Form DA 4187 Personnel Action

INSTRUCTIONS : PERSONNEL ACTION (DA Form 4187)

A DA Form 4187 is the United States Army’s form for requesting a personnel action. This form can be used for numerous personnel actions, so it is recommended that you have available as much information about your specific action before completing the form.

The DA Form 4187 is available on the United States Army website or can be supplied by the U.S. Army personnel division administering the physical fitness test.

Section I requires the basic soldier identification information who is requesting the personnel action.

1. You must identify the solider with their name, rank, and social security number.

If the soldier is having a change of duty, then Section II must be filled out.

2. You must supply the soldier’s former duty, new duty, and the effective date and time the change and duty will take place.

If a different personnel action request is being made, then it must be checked off in Section III.

3. You can request more than one personnel action on a single DA Form 4178.

4. Check the appropriate personnel action for which you are requesting. If your request does not appear as an option, you will need to write the request in the “other” column and give a description.

5. Sign and date Section III.

In Section IV, you may provide any remarks regarding your request.

6. In drafting your remarks, it is important that you provide a reason for the request and supply as much information as will be helpful for the deciding department of officer who will make the decision.

Finally, in Section V, your request must supply a certification and also have a recommendation from a commanding officer or authorized representative.

7. The authorized representative can either provide verification, a recommendation, or approval regarding the soldier’s request.

8. The authorized representative then must sign the DA Form 4178 before the form can be sent to the appropriate agency or department.

Form DA 5500 Body Fat Content Worksheet

INSTRUCTIONS : BODY FAT CONTENT WORKSHEET (DA Form 5500)

A DA Form 5500 is a United States Army form used to record the body fat of a male military member. The form is used for evaluating soldiers who are enrolled in the Army Weight Control Program and is filed to detail their body fat through their progression in the program.

The DA Form 5500 is available on the United States Army documentation website or can be supplied through the Army chain of command.

The first lines require only the name and rank of the soldier for whom the form is for.

1. Additionally, you must include the current height, weight, and age of the military member.

Next, the military member must be tested for body fat, using the fat content guidelines.

2. The guidelines can be found in Army Regulation 600-9.

3. The Army member must be measured around the abdomen at the level of the naval and then measured at the neck around the larynx.

4. These measurements must be made 3 times with the average measurement recorded in the final box.

The final averages of the two measurements types must be recorded in boxes 3 and 4.

5. The circumference value of boxes 3 and 4 must be entered in box 5.

6. The height of the Army member is to be written in inches on box 6.

Using the chart supplied with the form, compare the circumference value and height on the grid that corresponds to the body fat percentage.

7. Record the body fat percentage in box 7.

Any additional remarks can be written in the box below the recorded values.

8. In the next corresponding box, the testing individual should check whether the Army member is in compliance with Army body fat standards or not in compliance with such standards.

Finally, the preparer of the DA Form 5500 must provide their name, rank, and date while a supervisor likewise approves the Form 5500.

Form VA 22-1990 Application for VA Education Benefits

INSTRUCTIONS : APPLICATION FOR VA EDUCATION BENEFITS (VA Form 22-1990)

A VA Form 22-1990 is the Department of Veteran Affairs form for applying for education benefits. This form is used for applying for the various GI Bill educational funds, reserve educational assistance program, and post-Vietnam era educational assistance program provided to military veterans.

The VA Form 22-1990 is available on the Department of Veteran Affairs website or can be supplied by the Veteran Affairs office near you.

Part I requires the basic veteran identification information who is applying for the education benefits.

1. You must your name, social security number, address, phone number, and direct deposit information for your educational funds.

2. You must also provide the name and contact information for someone who will know where to contact you.

Part II asks you to identify the education benefits for which you are applying.

3. If you are unsure of which benefits you may be eligible, the VA Form 22-1990 also comes with instructions which provide basic information on the different types of education benefits and the qualifying criteria.

Part III requires that you identify the education type you plan on using the educational funds for.

4. Your selection in this section must match with the type of funds you are applying for in Section II. If you are unsure of which funds to apply for, check with the instructions or contact the Veteran Affairs office for assistance.

Part IV requires that you provide a history of your military service and all specific details pertaining to your service.

5. You must provide the dates you were active, the service area, your current status, and your active duty history.

Part V requires that you provide all of your education and non-military employment.

6. Supply as much detail about your education and employment history. If you need more space, you can attach additional information with your VA Form 22-1990.

In Part VI, you must provide any additional entitlements you are receiving from your military service.

7. This can include multiple sources of entitlements, such as scholarships, kickers, or other forms of financial aid. Check with your school to ensure that you include all amounts that are required in this section.

Part VIII requires you identify your marital status and whether you are responsible for any dependents.

Once your VA Form 22-1990 is completed, you must submit it to your regional Veterans Affairs office, which are listed on the instructions.

Form DA 7566 Composite Risk Management Worksheet

INSTRUCTIONS : COMPOSITE RISK MANAGEMENT WORKSHEET (Form DA 7566)

A DA Form 7566 is a United States Army form used to record the composite risk management worksheet. It is used for documenting all on duty and off duty risks that arise during any scheduled events, whether involving military training or non-training exercises.

The DA Form 7566 is available on the United States Army documentation website or can be supplied through the Army chain of command.

The first boxes require the general information about the event.

1. Ensure that you include the type of event or task in box 1, followed by the time of the event in boxes 2 and 3, then putting the date you are preparing the DA Form 7566.

2. In box 4, you must put your name, followed by your rank and position.

Box 5 begins the spaces provided for naming the subtasks of the event, followed by the boxes used for risk assessment.

3. You must include in box 6 the hazards faced by the event, followed by the level of risk, controls, and supervision plans that will be implemented during the event.

4. In box 12, you must make a determination if the controls and supervision were adequate and effective in suppressing the hazards.

5. Should there be more than 6 sub tasks for your event, more space is provided on a second page, which can serve as an addendum for additional tasks of the event.

Once the risks are assessed, box 13 requires you to provide the overall risk level of the tasks after the controls have been put in place.

6. You may indicate the task has risk levels of low, moderate, high, or extreme.

Finally, the risk decision authority must sign off on the DA Form 7566 before it can be recorded and kept in the proper recording place.

Form VA 26-1880Request for a Certificate of Eligibility

INSTRUCTIONS : REQUEST FOR A CERTIFICATE OF ELIGIBILITY (VA Form 26-1880)

A VA Form 26-1880 is the Department of Veteran Affairs form for requesting a certificate of eligibility for the VA Home Loan Program. The form needs to be filled out before any loan can be processed through the VA Home Loan Program.

The VA Form 26-1880 is available on the Department of Veteran Affairs website or can be supplied by the Veteran Affairs office near you.

Boxes 1 through 8 require you personal identification information.

1. The veteran's name, date of birth, social security number, and contact information must be provided in order to process your VA Form 26-1880.

2. You must provide information about any disability that may have caused your discharge from the military.

Box 9 requires that you provide your military service history.

3. You must provide all active service and reserve service dates, ranks, and service numbers. If you need additional space, you may provide an attached paper listing all of your service history.

Boxes 10 through 13 require all information for previously VA loans you have applied for or received.

4. If this is the first time applying for a Veterans Affairs loan, you can indicate so in the boxes provided and you may leave the date sections blank.

5. You must list all VA home loans that you have received for purchasing, remodeling, or refinancing your home. If you are unsure of the status of previous loans, contact the local Veterans Affairs office for help.

Finally, you must certify the VA Form 26-1880 with your signature and date.

6. You must send in your VA Form 26-1880 to the provided address on the top of the form.

7. Veterans Affairs will contact you shortly in regards to your loan status. If your application is insufficient, your form will be returned to you with instructions on completing the form.

Form VA 10-2850c Application for Associated Health Occupations

INSTRUCTIONS : APPLICATION FOR ASSOCIATED HEALTH OCCUPATIONS (VA Form 10-2850c)

A VA Form 10-2850c is a United States Department of Veteran Affairs form used for the application for employment in the associated health occupations.

The VA Form 10-2850c is available on the Veterans Affairs documentation website or can be supplied through a local Veterans Affairs office.

The first box is used to identify the position for which you are applying.

1. Select the position for which you are applying. If the position is not one of the named options, select “other” and write in the position in the box.

Boxes 2 through 12 are used for your personal identification information.

2. Fill in the appropriate boxes with your name, address, contact information, date of birth, social security number, citizenship, and past applications with the Veterans Affairs Department.

In Section I, box 13, identify whether you are currently or have ever been on active military duty.

3. If you have never been on active duty, leave these boxes blank.

Section II is to be used to identify all licenses or certifications that you hold.

4. In boxes 14 through 17, you must indicate all licenses that you currently hold or have held in the past. Do not leave out any certifications. If you need additional space for your list, attach them as an addendum at the end of the application.

Do not fill in information in Section III, this is for use only by the reviewing agency.

If you have any current or previous professional liability insurance, you must identify the carrier in Section IV and state whether your insurance has ever been canceled.

5. If you have had professional liability insurance canceled or denied, you must write a brief explanation on a separate sheet and attach it at the end of the VA Form 10-1850c.

In Sections V and VI, you must give a complete description of your education history and professional experience.

Sections VII and VIII are to be used for additional information and professional references.

6. Make sure to include all publications, papers and honors as they will help your application through the evaluation process.

Items 28 through 37 are general questions for employment with the federal government, for which you must supply yes or no answers.

Finally, certify the VA Form 10-2850c with your signature and submit it to the proper office for processing.

Form DA 2823 Sworn Statement

INSTRUCTIONS : SWORN STATEMENT (DA Form 2823)

A DA Form 2823 is a United States Army form for a sworn statement used for a variety of purposes. Sworn statements may be taken in documenting informal events or recording evidence for a formal investigation. The information taken on this form can be provided to non-military law enforcement agencies.

The DA Form 2823 is available on the United States Army documentation website or can be supplied through the Army chain of command.

The army personnel filing this form must first put the general information surrounding the investigation.

1. The location, date, time, and file number must be placed in boxes 1 through 4 in order to properly file the form and to ensure that it is properly documented under Army regulations.

Boxes 5 through 8 are used to identify the party that is giving the sworn statement.

2. The party giving the statement must provide on the document their name, social security number, their rank, and contact information.

Once this basic identifying information has been provided, the party giving the statement must write their name in box 9.

3. By putting their name in box 9, the party is swearing under oath that the statement is accurate and truthful. Failure to provide truthful information can lead to disciplinary action taken.

Box 9 should be filled out using the words of the declaring party.

4. Box 9 can be written by the swearing party or it can be written word for word by another party taking the statement.

5. It is highly important that the statement is neatly written so as to be understood by any other parties that may use the statement.

6. Should the statement not fit on the pages provided, the second page is available. If the provided pages do not support enough space, copies of the second page can be used as additional pages.

7. These additional pages must be identified and initialed by the party giving the statement.

Once the statement has been recorded and all signatures and initials placed in the proper boxes, the person making the statement must provide the affidavit on the final page of the DA Form 2823.

8. Witnesses must be present during the statement and must sign off on the affidavit.

9. Likewise, the party taking the statement must sign off on the DA Form 2823

Form VA 21-4142 Authorization and Consent to Release Information to the Department of Veterans Affairs

INSTRUCTIONS : AUTHORIZATION AND CONSENT TO RELEASE INFORMATION TO THE DEPARTMENT OF VETERANS AFFAIRS (VA) (VA Form 21-4142)

A VA Form 21-4142 is a United States Department of Veteran Affairs form used to authorize and provide consent for the release of medical information to the VA. This form must be on file before Veterans Affairs can review any medical or disability claims.

The VA Form 21-4142 is available on the Veterans Affairs documentation website or can be supplied through a local Veterans Affairs office.

The first Section is used for general identification information

1. Boxes 1, 2 and 4 are to be filled out with the veteran's name, file number, and social security number. These boxes must be filled in.

2. If a claimant other than the veteran is seeking benefits on behalf of the veteran, they must provide their name, relationship, and social security number in boxes 3, 5, and 6.

In Section II, you must identify all sources of medical information for which you are allowing Veterans Affairs to have.

3. You must include the name and addresses of all offices for which your medical or disability claim involves. You must also include the dates and conditions or illnesses for which you were treated.

4. In box 8, provide any additional comments about your consent that will be helpful for Veterans Affairs to seek your medical history and to view them.

Section III provides all of the important privacy information that the Department of Veterans Affairs will be held.

5. Read all of the information and check the authorization box in box 9c.

In box 10, the veteran, the claimant, or a legal representative must certify with their signature their consent of the Va Form 21-4142.

6. Provide your contact information including address and phone numbers. This is important as Veterans Affairs may need to contact you in regards to this form and to further obtain your consent for additional information they need for processing your claims.

In box 11, it is important that you have a witness sign and date the form. While this is not necessary for all medical records, Veterans Affairs may need a witness statement when seeking some of your records.

Once completed, your VA Form 21-4142 is ready for submission to Veterans Affairs. Keep a copy on record, as you may need to submit additional consent forms if you make additional claims.

Form DA 3161 Request for Issue or Turn-in

INSTRUCTIONS : REQUEST FOR ISSUE OR TURN-IN (DA Form 3161)

A DA Form 3161 is a United States Army form for a request for issue or turn in. The form is used for detailing supplies that are to be turned in or are being issued to a certain party.

The DA Form 3161 is available on the United States Army documentation website or can be supplied through the Army chain of command.

The party who is filing the DA Form 3161 must first identify whether the sheet is being used to report a turn in or an issue.

1. Check the appropriate box that corresponds to the use of this form.

Next you must supply all of the general information surrounding the request.

2. You must identify the request number and voucher number in boxes 1 and 2.

3. Boxes 3 through 9 will identify who the materials are being sent to, the date they are required, priority and authorizations, and all identifying information about the items to be issued or turned in.

Next, box 12 must be completed, which verifies all of the specific information about the items to be disbursed or turned in.

4. You must provide Item numbers, stock numbers, descriptions, quantities, codes, prices and cost for each individual item that is to be covered by your DA Form 3161.

5. All of the numbered quantities and costs must be added and totaled at the bottom of box 12.

Finally, the DA Form 3161 must be signed by the authorizing party, with all supply chain officers involved signing off on the issuance or turn in of the named supplies in the form.

6. A copy of the form should be kept for record keeping purposes, in order to assure that all items are accounted for and properly issued through the supply chain.

DD Form 577 Appointment Termination Record

INSTRUCTIONS : APPOINTMENT/TERMINATION RECORD (DD Form 577)

A DD Form 577 is a Department of Defense form is used for recording appointments and terminations of an officer in military or governmental functions. The form is used to identify and inform the officer of the appointment or the elimination of the appointment.

The DD Form 577 is available on the Department of Defense documentation website or can be supplied through the chain of command.

The first section of the DD Form 577 is to be filled out by the appointing authority.

1. The appointing authority must state the appointing official’s name and title in boxes 1 and 2.

2. In box 3, the appointing authority will identify itself with their Department of Defense component or organization name.

3. The appointing official will sign and date the form in boxes 4 and 5.

4. In section II, the appointing authority will identify the individual being appointed and provide their information, taken from Department of Defense records.

5. Boxes 6 through 11 must contain the name and contact information of the appointed officer. Their name, social security number, organization, title, address and telephone number should be filled in the appropriate boxes.

6. The appointing authority will indicate the date of appointment in box 12.

7. In boxes 13 and 14, the appointing authority will describe the position and the duties that will come with the appointment.

8. After sections I and II are filled out by the appointing authority, the DD Form 577 is to be given to the appointed official, who must acknowledge the appointment, signing boxes 16 and 17.

9. If or when the appointment terminates, the appointing authority can use the filed DD Form 577 and fill in the termination information in Section IV, revoking the appointment. Once revoked, the completed form must be provided to the appointed official to inform him or her of the termination of appointment.

Military

DD FORM 2813 Active Duty Reserve Forces Dental Examination

Form DA 2166-8-1 NCOER Counseling and Support