Fillable Form DD 1172-2

DD Form 1172-2 Online is used to process a request for an identification card for someone who is a dependent of a member of the military.

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What is Form DD 1172-2?

Form DD 1172-2, Application for Identification Card/Deers Enrollment, is a document used to apply for and enroll in the Defense Enrollment Eligibility Reporting System (DEERS).

 

It is also used to obtain Department of Defense (DoD) benefits, such as medical coverage, DoD identification cards, and access to DoD installation, buildings or facilities, computer systems, and networks.

 

How to fill out Form DD 1172-2?

Follow the instructions in filling out Form DD 1172-2 to ensure and preclude accurate data collection.

 

NOTES:

 

  • Fill out sections I, II, and V if you are enrolling your dependents in DEERS.

  • Fill out sections I and II if you are an eligible employee applying for a Common Access Card (CAC).

  • Fill out sections I, II, and IV if you are an eligible employee applying for a CAC and a foreign affiliate on orders to the U.S. with authorized dependents.

  • Fill out Sections I and II if you are a DoD sponsor updating your status or adding a personnel condition impacting benefits.

    •  

    SECTION I — SPONSOR/EMPLOYEE INFORMATION

     

    1. NAME

    Enter your name.

     

    1. GENDER

    Enter F if you are a female. Enter M if you are a male.

     

    1. SSN OR DOD ID NO.

    Enter your Social Security Number (SSN) or Department of Defense (DoD) Identification (ID) Number.

     

    1. STATUS

    Enter your status code.

     

    Refer to the following codes below.

    • ACADMY — Academy or Navy Officer Candidate School (OCS) Student

    • AD — Active duty (excluding Guard and Reserve on extended active duty for more than 30 days)

    • AD-DEC — Active duty deceased

    • CIV — Civilian

    • CONTR — Contractor

    • DAVDEC 100 — percent disabled veteran deceased (either temporary (TMP) or permanent (PRM)

    • DAVPRM 100 — percent disabled veteran, permanent disability

    • DAVTMP 100 — percent disabled veteran, temporary disability

    • FP — Foreign military personnel

    • FMRMR — Former member who is in receipt of retired pay for non-regular service but who has been discharged from the Service and maintains no military affiliation

    • FMRDEC — A former member who qualified for retired pay for non-regular service at his or her sixtieth birthday, before his or her discharge from the Service, but died while in receipt of retired pay

    • GRD — National Guard (all categories)

    • GRDDEC — National Guard deceased

    • GRD-AD — Guard on extended active duty for more than 30 days

    • MH — Medal of Honor recipient

    • MH-DEC — Medal of Honor recipient deceased

    • OTHER — Non-DoD eligible beneficiaries (including credit union employees, and other civilians employed in support of U.S. forces overseas, who are authorized benefits and privileges)

    • PDRL — Retired member, on the Permanent Disability Retired List (PDRL)

    • PR-APL — Prisoner or Appellate leave

    • RCL-AD — Recalled to active duty

    • RES — Reserve (all categories)

    • RES-AD — Reserve members on extended active duty for more than 30 days

    • RESDEC — Reserve deceased

    • RESRET — National Guard and Reserve members who retire, but are not entitled to retired pay until age 60

    • RET — Retired member entitled to retired pay

    • RETDEC — Deceased retired member entitled to retired pay. Code applies to active duty retired, Retired Reserve beginning on their 60th birthday, the TDRL, and the PDRL.

    • SSB — Special Separation Benefits (SSB) recipient member with 120 days medical benefits (CHAMPUS/TRICARE and MTF)

    • TDRL — Retired member, on the TDRL

    • TA-RES — Selected Reserve Transition Assistance Management Program members and their eligible dependents

    • TA-30 — Involuntarily separated member of Reserve or Guard Component entitled to 30 days medical benefits (CHAMPUS/TRICARE and MTF)

    • TA-60 — Involuntarily separated member with 60 days medical benefits (CHAMPUS/TRICARE and MTF)

    • TA-120 — Involuntarily separated member with 120 days medical benefits (CHAMPUS/TRICARE and MTF)

    • TA-180 — Involuntarily separated member with 180 days medical benefits (CHAMPUS/TRICARE and MTF).

    • VSI — Voluntary Separation Incentive (VSI) recipient with 120 days medical benefits (CHAMPUS/TRICARE and MTF)

      •  

      1. ORGANIZATION

      Enter the code of your organization, branch, or service.

       

      Refer to the codes below.

    • USA — U.S. Army

    • USAF — U.S. Air Force

    • USN — U.S. Navy

    • USMC — U.S. Marine Corps

    • USCG — U.S. Coast Guard

    • USPHS — U.S. Public Health Service

    • NOAA — National Oceanic and Atmospheric Administration

    • DoD — Department of Defense

    • FED — Employee of an Agency other than DoD

    • OTHER — Used when the sponsor/employee is not affiliated with one of the uniformed services listed above 

      •  

      1. PAY GRADE

      Enter the code of your pay grade.

       

      Refer to the codes below.

    • El-E9 — Enlisted pay grades 1 through 9

    • W1-W5 — Warrant officer pay grades 1 through 5

    • STDT — Academy and/or Navy OCS student (ENTER PAY GRADE IF STDT RECEIVING PAY)

    • 001-011 — Officer pay grades 1 through 11 (011 is reserved)

    • GS01-GS18 — Federal employees with General Schedule pay grades

    • NF1-NF6 — Federal employees with Nonappropriated Fund pay grades

    • OTHER — Other (non-uniformed service) pay grades not defined above, to include all contractors

    • N/A — Not applicable. Use this code with the Block 4 status codes of “FMRMR” or FMRDEC”

      •  

      1. GEN. CAT

      Do not enter anything on this item. The DEERS or RAPIDS will automatically generate your Geneva Convention Category (GEN. CAT).

       

      1. CITIZENSHIP

      Enter your country name abbreviation for your citizenship.

       

      1. DATE OF BIRTH

      Enter your birthdate.

       

      1. PLACE OF BIRTH

      Enter your birthplace.

       

      1. CURRENT HOME ADDRESS

      Enter your current home address.

       

      1. CITY

      Enter your city.

       

      1. STATE

      Enter your state.

       

      1. ZIP CODE

      Enter your ZIP code.

       

      1. COUNTRY

      Enter your country.

       

      1. PRIMARY E-MAIL ADDRESS

      Enter your primary email address. Then, mark the box if you permit the use of your email address for benefits notification.

       

      1. TELEPHONE NUMBER

      Enter your telephone number.

       

      1. CITY OF DUTY LOCATION

      Enter the city of your duty location.

       

      1. STATE OF DUTY LOCATION

      Enter the state of your duty location.

       

      1. COUNTRY OF DUTY LOCATION

      Enter the country of your duty location.

       

      SECTION II — SPONSOR/EMPLOYEE DECLARATION AND REMARKS

       

      1. REMARKS

      Enter your remarks, then attach supplementary documents if applicable.

       

      1. SIGNATURE

      Enter your signature.

       

      1. DATE SIGNED

      Enter the date upon signing Form DD 1172-2.

       

      SECTION III — AUTHORIZED BY

      This section is for DoD sponsor's use only.

       

      1. SPONSORING OFFICE NAME

      Enter the name of the office where the employee is working or has worked.

       

      1. CONTRACT NUMBER

      Enter the contract number of the employee.

       

      1. SPONSORING OFFICE ADDRESS

      Enter the sponsoring office address.

       

      1. SPONSORING OFFICE TELEPHONE NUMBER

      Enter the sponsoring office telephone number.

       

      1. OFFICE EMAIL ADDRESS

      Enter the office email address of the employee if applicable.

       

      1. OVERSEAS ASSIGNMENT

      Enter the country of assignment of the employee.

       

      1. OVERSEAS ASSIGNMENT BEGIN DATE

      Enter the effective date of the employee for the overseas assignment.

       

      1. OVERSEAS ASSIGNMENT END DATE

      Enter the end date of the employee for the overseas assignment.

       

      1. ELIGIBILITY EFFECTIVE DATE

      Enter the effective date of the employee's qualifying status.

       

      1. ELIGIBILITY EXPIRATION DATE

      Enter the expiration date of the employee's qualifying status.

       

      1. SPONSORING OFFICIAL NAME

      Enter the name of the sponsoring official.

       

      1. UNIT/ORGANIZATION NAME

      Enter the unit or organization name of the sponsoring official.

       

      1. TITLE

      Enter the title of the sponsoring official.

       

      1. PAY GRADE

      Enter the pay grade of the sponsoring official.

       

      1. SIGNATURE

      Enter the signature of the sponsoring official.

       

      1. DATE VERIFIED

      Enter the date upon signing Form DD 1172-2.

       

      SECTION IV — VERIFIED BY

      This section is for the personnel at the ID Card office or the verifying official's use only.

       

      1. VERIFYING OFFICIAL NAME

      Enter the name of the verifying official.

       

      1. SITE IDENTIFICATION

      Enter the 6-digit site ID of the verifying official.

       

      1. TELEPHONE NUMBER

      Enter the office or business telephone number of the verifying official.

       

      1. SIGNATURE

      Enter the signature of the verifying official.

       

      SECTION V — DEPENDENT INFORMATION

      For A and B, enter your dependent or dependents' information.

       

      A.

       

      1. NAME

      Enter the name of your dependent.

       

      1. GENDER

      Enter the gender of your dependent. Enter F for females. Enter M for males.

       

      1. DATE OF BIRTH

      Enter the birthdate of your dependent.

       

      1. RELATIONSHIP

      Enter the code of your relationship with the dependent.

       

      Refer to the codes below.

    • CH — Child

    • DB — DoD Beneficiary

    • FC — Foster Child

    • PAR — Parent

    • PL — Parent-in-law

    • PACH — Pre-adoptive Child

    • SP — Spouse

    • SC — Stepchild

    • STP — Stepparent

    • SPL — Stepparent-in-law

    • UMW — Unmarried Widow(er)

    • URW — Unremarried Widow(er)

    • WARD — Ward

      •  

      1. SSN OR DOD ID NO.

      Enter the SSN or DoD ID number of your dependent.

       

      1. CURRENT HOME ADDRESS

      Enter the current home address of your dependent.

       

      1. PRIMARY E-MAIL ADDRESS

      Enter the primary email address of your dependent.

       

      1. TELEPHONE NUMBER

      Enter the telephone number of your dependent.

       

      1. CITY

      Enter the city of your dependent.

       

      1. STATE

      Enter the state of your dependent.

       

      1. ZIP CODE

      Enter the ZIP code of your dependent.

       

      1. COUNTRY

      Enter the country of your dependent.

       

      1. ELIGIBILITY EFFECTIVE DATE

      Enter the effective date of the dependent's qualifying status.

       

      1. ELIGIBILITY EXPIRATION DATE

      Enter the expiration date of the dependent's qualifying status.

       

      58-71

      Enter your second dependent's information.

       

      If you have more than two dependents, you may attach additional pages to Form DD 1172-2.

       

      SECTION VI — RECEIPT

       

      1. SIGNATURE

      Enter the signature of the card recipient.

       

      1. DATE ISSUED

      Enter the date when the card recipient has signed Form DD 1172-2.

    Table of Contents
    Fillable Form DD 1172-2