvenile Gang |
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32 |
Hunting Accident |
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C Criminal attacked a civilian |
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6 |
Domestic Quarrel |
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33 |
Other Negligent Weapon Handling |
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D Criminal attempted flight from a crime |
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7 |
Mercy Killing |
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Other Negligent Killings |
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E Criminal killed in commission of a crime |
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Other Felony Involved |
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F Criminal resisted arrest |
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G Unable to determine |
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10. BIAS MOTIVATION (As applicable) |
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YES |
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NO |
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UNKNOWN |
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DA FORM |
PAGE |
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OF |
APD V1.01
1a. |
OFFENSE NO. |
1b. SUBJECT NO. |
1c. VICTIM NO. |
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1d. NIBRS |
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1e. |
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1f. SAME OFFENSE DATA FOR ALL |
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INVOLVEMENT |
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INVOLVEMENT |
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LOCATION CODE |
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ATTEMPTED |
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OFFENSE CODES |
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COMPLETED |
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YES |
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NO |
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1g. |
OFFENSE |
1h. OFFENSE DESCRIPTION(s) |
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1i. |
OFFENSE LOCATION ADDRESS |
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CODE(s) |
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2a. BEGIN DATE (YYYYMMDD) |
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3. TYPE OF CRIMINAL ACTIVITY |
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4. OFFENSE STATUTORY |
5. OFFENDER USED |
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(Check up to three) |
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BASIS |
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(Check up to three) |
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B Buying/Receiving |
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A UCMJ |
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A Alcohol |
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2b. |
BEGIN TIME (24 Hour) |
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C Cultivating/Manufacturing/Publishing |
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B |
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C Computer Equipment |
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D Distributing/Selling |
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C State |
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D Drugs/Narcotics |
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2c. |
END DATE |
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E Exploiting Children |
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D Local |
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N Not Applicable |
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(YYYYMMDD) |
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O Operating/Promoting/Assisting |
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E Foreign |
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P Possessing/Concealing |
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F Federal, |
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2d. |
END TIME (24 Hour) |
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T Transporting/Importing |
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U Using/Consuming |
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6. TYPE OF WEAPON/FORCE. Check up to three and indicate in the second block next to the item whether: |
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F - Fully Automatic |
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M - Manual |
U - Unknown |
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11 Firearm (Unk Type) |
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35 Motor Vehicle |
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90 OTHER |
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12 Handgun |
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50 Poison |
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13 Rifle |
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60 Explosives |
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65 Fire/Incendiary |
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14 Shotgun |
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99 None |
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7. |
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NUMBER OF PREMISES ENTERED (For |
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Burglary/Housebreaking only) |
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40 Personal Weapons |
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70 Narcotics/Drugs |
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20 Knife/Cutting Instrument |
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85 Asphyxiation |
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30 Blunt Object |
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95 Unknown |
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Forcible Entry |
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No Forcible Entry |
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8. AGGRAVATED ASSAULT/HOMICIDE CIRCUMSTANCES (Check up to two) |
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9. ADDITIONAL JUSTIFIABLE HOMICIDE CIRCUMSTANCES |
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1 Argument |
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20 Criminal Killed by Private Citizen |
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A Criminal attacked police officer and that police officer |
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2 Assault on Law officer |
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21 Criminal Killed by Law Enforcement |
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killed the criminal |
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3 Drug Dealing |
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30 Child Playing With Weapon |
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B Criminal attacked police officer and was killed by |
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4 Gangland |
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31 Gun Cleaning Accident |
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another police officer |
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5 Juvenile Gang |
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32 Hunting Accident |
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C Criminal attacked a civilian |
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6 Domestic Quarrel |
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33 Other Negligent Weapon Handling |
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D Criminal attempted flight from a crime |
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7 Mercy Killing |
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35 Other Negligent Killings |
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E Criminal killed in commission of a crime |
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8 Other Felony Involved |
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F Criminal resisted arrest |
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G Unable to determine |
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10. BIAS MOTIVATION (As applicable) |
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YES |
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NO |
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UNKNOWN |
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1a. |
OFFENSE NO. |
1b. SUBJECT NO. |
1c. VICTIM NO. |
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1d. NIBRS |
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1e. |
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1f. SAME OFFENSE DATA FOR ALL |
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INVOLVEMENT |
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INVOLVEMENT |
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LOCATION CODE |
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ATTEMPTED |
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OFFENSE CODES |
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COMPLETED |
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YES |
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NO |
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1g. |
OFFENSE |
1h. OFFENSE DESCRIPTION(s) |
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1i. |
OFFENSE LOCATION ADDRESS |
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CODE(s) |
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2a. BEGIN DATE (YYYYMMDD) |
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3. TYPE OF CRIMINAL ACTIVITY |
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4. OFFENSE STATUTORY |
5. OFFENDER USED |
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(Check up to three) |
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BASIS |
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(Check up to three) |
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B Buying/Receiving |
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A UCMJ |
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A Alcohol |
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C Cultivating/Manufacturing/Publishing |
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2b. |
BEGIN TIME (24 Hour) |
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B |
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C Computer Equipment |
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D Distributing/Selling |
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C State |
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D Drugs/Narcotics |
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E Exploiting Children |
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2c. |
END DATE |
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D Local |
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N Not Applicable |
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(YYYYMMDD) |
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O Operating/Promoting/Assisting |
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E Foreign |
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P Possessing/Concealing |
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F Federal, |
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T Transporting/Importing |
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2d. |
END TIME (24 Hour) |
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U Using/Consuming |
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PAGE 2, DA FORM |
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PAGE |
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OF |
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APD V1.01
6. TYPE OF WEAPON/FORCE. Check up to three and indicate in the second block next to the item whether: |
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F - Fully Automatic |
S - |
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M - Manual |
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U - Unknown |
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11 |
Firearm (Unk Type) |
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35 |
Motor Vehicle |
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90 OTHER |
(Specify) |
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12 |
Handgun |
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50 |
Poison |
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13 |
Rifle |
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60 |
Explosives |
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14 |
Shotgun |
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65 |
Fire/Incendiary |
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99 None |
7. |
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NUMBER OF PREMISES ENTERED (For |
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Burglary/Housebreaking only) |
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40 |
Personal Weapons |
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70 |
Narcotics/Drugs |
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20 |
Knife/Cutting |
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85 |
Asphyxiation |
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30 |
Blunt Object |
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95 |
Unknown |
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Forcible Entry |
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No Forcible Entry |
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8. AGGRAVATED ASSAULT/HOMICIDE CIRCUMSTANCES (Check up to two) |
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9. ADDITIONAL JUSTIFIABLE HOMICIDE CIRCUMSTANCES |
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1 |
Argument |
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20 |
Criminal Killed by Private Citizen |
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A Criminal attached police officer and that police officer |
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2 |
Assault on Law officer |
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21 |
Criminal Killed by Law Enforcement |
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killed the criminal |
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3 |
Drug Dealing |
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30 |
Child Playing With Weapon |
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B Criminal attacked police officer and was killed by |
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4 |
Gangland |
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31 |
Gun Cleaning Accident |
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another police officer |
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5 |
Juvenile Gang |
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32 |
Hunting Accident |
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C Criminal attacked a civilian |
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6 |
Domestic Quarrel |
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33 |
Other Negligent Weapon Handling |
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D Criminal attempted flight from a crime |
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7 |
Mercy Killing |
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35 |
Other Negligent Killings |
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E Criminal killed in commission of a crime |
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8 |
Other Felony Involved |
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F Criminal resisted arrest |
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G Unable to determine |
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10. BIAS MOTIVATION (As applicable) |
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YES |
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NO |
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UNKNOWN |
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PAGE 3, DA FORM |
PAGE |
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OF |
APD V1.01