The DD Form 1172-2 is a pivotal document intended for the application and enrollment in the Defense Enrollment Eligibility Reporting System (DEERS), which extends benefits and privileges such as medical coverage, DoD Identification Cards, and access to DoD installations and systems to eligible service members, retirees, and their dependents. This form facilitates the verification process necessary to secure these vital entitlements. If you are looking to apply or renew your DoD identification card and ensure your DEERS enrollment, explore the specifics on filling out the form by clicking the button below.
The DD Form 1172-2, serving as a vital instrument for personnel associated with the Department of Defense (DoD) and Uniformed Services, facilitates the application and enrollment in the Defense Enrollment Eligibility Reporting System (DEERS), a crucial system for the provision of various DoD benefits and privileges. From medical coverage to access to military installations and secure computer networks, this form is the gateway to a spectrum of entitlements for service members, their dependents, and contractors. It meticulously gathers the sponsor or employee's personal information, including details pertinent to their duty status and organizational affiliation, under the auspices of specific authoritative directives. Moreover, it provides a structured platform for the declaration by sponsors about the accuracy of the provided information, a process that may require notarization if not verified in the presence of an authorizing official. This thorough document not only underscores the intricate processes involved in securing military benefits but also the stringent verification mechanisms in place to safeguard against unauthorized access, reflecting a balance between accessibility to entitled services and the imperatives of security and data privacy. The inclusion of a detailed Privacy Act Statement and Agency Disclosure Notice further articulates the legal nuances governing the collection, use, and disclosure of personal information within this framework, emphasizing the legal obligations of both the information provider and the receiving entity. By delineating the essentials for enrollment in DEERS, the DD Form 1172-2 encapsulates the procedural and regulatory norms that underpin the entitlement to benefits within the military community.
APPLICATION FOR IDENTIFICATION CARD/DEERS ENROLLMENT
Please read Agency Disclosure Notice, Privacy Act Statement, and Instructions prior to completing this form.
OMB No. 0704-0415 OMB approval expires 20230430
SECTION I - SPONSOR/EMPLOYEE INFORMATION
1.NAME (Last, First, Middle)
2. GENDER
3. SSN OR DoD ID NO.
4. STATUS
5. ORGANIZATION
6. PAY GRADE
7. GEN. CAT
8. CITIZENSHIP
9. DATE OF BIRTH (YYYYMMDD)
10. PLACE OF BIRTH
11. CURRENT HOME ADDRESS
12. CITY
13. STATE
14. ZIP CODE
15. COUNTRY
16. PRIMARY EMAIL ADDRESS
Permission to use for benefits notifications
17.TELEPHONE NUMBER (Include Area Code/DSN)
18. CITY OF DUTY LOCATION
19.STATE OF DUTY LOCATION
20. COUNTRY OF DUTY LOCATION
SECTION II - SPONSOR/EMPLOYEE DECLARATION AND REMARKS
21.REMARKS (Cite legal documentation, as applicable.)
NOTARY SIGNATURE
AND SEAL
I certify the information provided in connection with the eligibility requirements of this form is true and accurate to the best of my knowledge. (If not signed in the presence of the authorizing/verifying official, the signature must be notarized.)
22. SPONSOR/EMPLOYEE SIGNATURE
23. DATE SIGNED (YYYYMMDD)
SECTION III - AUTHORIZED BY
24. SPONSORING OFFICE NAME
25. CONTRACT NUMBER
26. SPONSORING OFFICE ADDRESS
27. SPONSORING OFFICE TELEPHONE
28. OFFICE EMAIL ADDRESS
29. OVERSEAS ASSIGNMENT (Country)
(Street, City, State, ZIP Code)
NUMBER (Include Area Code/DSN)
30.OVERSEAS ASSIGNEMENT BEGIN DATE (YYYYMMDD)
31.OVERSEAS ASSIGNEMENT END DATE (YYYYMMDD)
32.ELIGIBILITY EFFECTIVE DATE (YYYYMMDD)
33.ELIGIBILITY EXPIRATION DATE (YYYYMMDD)
I certify the individual identified above, based on personal knowledge and available documentation, is in a status eligible for and requires an identification card in the performance of their duties with the DoD or Uniformed Services.
34. SPONSORING OFFICIAL NAME (Last, First, Middle)
35. UNIT/ORGANIZATION NAME
36. TITLE
37. PAY GRADE
38. SIGNATURE
39. DATE VERIFIED (YYYYMMDD)
SECTION IV - VERIFIED BY
40.VERIFYING OFFICIAL NAME (Last, First, Middle Initial)
41. SITE IDENTIFICATION
42.TELEPHONE NUMBER (Include Area Code/DSN)
43. SIGNATURE
SECTION V - DEPENDENT INFORMATION (Attach additional pages if necessary)
44. NAME (Last, First, Middle)
45. GENDER
46. DATE OF BIRTH (YYYYMMDD)
47. RELATIONSHIP
48. SSN OR DoD ID NO.
49. CURRENT HOME ADDRESS
50. PRIMARY EMAIL
Permission to use for benefits
51. TELEPHONE NUMBER
A
ADDRESS
notifications (18 and above)
(Include Area Code/DSN)
52. CITY
53. STATE
54. ZIP CODE
55. COUNTRY
56. ELIGIBILITY EFFECTIVE DATE
57. ELIGIBILITY EXPIRATION DATE
(YYYYMMDD)
58. NAME (Last, First, Middle)
59. GENDER
60. DATE OF BIRTH (YYYYMMDD)
61. RELATIONSHIP
62. SSN OR DoD ID NO.
63. CURRENT HOME ADDRESS
64. PRIMARY EMAIL
65. TELEPHONE NUMBER
B
66. CITY
67. STATE
68. ZIP CODE
69. COUNTRY
70. ELIGIBILITY EFFECTIVE DATE
71. ELIGIBILITY EXPIRATION DATE
SECTION VI - RECEIPT
Receipt of new card is acknowledged.
72. SIGNATURE
73. DATE ISSUED (YYYYMMDD)
DD FORM 1172-2, APRIL 2020
PREVIOUS EDITION IS OBSOLETE.
This form is valid for issue of DoD ID Card for 90 days
from date of verification.
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whd.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ORGANIZATION.
RETURN COMPLETED FORM TO A REAL-TIME AUTOMATED PERSONNEL IDENTIFICATION SYSTEM WORK STATION.
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Chapter 53, Miscellaneous Rights and Benefits; 10 U.S.C. Chapter 54, Commissary and Exchange Benefits; 50 U.S.C. Chapter 23, Internal Security; DoD Instruction 1341.2, Defense Enrollment Eligibility Reporting System (DEERS) Procedures; Homeland Security Presidential Directive 12, Policy for a Common Identification Standard for Federal Employees and Contractors; and E.O. 9397 (SSN), as amended.
PRINCIPAL PURPOSE(S): To apply for and enroll in the Defense Enrollment Eligibility Reporting System (DEERS) for DoD benefits and privileges. These benefits and privileges include, but are not limited to, medical coverage, DoD Identification Cards, access to DoD installations, buildings or facilities, and access to DoD computer systems and networks.
ROUTINE USE(S): To Federal and State agencies and private entities; individual providers of care, and others, on matters relating to claim adjudication, program abuse, utilization review; professional quality assurance; medical peer review, program integrity, third party liability, coordination of benefits and civil and criminal litigation, and access to Federal government and contractor facilities, computer systems, networks, and controlled areas. The DD Form 1172-2 currently covers the RUs that would include retirees and dependents. To the Department of Health and Human Services, the Department of Veterans Affairs, the Social Security Administration, and to other Federal, state, and local government agencies to identify individuals having benefit eligibility in another plan or program. Additional Routine Uses can be found in system of records notice DMDC 02, at: https://dpcld.defense.gov/Portals/49/Documents/Privacy/
SORNs/OSDJS/DMDC-02-DoD.pdf?ver=2019-12-09-111827-743
Applicant information is subject to computer matching within the Department of Defense or with other Federal or non-Federal agencies. Matching programs are conducted to assure that an individual eligible under a Federal program is not improperly receiving duplicate benefits from another program. A beneficiary or former beneficiary who has applied for privileges of a Federal Benefit Program and has received concurrent assistance under another plan will be subject to adjustment or recovery of any improper payments made or delinquent debts owed.
DISCLOSURE: Voluntary; however, failure to provide information may result in denial of a Uniformed Services Identification Card and/or non-enrollment in the Defense Enrollment Eligibility Reporting System, refusal to grant access to DoD installations, buildings, facilities, computer systems and networks.
Penalty for presenting false claims or making false statements in connection with claims: fine of up to $10,000 or imprisonment for up to five years or both.
INSTRUCTIONS
The instructions for completing the DD Form 1172-2 should be closely followed to ensure accurate data collection and to preclude over collection of information. Section IV of this form should only be completed if benefits or sponsorship is being requested for/by an eligible sponsor or their dependent. Instructions for the DD Form 1172-2 can be found at: http://www.cac.mil/Portals/53/Documents/1172-2-Instructions.pdf.
The process of completing the DD Form 1172-2 is crucial for individuals seeking to enroll in the Defense Enrollment Eligibility Reporting System (DEERS) for DoD benefits and privileges. This includes applying for military ID cards necessary for access to various DoD resources. To ensure the process is completed accurately and efficiently, follow the steps outlined below.
After you have filled out the form accurately, review all the information to ensure completeness and accuracy. Remember, this form is a key step in securing the necessary DoD benefits and privileges, including medical coverage and access to military facilities. Once completed, return the form to a Real-Time Automated Personnel Identification System (RAPIDS) workstation for processing. Do not return the form to the Department of Defense address listed on the notice. Ensure you have all necessary supporting documents on hand when you submit your form, as these will be needed to complete the enrollment process.
The DD Form 1172-2 is an application form used for enrollment in the Defense Enrollment Eligibility Reporting System (DEERS) and to apply for a Department of Defense (DoD) Identification Card. This form is crucial for military members, retirees, and their dependents to access benefits, facilities, and services provided by the DoD.
This form needs to be completed by or for individuals who require an identification card to access military benefits and privileges. This includes active-duty military members, retirees, and their eligible dependents.
To accurately complete the DD Form 1172-2, you will need the following information:
After completion, the form should not be returned to the issuing organization but to a Real-Time Automated Personnel Identification System (RAPIDS) work station for processing.
Yes, individuals who present false claims or make false statements on the DD Form 1172-2 may face a fine of up to $10,000, imprisonment for up to five years, or both.
The form is valid for the issuance of a DoD ID Card for 90 days from the date of verification.
Instructions for completing the DD Form 1172-2 can be found on the official Common Access Card (CAC) website at the provided link in the form content.
The Privacy Act Statement provides the authority under which the information is collected, explains the principal purposes for which the information is intended to be used, outlines the routine uses of the data, and describes the consequences of not providing the requested information.
Yes, dependents of eligible sponsors can use the DD Form 1172-2 to apply for and enroll in DEERS to receive dependent ID cards for accessing benefits and privileges.
If the DD Form 1172-2 is not signed in front of an authorizing/verifying official, the signature must be notarized to certify the veracity of the provided information.
Filling out the DD Form 1172-2, which is an application for an identification card and DEERS enrollment, seems straightforward but it's easy to make mistakes if you're not careful. Here are some of the most common errors people tend to make while completing this form:
By avoiding these common mistakes, you can ensure a smoother process for your application and reduce the risk of delays or denials. Remember, accuracy and completeness are key when filling out any official form, especially the DD 1172-2 form.
When completing the DD Form 1172-2 for an application for identification card/DEERS enrollment, several other forms and documents are often required to support the application process. These additional forms play critical roles in verifying the eligibility, identity, and entitlements of the applicants seeking benefits under the Department of Defense. Below is an overview of these crucial documents.
Navigating the various requirements and documents associated with the DD Form 1172-2 application can be complex. Each document serves a specific function in verifying eligibility and ensuring the accurate provision of benefits to service members and their dependents. If you are preparing to submit a DD Form 1172-2 or need to update your DEERS information, making sure you have the proper documentation in order can facilitate a smoother process and prevent delays in receiving the identification and benefits to which you are entitled.
The SF-86 Form, also known as the Questionnaire for National Security Positions, is similar to the DD Form 1172-2 in that it collects detailed personal information for security clearance purposes, covering areas such as employment history, citizenship, education, and personal references, much like the personal and employment information required in the DD Form 1172-2 for identification card and DEERS enrollment.
The VA Form 10-10EZ, Application for Health Benefits, shares similarities with the DD Form 1172-2 as both are used by veterans and service members to apply for benefits. The VA Form 10-10EZ is specifically for healthcare benefits through the Department of Veterans Affairs, requiring personal identification and eligibility information similar to that on the DD Form 1172-2 for DEERS enrollment and ID card issuance.
The I-9 Form, Employment Eligibility Verification, is used by employers to verify an employee's identity and eligibility to work in the United States. It is similar to the DD Form 1172-2 in that both forms require personal identification details, although the I-9 Form is focused on employment eligibility verification for all employees in the U.S.
The DS-11 Form, Application for a U.S. Passport, collects personal information, citizenship details, and identification similar to the DD Form 1172-2. Both forms are used to verify identity and citizenship status, but the DS-11 Form is for the purpose of issuing a U.S. Passport for international travel.
The Form I-130, Petition for Alien Relative, while primarily for immigration purposes, shares the aspect of verifying and documenting personal and family information with the DD Form 1172-2. It involves the collection of biographic information to establish a relationship between the petitioner and the beneficiary, akin to the dependent information section in the DD Form 1172-2 for DEERS enrollment.
The SS-5 Form, Application for a Social Security Card, like the DD Form 1172-2, involves the collection of personal identification information such as name, date of birth, and citizenship status for the purpose of issuing a Social Security Card, which is a key piece of identification in the United States.
The Form 1040, U.S. Individual Income Tax Return, though its primary purpose is for annual income reporting, requires personal and dependent information similar to what is collected on the DD Form 1172-2 for the purpose of tax filing and determination of certain benefits eligibility.
When filling out the DD Form 1172-2, an Application for Identification Card/DEERS Enrollment, there are specific do's and don'ts that can help streamline the process and ensure the accuracy of the information provided. These guidelines are crucial for the successful enrollment in the Defense Enrollment Eligibility Reporting System (DEERS), which is vital for securing DoD benefits and privileges.
Do's:
Don'ts:
Accuracy, completeness, and honesty are paramount when filling out the DD Form 1172-2. These practices not only facilitate a smoother processing experience but also ensure that individuals and their dependents can access the important benefits to which they are entitled.
Understanding the DD Form 1172-2, the application for identification card/DEERS enrollment, is crucial for service members, their dependents, and civilian employees of the Department of Defense (DoD). However, there are several misconceptions surrounding its use and requirements. Here, we aim to clarify some of these misunderstandings.
This is incorrect. Although primarily used by service members, the DD Form 1172-2 is also required for enrolling civilian employees, contractors, and dependents in the DEERS for obtaining DoD benefits and privileges.
Not exactly true. In some cases, life events such as a change in marital status, dependents, or employment can necessitate an update to your DEERS information and a new ID card issuance before the current one expires.
Actually, while sponsors typically initiate the form, dependents aged 18 and above can also sponsor themselves in certain circumstances and complete the form with the necessary documentation.
This overlooks the comprehensive role of the form. Beyond ID cards, it's integral for enrolling in DEERS, which grants access to a wide range of benefits, including healthcare and facility access.
Completing the DD Form 1172-2 is a step towards eligibility, but benefits access depends on the individual’s specific status, relationship to the sponsor, and the nature of the benefits in question.
Not always the case. Some sections apply specifically to certain categories of applicants. It’s vital to follow the instructions closely to avoid unnecessary collection of information.
While digital completion and submission are becoming more common, in some instances, the form must be submitted in person, especially when verification of original documents is required.
Clear understanding and adherence to the DD Form 1172-2 requirements ensure that eligible individuals receive the identification and benefits they are entitled to, without undue delay or complication.
Understanding the DD Form 1172-2 is crucial for accurate and efficient processing of identification cards and DEERS enrollment.
The purpose of the DD Form 1172-2 is to apply for and enroll in DEERS to access various DoD benefits and privileges, such as medical coverage and facility access.
It is the responsibility of the applicant to ensure that the information provided on the form is true and accurate to avoid penalties, including fines or imprisonment, for presenting false claims.
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