Dd Form 2005 PDF Details

Dd Form 2005 is the Department of Defense form used to document separations from active duty service. It is also used to initiate and process benefits for service members and their families. The form must be completed and filed within 30 days of the service member's separation from active duty. The instructions for completing the form can be found on the back of the form. The purpose of this blog post is to provide a brief overview of Dd Form 2005, specifically what information is required on the form, and some tips for completing it. Service members who are separating from active Duty should read through the entire form carefully before completing it. There may be other documentation that needs to be submitted in addition to Dd Form 2005 in order to receive benefits,

QuestionAnswer
Form NameDd Form 2005
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescommunicable, 2005, inclusive, enactment

Form Preview Example

PRIVACY ACT STATEMENT - HEALTH CARE RECORDS

THIS FORM IS NOT A CONSENT FORM TO RELEASE OR USE HEALTH CARE INFORMATION PERTAINING TO YOU.

1. AUTHORITY FOR COLLECTION OF INFORMATION INCLUDING SOCIAL SECURITY NUMBER (SSN)

Sections 133, 1071-87, 3012, 5031 and 8012, title 10, United States Code and Executive Order 9397.

2. PRINCIPAL PURPOSES FOR WHICH INFORMATION IS INTENDED TO BE USED

This form provides you the advice required by The Privacy Act of 1974. The personal information will facilitate and document your health care. The Social Security Number (SSN) of member or sponsor is required to identify and retrieve health care records.

3. ROUTINE USES

The primary use of this information is to provide, plan and coordinate health care. As prior to enactment of the Privacy Act, other possible uses are to: Aid in preventive health and communicable disease control programs and report medical conditions required by law to federal, state and local agencies; compile statistical data; conduct research; teach; determine suitability of persons for service or assignments; adjudi- cate claims and determine benefits; other lawful purposes, including law enforcement and litigation; con- duct authorized investigations; evaluate care rendered; determine professional certification and hospital accreditation; provide physical qualifications of patients to agencies of federal, state, or local govern- ment upon request in the pursuit of their official duties.

4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION

In the case of military personnel, the requested information is mandatory because of the need to document all active duty medical incidents in view of future rights and benefits. In the case of all other personnel/ beneficiaries, the requested information is voluntary. If the requested information is not furnished, compre- hensive health care may not be possible, but CARE WILL NOT BE DENIED.

This all inclusive Privacy Act Statement will apply to all requests for personal information made by health care treatment personnel or for medical/dental treatment purposes and will become a permanent part of your health care record.

Your signature merely acknowledges that you have been advised of the foregoing. If requested, a copy of this form will be furnished to you.

SIGNATURE OF PATIENT OR SPONSOR

SSN OF MEMBER OR SPONSOR

DATE

DD FORM 2005, FEB 76

PREVIOUS EDITION IS OBSOLETE.

How to Edit Dd Form 2005 Online for Free

You may complete 1974 easily with the help of our online tool for PDF editing. To make our tool better and more convenient to utilize, we constantly implement new features, with our users' suggestions in mind. Getting underway is easy! All you need to do is take the following easy steps directly below:

Step 1: Click on the "Get Form" button above on this webpage to open our PDF tool.

Step 2: Once you access the PDF editor, you will find the form all set to be filled out. Aside from filling in different blanks, you could also do several other things with the PDF, specifically adding custom text, editing the initial text, adding illustrations or photos, affixing your signature to the PDF, and a lot more.

As a way to finalize this PDF document, ensure that you provide the required information in every single area:

1. Firstly, once completing the 1974, begin with the section that has the next blanks:

Writing section 1 of accreditation

Step 3: Prior to moving on, you should make sure that all blank fields have been filled in the proper way. The moment you’re satisfied with it, click “Done." Go for a free trial plan with us and get direct access to 1974 - download or modify inside your FormsPal account page. With FormsPal, it is simple to complete documents without the need to worry about database breaches or records being shared. Our protected system ensures that your personal data is kept safe.

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