Dd Form 1842 PDF Details

Navigating through the complexities of recovering from personal property loss or damage during service, military personnel find a beacon of guidance in the DD Form 1842. This form serves as a structured pathway for service members to submit claims for personal property loss or damage directly tied to their service. The form meticulously requires claimants to provide detailed information including their name, rank, contact information, and specifics of the claim such as the circumstances of the loss or damage, the amount being claimed, and whether private insurance covers the property in question. It is designed to ensure a comprehensive understanding of each case, facilitating a smoother investigation and processing of claims. The form also elucidates the procedures for claiming against private insurance and insists on transparency regarding previous claims or compensations related to the lost or damaged property. Notably, the DD Form 1842 underscores the importance of honesty in its completion, as it directly mentions the legal implications of providing false information. By outlining specific instructions for claimants and integrating measures to prevent fraud, the form upholds the integrity of the claims process, ensuring that service members are duly compensated in accordance with the law under the provisions of 31 U.S.C. 3721 and the Privacy Act. Recognizing the nuances in each claim, the form is tailored to encapsulate all possible scenarios, reflecting the government's commitment to addressing the concerns of its service members with the respect and thoroughness they deserve.

QuestionAnswer
Form NameDd Form 1842
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessubstantiated denial dd, 3721 approving signature, claims s loss, authority denial dd

Form Preview Example

CLAIM FOR LOSS OF OR DAMAGE TO PERSONAL PROPERTY INCIDENT TO SERVICE

PART I - TO BE COMPLETED BY CLAIMANT (See back for Privacy Act Statement and Instructions.)

1.

NAME OF CLAIMANT (Last, First, Middle Initial)

2. BRANCH OF SERVICE

3. RANK OR GRADE

4. SOCIAL SECURITY NUMBER

 

 

 

 

 

5.

HOME ADDRESS (Street, City, State and Zip Code)

6. CURRENT

MILITARY DUTY ADDRESS (If applicable) (Street, City,

 

 

State and Zip Code)

7.HOME TELEPHONE NO. (Include area code)

8.DUTY TELEPHONE NO. (Include area code)

9. AMOUNT CLAIMED

10.CIRCUMSTANCES OF LOSS OR DAMAGE (Explain in detail. Include date, place, and all relevant facts. Use additional sheets if necessary.)

11. DID YOU HAVE PRIVATE INSURANCE COVERING YOUR PROPERTY? (E.g., say "Yes" on a shipment or quarters claim if you YES NO had transit, renter's or homeowner's insurance; say "Yes" on a vehicle claim if you had vehicle insurance. Attach a copy of

your policy.)

12.HAVE YOU MADE A CLAIM AGAINST YOUR PRIVATE INSURER? (If "Yes," attach a copy of your correspondence. If you have insurance covering your loss, you must submit a demand before you submit a claim against the Government.)

13.HAS A CARRIER OR WAREHOUSE FIRM INVOLVED PAID YOU OR REPAIRED ANY OF YOUR PROPERTY? (If "Yes," attach a copy of your correspondence with the carrier or warehouse firm.)

14.DID ANY OF THE CLAIMED ITEMS BELONG TO THE GOVERNMENT OR TO SOMEONE OTHER THAN YOU OR YOUR FAMILY MEMBER? (If "Yes," indicate this on your "List of Property and Claims Analysis Chart," DD Form 1844.)

15.WERE ANY OF THE CLAIMED ITEMS ACQUIRED OR HELD FOR SALE, OR ACQUIRED OR USED IN A PRIVATE PROFESSION OR BUSINESS? (If "Yes," indicate this on your "List of Property and Claims Analysis Chart," DD Form 1844.)

16.UNDER PENALTY OF LAW, I DECLARE THE FOLLOWING AS PART OF SUBMITTING MY CLAIM:

If any missing items for which I am claiming are recovered, I will notify the office paying this claim. (For shipment claims.) Missing items

were packed by the carrier; they were owned prior to shipment but not delivered at destination; after my property was packed, I/my agent checked all rooms in my dwelling to make sure nothing was left behind.

I assign to the United States any right or interest I have against a carrier, insurer, or other person for the incident for which I am claiming; I authorize my insurance company to release information concerning my insurance coverage.

I authorize the United States to withhold from my pay or accounts for any payments made to me by a carrier, insurer, or other person to the extent I am paid on this claim, and for any payment made on this claim in reliance on information which is determined to be incorrect or untrue. I have not made any other claim against the United States for the incident for which I am claiming. I understand that if any information I provide as part of my claim is false, I can be prosecuted.

17. SIGNATURE OF CLAIMANT (or designated agent)

18.DATE SIGNED

(YYYYMMDD)

PART II - CLAIMS APPROVAL (To be completed by Claims Office)

19.PROCEDURE (X one) 20. AMOUNT AWARDED. The claim is cognizable and meritorious under 31 U.S.C. 3721;

a. SMALL CLAIMS

the claimant is a proper claimant; the property is reasonable and useful; the loss has

$

been verified in accordance with applicable procedures as prescribed by the controlling

 

 

b. REGULAR CLAIMS

departmental regulation; and the following award is substantiated:

 

21.SIGNATURES (Signatures at a and c not required if small claims procedure is utilized)

a. CLAIMS EXAMINER

b. DATE SIGNED

c. REVIEWING AUTHORITY

d. DATE SIGNED

 

(YYYYMMDD)

 

(YYYYMMDD)

 

 

 

 

e. TYPED NAME AND GRADE OF APPROVING AUTHORITY

f. SIGNATURE OF APPROVING AUTHORITY

g. DATE SIGNED

 

 

 

(YYYYMMDD)

DD FORM 1842, MAY 2000

PREVIOUS EDITION IS OBSOLETE.

PRIVACY ACT STATEMENT

AUTHORITY: 31 U.S.C. 3721, and EO 9397, November 1943 (SSN).

PRINCIPAL PURPOSE(S): Filing, investigation, processing and settlement of claims for losses incident to service.

ROUTINE USES:

a.Information is principally used to provide a legal basis for the administrative payment of claims against the Government. Information is also used in connection with:

(1)Recovery from common carriers, warehouse firms, insurers and other third parties.

(2)Collection from claimants of improper payments or overpayments.

(3)Investigation of possible fraudulent claims.

(4)Possible criminal prosecution by the Department of Justice or other agencies if fraud is established.

b.Social Security Numbers are used to assure correct identification of claimants in order to assure payment to the proper claimant and avoid duplication of claims.

DISCLOSURE: Voluntary; however, failure to supply information will cause delay in settlement and may result in denial of a portion or all of the claim.

INSTRUCTIONS TO CLAIMANTS

1.You must submit your claim in writing within two years of the date of the incident giving rise to the claim. This two year time limitation may not be waived.

2.The claimant or an authorized agent must complete and sign Part I of this form, answering all questions. If the claim is signed by an agent (such as a spouse) or a survivor of a deceased proper claimant, that person must have a document showing his or her authority to present the claim, such as a power of attorney, etc.

3.If the claim is for property lost or damaged while being shipped or stored pursuant to travel orders, submit copies of your orders and all shipping documents, including your inventory and your "Joint Statement of Loss or Damage at Delivery/Notice of Loss or Damage," DD Forms 1840/1840R. If you notice damage after delivery, you must complete the DD Form 1840R and get it to the Claims Office within 70 days after delivery.

4.You may obtain further information from a Claims Office.

5.You are entitled to claim the following:

a.Reasonable local repair cost, if an item can be economically repaired. (You may claim small amounts without an estimate. Otherwise, submit an estimate of repair from a repair firm or, if repairs have been completed, your receipt. The claims office may waive this in appropriate cases.)

b.Reasonable local replacement cost if an item is missing, destroyed, or not economic to repair. (Replacement costs may be obtained from commercial catalogs or a military exchange. If you cannot find the item in a catalog or the exchange and the cost is more than $100.00, obtain a statement from a commercial firm for the cost of a similar item. If you have purchase receipts, bring these to the Claims Office as well.)

c.Reasonable cost of obtaining local estimates of repair, if the cost of such estimates will not be credited if repair work is done. (Normally, you may not claim appraisal fees.)

PART III - DENIAL OR SUPPLEMENTAL PAYMENT (To be completed by Claims Office)

 

23. DENIAL (X if applicable)

 

24. SUPPLEMENTAL PAYMENT (X and complete if applicable)

 

The claim is not cognizable or meritorious under 31 U.S.C.

 

The claim is cognizable and meritorious

 

 

 

 

 

 

 

3721 and the applicable provisions of the controlling

 

under 31 U.S.C. 3721, and the following

 

$

 

 

 

 

departmental regulation, and is denied.

 

additional award is substantiated:

 

 

 

 

 

 

 

 

25. SIGNATURES

a. CLAIMS EXAMINER

b. DATE SIGNED (YYYYMMDD)

c. REVIEWING AUTHORITY

d. DATE SIGNED (YYYYMMDD)

26.APPROVING/SETTLEMENT AUTHORITY (Settlement Authority is required for denial.)

a. TYPED NAME

DD FORM 1842 (BACK), MAY 2000

b. GRADE

b. SIGNATURE

c. DATE SIGNED (YYYYMMDD)

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Pay attention while completing this document. Ensure every field is completed properly.

1. It is critical to fill out the form 1842 correctly, therefore take care while filling in the areas including all these blank fields:

Filling in segment 1 in dd 1842

2. Soon after filling out the last part, go to the next part and complete the essential details in these blanks - DID YOU HAVE PRIVATE INSURANCE, HAVE YOU MADE A CLAIM AGAINST, HAS A CARRIER OR WAREHOUSE FIRM, DID ANY OF THE CLAIMED ITEMS, WERE ANY OF THE CLAIMED ITEMS, UNDER PENALTY OF LAW I DECLARE, SIGNATURE OF CLAIMANT or, DATE SIGNED YYYYMMDD, and PART II CLAIMS APPROVAL To be.

Filling out part 2 in dd 1842

Concerning HAVE YOU MADE A CLAIM AGAINST and PART II CLAIMS APPROVAL To be, be certain you take a second look in this current part. Those two are viewed as the most important ones in this form.

3. Completing PART II CLAIMS APPROVAL To be, PROCEDURE X one, a SMALL CLAIMS b REGULAR CLAIMS, AMOUNT AWARDED The claim is, SIGNATURES Signatures at a and c, c REVIEWING AUTHORITY, b DATE SIGNED YYYYMMDD, e TYPED NAME AND GRADE OF, f SIGNATURE OF APPROVING AUTHORITY, DD FORM MAY, PREVIOUS EDITION IS OBSOLETE, d DATE SIGNED YYYYMMDD, and g DATE SIGNED YYYYMMDD is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

c REVIEWING AUTHORITY, g DATE SIGNED YYYYMMDD, and d DATE SIGNED YYYYMMDD in dd 1842

4. To go forward, your next part involves completing a handful of blanks. Included in these are PART III DENIAL OR SUPPLEMENTAL, DENIAL X if applicable The claim, SUPPLEMENTAL PAYMENT X and, SIGNATURES a CLAIMS EXAMINER, b DATE SIGNED YYYYMMDD, c REVIEWING AUTHORITY, APPROVINGSETTLEMENT AUTHORITY, b GRADE, b SIGNATURE, DD FORM BACK MAY, d DATE SIGNED YYYYMMDD, and c DATE SIGNED YYYYMMDD, which you'll find vital to moving forward with this form.

b DATE SIGNED YYYYMMDD, b GRADE, and DD FORM BACK MAY of dd 1842

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