Dd Form 1853 PDF Details

Dd Form 1853 is a form used in the United States military. This form is used to record medical and dental information for service members. The form is also used to track any medical or dental treatment that the service member has received. Any changes to the service member's medical or dental information must be documented on this form. Dd Form 1853 must be updated whenever there are any changes to the service member's health status.

The listing features information about the dd form 1853. It might be helpful to know its size, the average time to fill out the form, the blanks you'll have to fill in, and so forth.

QuestionAnswer
Form NameDd Form 1853
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesform dd 1853, verifying dd status, form 1853, official form reserve

Form Preview Example

 

VERIFICATION OF RESERVE STATUS FOR TRAVEL ELIGIBILITY

1.

DATE PREPARED

 

(Part B may be complet ed by t he request er' s commander, First Sergeant ,

 

(YYYYM M DD)

 

 

 

 

or a DoD personnel of f icial w it h access t o t he Personnel Dat a Syst em.)

 

 

 

 

 

 

 

 

 

 

 

 

PRIVACY ACT STATEMENT

 

 

 

AUTHORITY: 10 USC 8102, 44 USC 3101 and EO 9397.

 

 

 

 

 

 

PRINCIPAL PURPOSE: Use of your SSN is necessary to positively identify you.

 

 

 

ROUTINE USE: Used by Reserve personnel to verify eligibility for space available transportation on DoD-ow ned or controlled aircraft.

 

DISCLOSURE: Voluntary; how ever, failure to disclose w ill prevent the applicant from traveling on a DoD-ow ned or controlled aircraft.

 

 

 

 

 

 

 

 

PART A - TO BE COMPLETED BY APPLICANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

NAME (Last , First , Middle Init ial)

3. PAY GRADE

4. BRANCH OF SERVICE

5.

SSN

 

 

 

 

 

 

 

 

6. UNIT/COMMAND NAME

 

7. UNIT/COMMAND ADDRESS

 

 

 

 

 

 

 

 

 

 

8.

SIGNATURE

 

 

 

 

9.

DATE SIGNED (YYYYMMDD)

 

 

 

 

 

 

 

PART B - TO BE COMPLETED BY VERIFYING OFFICIAL

 

 

 

 

 

 

 

 

 

 

The Reservist named above is an active reserve component member and is eligible for space available transportation on DoD-ow ned or

 

controlled aircraft in accordance w ith DoD Regulation 4515.13-R, and is authorized to so travel (not t o exceed six mont hs).

 

 

 

 

 

10. FROM (YYYYMMDD)

 

11. TO (YYYYMMDD)

 

 

 

 

 

 

 

 

12. NAME OF VERIFYING OFFICIAL (Last , First , Middle Init ial)

13. PAY GRADE

14.

TITLE

 

 

 

 

 

 

 

 

15. ORGANIZATION

16. SIGNATURE

 

 

 

17. DATE SIGNED (YYYYMMDD)

 

 

 

 

 

 

 

 

DD FORM 1853, OCT 1999

PREVIOUS EDITION MAY BE USED.

Adobe Professional 7.0

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portion of empty spaces in official form reserve

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