Dd 2883 Form PDF Details

The DD Form 2883 plays a crucial role in the management of Government Travel Charge Cards by providing an alternate credit worthiness evaluation for applicants who choose not to or cannot use traditional credit scores for verification. Mandated by the Department of Defense Instruction (DoDI) 5154.31, Volume 4, this form serves as a comprehensive tool to assess the financial integrity and reliability of an individual seeking to obtain a government travel charge card. Its structure encompasses sections for personal identifying information, financial statements affirmation, certification by the applicant, and final approvals by relevant agency personnel. Specifically, it requires applicants to attest to their financial history and current status, including any bankruptcy filings, delinquencies, or misuse of government charge cards in the past seven years. Additionally, the form outlines the consequences of submitting false information, demonstrating the seriousness with which the Department of Defense approaches the issuance of these financial instruments. By offering an alternative to traditional credit score evaluations, the DD Form 2883 ensures that those serving in various capacities—active duty, guard, reserve, and civilian employees—can access government travel charge cards while maintaining financial accountability and trustworthiness.

QuestionAnswer
Form NameDd 2883 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesdd2883, irs form 2883, dd2883 form pdf, dd2883 army

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Prescribed by DoDI 5154.31, volume 4

GOVERNMENT TRAVEL CHARGE CARD ALTERNATE CREDIT WORTHINESS EVALUATION

(Read Privacy Act Statement and Instructions on back before completing form.)

 

 

SECTION I - PERSONAL IDENTIFYING INFORMATION

 

 

 

 

 

 

 

 

 

 

1. NAME (Last, First, Middle Initial, Suffix (Jr., Sr., etc.))

 

2. EMPLOYMENT STATUS (X one)

3. MILITARY RANK/CIVILIAN GRADE

 

 

 

ACTIVE

GUARD

 

 

 

 

 

 

RESERVE

CIVILIAN

 

 

 

 

 

 

 

 

 

 

 

4. CONTACT TELEPHONE NO.

5. ADDRESS (Street, Apartment/Suite Number, City, State, ZIP

 

6. BILLING ADDRESS (If different from Item 5)

 

(Include area code)

Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7. E-MAIL ADDRESS

 

 

 

 

 

 

8. U.S. CITIZEN (X one)

 

 

 

 

 

 

 

 

YES

NO

 

 

 

 

 

 

 

 

 

SECTION II - PERSONAL FINANCIAL INFORMATION

This form is being used in lieu of a credit score submitted through a credit reporting agency. By signing in Block 15 you are certifying that ALL of the following statements are true as they apply to your current financial situation. If any of the statements are not true as they apply to your circumstances, you should NOT submit this form and you are not eligible to receive a government travel charge card. False statements may result in penalties for both military and civilian personnel (Article 107, UCMJ, and 18 U.S.C. 1001).

For the purpose of the government travel charge card, individuals who decline a credit score and complete this form will only be issued a restricted card having half the credit limits of a standard card. If you previously agreed to a credit score and were denied a card as a result, you may not obtain a card through this self certification. Individuals who decline both a credit score and completion of this form will not be issued a travel card.

9. In the past 7 years, I have not, nor has a company over which I exercise control, filed for bankruptcy, been declared bankrupt, been subject to a tax

 

True

 

False

 

 

lien, or had legal judgment rendered for a debt.

 

 

 

 

 

 

 

 

 

 

 

 

10.

I am not currently over 120 days delinquent on any loan or financial obligation. This includes loans or obligations funded or guaranteed by the

 

True

 

False

 

 

 

Federal Government.

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

In the past 7 years, I have not had a government charge card cancelled as a result of delinquency or misuse.

 

True

 

False

 

 

 

 

 

 

 

 

12.

In the past 7 years, I have not been subject to any disciplinary action, adverse action, or UCMJ action (military personnel) stemming from the

 

True

 

False

 

 

 

improper use of a government charge card. (Actions which were reversed through appeal do not have to be included.)

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

I have not been informed of any current investigations on my use of a government charge card or government purchasing instrument.

 

True

 

False

 

 

 

 

 

 

 

 

14.

I do not have debts to financial institutions or other third parties that are more than 120 days delinquent in accordance with the written agreements

 

True

 

False

 

 

 

with those parties.

 

 

 

 

 

 

 

SECTION III - CERTIFICATION

I certify that the statements above, and any attachments added, are true, complete, and correct to the best of my knowledge and belief, and are made in good faith. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both. (See Section 1001 of Title 18, United States Code and Article 107, UCMJ, False Official Statements.)

15. SIGNATURE

16.DATE (YYYYMMDD)

 

SECTION IV - TO BE COMPLETED BY THE AGENCY PROGRAM COORDINATOR (APC)

 

 

 

17. CARD TYPE (X one)

 

18. ACCOUNT HIERARCHY NUMBER

IBA TRAVEL

 

 

 

 

 

19. ORGANIZATION/UNIT NAME:

 

20. FIPS CODE:

a. NAME (Last, First, Middle Initial)

b. SIGNATURE

c.DATE (YYYYMMDD)

21. APC:

SECTION V - TO BE COMPLETED BY THE COMMANDER/SUPERVISOR

22.COMMAND/SUPERVISOR (acknowledging IBA need)

a. NAME (Last, First, Middle Initial)

b. TELEPHONE (Include area code)

c. WORK ADDRESS

DD FORM 2883, JAN 2020

PREVIOUS EDITION IS OBSOLETE.

Page 1 of 2

GOVERNMENT TRAVEL CHARGE CARD ALTERNATE CREDIT WORTHINESS EVALUATION

PRIVACY ACT STATEMENT

AUTHORITY: 5 U.S.C. 5701 note, Creditworthiness of Individuals To Be Issued Government Charge Cards; 10 U.S.C. 2784a. Management of travel cards; 41

U.S.C. 101 note, Administrator; DoDI 5154.31, V4, “Commercial Travel Management: DoD Government Charge Card (GTCC) Program.

PRINCIPAL PURPOSE(S): To establish whether applicants or incumbents that are to be issued a government charge card are suitable for the public trust of the government instrument. The information from this form will be used primarily as the basis for evaluating the credit worthiness of an individual in the absence of an authorized credit score. Applicants completing this form may only be eligible for a restricted individually billed travel charge card account.

ROUTINE USE(S): To disclose information to a Federal, State, local, tribal, or foreign agency responsible for investigating, prosecuting, enforcing, implementing, or carrying out a statute, rule, regulation, or order, where an agency becomes aware of a violation or potential violation of civil or criminal law or regulation. Additional routine uses may be found in the applicable system of records notice GSA/GOVT-3, Travel Charge Card Program at: https:// www.federalregister.gov/documents/2013/04/03/2013-07669/privacy-act-of-1974-notice-of-revised-system-of-records

DISCLOSURE: Disclosure is voluntary; however, if you do not provide the requested information, you may not be able to obtain a government travel charge card to perform government official travel duties on behalf of the government.

INSTRUCTIONS

Follow instructions fully and answer all questions or we cannot process your form. Be sure to sign and date the certification statement in Section III. If you have any questions, contact the Agency Program Coordinator who gave you the form or your Component Program Manager.

Purpose of this Form:

Complete this form only if you declined to permit a credit score for an individually billed travel card. Your APC will enter the Component FIPs (https:// nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-87r2.pdf) in item 20.

The Review Process:

The information you provide is considered to be truthful and accurate. You should provide your completed form to your supervisor for review. Individuals unable or unwilling to sign this form will not be issued a government charge card. If your answers reflect no financial risk exists, your form will be maintained along with your application for the government charge card for which you are applying as a result of your official duties. Should information arise at a later date that would cause your current answers to be incorrect, you may revise and resubmit the form. Any information that indicates that your responses are not accurate or truthful may result in administrative action.

Completing this Form:

1.Follow the instructions given to you by the person who gave you the form and any other clarifying instructions furnished by that person to assist you in completion of the form. You must sign and date, in black ink, the original and each copy you submit.

2.Type or legibly print your answers in black ink. If your form is not legible, it will not be accepted. You may also be asked to submit your form in an approved electronic format.

3.Any changes you make to this form after you sign it must be initialed and dated by you. Under certain limited circumstances, agencies may modify the form consistent with their intent.

4.All telephone numbers must include area codes.

5.All dates provided on this form must be in Year/Month/Day (YYYYMMDD) format.

6.If the address is outside of the United States, please indicate the country.

Final Determination on Your Eligibility:

Final determination on your eligibility for credit worthiness and form acknowledgment is the responsibility of your commander/supervisor. The commander/ supervisor acknowledges the need for a travel card and does not validate the financial responses provided.However, it is DoD policy that failure to agree to a credit score or self-certify to your creditworthiness is sufficient reason to deny issuance of any such card.

Penalties for Inaccurate or False Statements:

The U.S. Criminal Code (Title 18, Section 1001) provides that knowingly falsifying or concealing a material fact is a felony that may result in fines of up to $10,000 and/or 5 years imprisonment, or both. In addition, Federal agencies usually remove from their employment, do not grant a security clearance, or disqualify individuals who have materially and deliberately falsified these forms, and this remains a part of the permanent record for future placements. Because the position you are in is considered necessary to require use of a government charge card, your trustworthiness and creditworthiness are important considerations in determining your eligibility for retention of a government charge card.

DD FORM 2883, JAN 2020

PREVIOUS EDITION IS OBSOLETE.

Page 2 of 2

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