DD Form 220: Active Duty Report

In Box 1, Reserve Component, select one: ARNGUS, ANGUS, USAR or AFRES.

Enter the Date (YYMMDD) in Box 2, the Appropriate Military Department in Box 3 (TO) and the Initial Active Duty Station in Box 4 (FROM).

Enter the Name (Last, First, MI) in Box 5, the DoD ID Number in Box 6, the Grade or Rank in Box 7, the Branch of Armed Svc in Box 8 and the Retirement Yr Ending in Box 9.

Enter the Effective Date of Entry on Active Duty in Box 10 by Year, Month and Day (Determined by personnel officer at first duty station IAW criteria outlined in AR 37-104-4).

Enter the Reporting Date in Box 11 by Year, Month and Day (Date specified in orders or the actual reporting date if later than date specified).

Enter the Date Departed from Duty Station to Home in Box 12 by Year, Month and Day.

For Box 13, Authority for Active Duty, enter the Orders No., Paragraph No. and Dated (YYMMDD), and the HQ (Designation and location of HQ issuing orders).

Enter the Length of Tour in Box 14 (Less than 90 days if ARNGUS or USAR).

In Box 15, Statement of Physical Condition (In lieu of medical examination), enter after "I have been treated by" the Name of Physician (Last, First, MI) and (YYMMDD), and after "which was accomplished at" the Name and location of hospital or medical treatment facility.

After "and since that time:", mark "I have been treated by" or "have not been treated by" clinics, physicians, healers or other practitioners.

After "I have been treated by", enter the Name of physician (Last, First, MI) during the period from (YYMMDD) to (YYMMDD) for the Description of injury or illness.

Enter the Name and location of hospital or medical treatment facility after "I was hospitalized in", the attending physician (Last, First, MI) after "The attending physician was" and the Description of injury or disease after "Diagnosis was".

Mark "I do" or "do not believe" that you are now medically qualified to perform satisfactory military service.

Sign in Box 15 and enter the Date (YYMMDD). The Adjutant or Other Officer Representing Commander signs in Box 19.

Box 16 is ARMY USE ONLY: upon mobilization this item will be filled in for members of units of reserve components of the Army and copies of orders will be attached to this form.

In Box 16, enter after "Entered on active duty as a member of" the Unit and unit home station, and after "Ordered to active duty from" the Home of record or home address (Include ZIP code).

In Box 17 (ARMY USE ONLY), under PREPARED AND FORWARDED, mark YES, FORWARDED TO with the Address of Reserve or NG unit (Include ZIP Code) and the DATE (YYMMDD), mark NO, REPORT WILL BE FORWARDED ON OR ABOUT with a date (YYMMDD), or mark NOT APPLICABLE.

In Box 18 (ARMY USE ONLY), enter the Date of Rank (YYMMDD); for officers and warrant officers ordered to active duty for 12 or more months, enter the computation.

Box 19 is for the Adjutant or Other Officer Representing Commander: 19a, the Typed Name (Last, First, MI), b, the Grade or Rank, and the SIGN line.

In Box 20, Enclosures, list enclosures, if any.

In Box 21, Remarks, explain the reason for delay, if any, in complying with orders.

DD Form 220 is the Active Duty Report. Privacy Act Statement. AUTHORITY: 10 USC 3013, Secretary of the Army; AR 635-8, Separation Processing and Documents. PRINCIPAL PURPOSE: Used to report items of information to individuals reporting for active duty. Also used to compute date of rank for officers and warrant officers ordered to active duty for 12 or more months. ROUTINE USE: The routine uses outlined in the applicable system of records notice (SORN) applies to this collection. SORN: A0635-200, Army Personnel System (APS) (March 27, 2013, 78 FR 18565). DISCLOSURE: Voluntary; however, if an individual refuses to complete the Statement of Physical Condition section, he/she will be scheduled for a medical examination.