Dd Form 2891 PDF Details

On July 17, 2012, the Department of Defense released a new form, DD Form 2891. This updated form is required for all members of the military who are requesting medical and dental care from a non-DoD provider. The purpose of this form is to ensure that all providers have the necessary information to provide quality care to our service members. filled out correctly, it will help you receive the best possible care. Let's take a closer look at this important document.

QuestionAnswer
Form NameDd Form 2891
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdd form 2891 instructions, dd 2891 pdf, form authorization cost, dd form 2891

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AUTHORIZATION FOR RETIRED SERVICEMAN'S FAMILY PROTECTION PLAN (RSFPP)

AND/OR SURVIVOR BENEFIT PLAN (SBP) COSTS DEDUCTION

PRIVACY ACT STATEMENT

AUTHORITY: Executive Order 9397; 10 U.S.C. Sections 1438 and 1452(d).

PRINCIPAL PURPOSE(S): The purpose is to obtain the military member's authorization to deduct the costs for either RSFPP or SBP from the member's Department of Veterans Affairs (VA) monthly compensation or pension payments. These payments are to be sent to the Defense Finance and Accounting Service by the VA.

ROUTINE USE(S): The information on this form may be disclosed as generally permitted under 5 U.S.C. Section 552(a)(b) of the Privacy Act of 1974, as amended. It may also be disclosed outside of the Department of Defense to the Department of Veterans Affairs (VA) relating to payments for RSFPP or SBP costs, to the spouses or former spouses who are designated either by the member or by a court order or filing order under 10 U.S.C. Sections 1448(a) or 1450(f)(3) to be the recipient of the retiree's SBP or RSFPP annuity, so they can determine if coverage is in effect or has been implemented. In addition, other Federal, State, or local government agencies, which have identified a need to know, may obtain this information for the purpose(s) identified in the DoD Blanket Routine Uses as published in the Federal Register.

DISCLOSURE: Disclosure is voluntary; however, failure to provide the information may result in a significant delay in the processing of your request to deduct the RSFPP or SBP costs from your VA compensation or pension payments.

SECTION I - TO BE COMPLETED BY MEMBER

1. I hereby authorize the Department of Veterans Affairs (VA) to deduct

$

 

for RSFPP costs, beginning 1

 

 

 

$

 

for SBP and/or

 

 

 

,and each month thereafter

from any compensation or pension payments due me. I also understand that when there is a cost-of-living increase for SBP, the SBP cost will increase accordingly. The Defense Finance and Accounting Service - Cleveland Center will inform the VA office, listed in Section II of this form, of the new rate of deduction and the month in which the increase becomes effective. The premium cost is required under the authority of 10 U.S. Code, Section 1438 or 1452(d). Deductions are to be forwarded each month to: Defense Finance and Accounting Service, DFAS-CL, SBP and RSFPP Remittance, P.O. Box 979013, St. Louis, MO 63197-9013.

A. SIGNATURE

B. DATE (YYYYMMDD)

SECTION II - TO BE COMPLETED BY THE VA

FOR VA ONLY: To assist in the identification of this deduction amount for proper deposit, please annotate the voucher which accompanies the check payment with the purpose "SBP" or "RSFPP" separately listed and each member's full name and Social Security number. Deductions are to be forwarded to: Defense Finance and Accounting Service, DFAS-CL, SBP and RSFPP Remittance, P.O. Box 979013, St. Louis, MO 63197-9013.

1.

MEMBER'S NAME (LAST, FIRST, MIDDLE)

 

2. SOCIAL SECURITY NUMBER

3. VA CLAIM NUMBER

 

 

 

 

 

C

 

 

 

 

 

 

4.

VA OFFICE NAME AND ADDRESS

 

 

5.

SBP MONTHLY DEDUCTION

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

6.

RSFPP MONTHLY DEDUCTION

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

7.

SUBMISSION DATE

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

DD FORM 2891, OCT 2005

PREVIOUS EDITION IS OBSOLETE.

 

ADOBE PROFESSIONAL 7.0

How to Edit Dd Form 2891 Online for Free

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It really is straightforward to finish the document with our practical tutorial! Here's what you must do:

1. It is advisable to complete the dd 2891 correctly, therefore be careful while filling in the areas comprising all of these blanks:

dd form 2891 fillable conclusion process described (step 1)

2. Once your current task is complete, take the next step – fill out all of these fields - MEMBERS NAME Last First Middle, SOCIAL SECURITY NUMBER, VA OFFICE NAME AND ADDRESS, VA CLAIM NUMBER C, SBP MONTHLY DEDUCTION, RSFPP MONTHLY DEDUCTION, SUBMISSION DATE YYYYMMDD, DD FORM OCT, and PREVIOUS EDITION IS OBSOLETE Adobe with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

VA CLAIM NUMBER C, SUBMISSION DATE YYYYMMDD, and PREVIOUS EDITION IS OBSOLETE Adobe of dd form 2891 fillable

Be extremely careful when filling out VA CLAIM NUMBER C and SUBMISSION DATE YYYYMMDD, as this is the section where many people make a few mistakes.

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