DD Form 2883: Government Travel Charge Card Alternate Credit Worthiness Evaluation

Enter the NAME (Last, First, Middle Initial, Suffix (Jr., Sr., etc.)) in Box 1 and mark one EMPLOYMENT STATUS in Box 2 (X one).

Mark ACTIVE, GUARD, RESERVE or CIVILIAN.

Enter the MILITARY RANK/CIVILIAN GRADE in Box 3.

Enter the CONTACT TELEPHONE NO. in Box 4 and include the area code.

Enter the ADDRESS (Street, Apartment/Suite Number, City, State, ZIP Code) in Box 5.

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

Enter the BILLING ADDRESS in Box 6 if it is different from Item 5.

Enter the E-MAIL ADDRESS in Box 7 and mark U.S. CITIZEN in Box 8 (X one): YES or NO.

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.

Box 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 lien, or had legal judgment rendered for a debt. Mark True or False.

Box 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 Federal Government. Mark True or False.

Box 11: In the past 7 years, I have not had a government charge card cancelled as a result of delinquency or misuse. Mark True or False.

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

Box 13: I have not been informed of any current investigations on my use of a government charge card or government purchasing instrument. Mark True or False.

Box 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 with those parties. Mark True or False.

By signing you certify that the statements in Section II, and any attachments added, are true, complete, and correct to the best of your knowledge and belief, and are made in good faith. You 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.)

Sign in Box 15 (SIGNATURE) and enter the date in Box 16 (DATE (YYYYMMDD)).

You must sign and date, in black ink, the original and each copy you submit.

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

Any changes you make to this form after you sign it must be initialed and dated by you.

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.

Section IV is to be completed by the Agency Program Coordinator (APC).

Box 17 is the CARD TYPE (X one), with IBA TRAVEL.

Box 18 is the ACCOUNT HIERARCHY NUMBER.

Box 19 is the ORGANIZATION/UNIT NAME and Box 20 is the FIPS CODE.

Your APC will enter the Component FIPs (https:// nvlpubs.nist.gov/nistpubs/SpecialPublications/NIST.SP.800-87r2.pdf) in item 20.

Box 21 is the APC: a. NAME (Last, First, Middle Initial), b. SIGNATURE and c. DATE (YYYYMMDD).

Section V is to be completed by the Commander/Supervisor.

Box 22 is the COMMAND/SUPERVISOR (acknowledging IBA need): a. NAME (Last, First, Middle Initial), b. TELEPHONE (Include area code) and c. WORK ADDRESS.

Individuals unable or unwilling to sign this form will not be issued a government charge card.

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 (checked October 21, 2026).