DD Form 1172-2 "Application for Identification Card/DEERS Enrollment"

What Is DD Form 1172-2?

DD Form 1172-2, Application for Identification Card/DEERS Enrollment is a form issued by the Department of Defense (DoD) and used for applying for a variety of Army identification cards, enrolling an individual into the Defense Enrollment Eligibility Reporting System (DEERS) database, or when updating an existing DEERS record.

The DD 1172-2 is often incorrectly referred to as the DD Form 1172 or DA Form 1172. The application - sometimes called the DD 1172 DEERS Form - is used to request a DD Form 2, a DD Form 1173, a DD Form 1173-1, a DD Form 2764, a DD Form 2765, and a Common Access Card (CAC) for eligible individuals.

The DD Form 1172-2 version released on April 1, 2020, is up-to-date and in use today: all previous editions are obsolete and should not be used. A fillable version of the application can be acquired through the chain of command, downloaded from the DoD documentation website, or found down below.

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DD Form 1172-2 Instructions

The DD 1172-2 Form is divided into six sections. These sections provide information about the employee or sponsor, sponsoring agency, and benefits eligibility. All the information being input must be valid and accurate. The penalty for false claims or statements is a fine of up to $10,000, a prison sentence of up to five years or both.

  1. Section I is filled by the applicant and contains personal identifying information including the name, social security number, gender, pay grade, status, and detailed contact information of the individual.
  2. Section II requires additional information regarding the current assignment and the benefits the individual is eligible for and is completed by the applicant or their department or agency.
  3. Section III contains all details and lists contact information regarding the applicant's sponsoring group or agency. This part provides details about the applicant's position and assignment and further information about the sponsoring official: their name, pay grade, and title. The section is then signed by a qualified official for authorization. All personal and contact information about any dependents is listed in the fourth section of the DD 1172-2. The standard form allows listing two individuals.
  4. The applicant must then acknowledge the receipt of their ID Card in Section V.

A copy of the DD Form 1172-2 must be kept on hand for further reference or to use when filing amended DD 1172-2 Forms in the future.

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Download DD Form 1172-2 "Application for Identification Card/DEERS Enrollment"

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OMB No. 0704-0415
APPLICATION FOR IDENTIFICATION CARD/DEERS ENROLLMENT
OMB approval expires
Please read Agency Disclosure Notice, Privacy Act Statement, and Instructions prior to completing this form.
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
17. TELEPHONE NUMBER
18. CITY OF DUTY LOCATION
19. STATE OF
20. COUNTRY OF DUTY LOCATION
Permission to use for benefits notifications
(Include Area Code/DSN)
DUTY LOCATION
SECTION II - SPONSOR/EMPLOYEE DECLARATION AND REMARKS
NOTARY SIGNATURE
21. REMARKS (Cite legal documentation, as applicable.)
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
31. OVERSEAS ASSIGNEMENT
32. ELIGIBILITY EFFECTIVE DATE
33. ELIGIBILITY EXPIRATION DATE
BEGIN DATE (YYYYMMDD)
END DATE (YYYYMMDD)
(YYYYMMDD)
(YYYYMMDD)
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
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.
40. VERIFYING OFFICIAL NAME (Last, First, Middle Initial)
41. SITE IDENTIFICATION
42. TELEPHONE NUMBER
43. SIGNATURE
(Include Area Code/DSN)
SECTION V - DEPENDENT INFORMATION (Attach additional pages if necessary)
45. GENDER
47. RELATIONSHIP
48. SSN OR DoD ID NO.
44. NAME (Last, First, Middle)
46. DATE OF BIRTH (YYYYMMDD)
Permission to use for benefits
50. PRIMARY EMAIL
51. TELEPHONE NUMBER
49. CURRENT HOME ADDRESS
notifications (18 and above)
A
ADDRESS
(Include Area Code/DSN)
52. CITY
53. STATE
54. ZIP CODE
55. COUNTRY
56. ELIGIBILITY EFFECTIVE DATE
57. ELIGIBILITY EXPIRATION DATE
(YYYYMMDD)
(YYYYMMDD)
58. NAME (Last, First, Middle)
59. GENDER
60. DATE OF BIRTH (YYYYMMDD)
61. RELATIONSHIP
62. SSN OR DoD ID NO.
Permission to use for benefits
63. CURRENT HOME ADDRESS
64. PRIMARY EMAIL
65. TELEPHONE NUMBER
notifications (18 and above)
B
ADDRESS
(Include Area Code/DSN)
66. CITY
67. STATE
68. ZIP CODE
69. COUNTRY
70. ELIGIBILITY EFFECTIVE DATE
71. ELIGIBILITY EXPIRATION DATE
(YYYYMMDD)
(YYYYMMDD)
SECTION VI - RECEIPT
Receipt of new card is acknowledged.
72. SIGNATURE
73. DATE ISSUED (YYYYMMDD)
This form is valid for issue of DoD ID Card for 90 days
DD FORM 1172-2, APRIL 2020
PREVIOUS EDITION IS OBSOLETE.
from date of verification.
OMB No. 0704-0415
APPLICATION FOR IDENTIFICATION CARD/DEERS ENROLLMENT
OMB approval expires
Please read Agency Disclosure Notice, Privacy Act Statement, and Instructions prior to completing this form.
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
17. TELEPHONE NUMBER
18. CITY OF DUTY LOCATION
19. STATE OF
20. COUNTRY OF DUTY LOCATION
Permission to use for benefits notifications
(Include Area Code/DSN)
DUTY LOCATION
SECTION II - SPONSOR/EMPLOYEE DECLARATION AND REMARKS
NOTARY SIGNATURE
21. REMARKS (Cite legal documentation, as applicable.)
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
31. OVERSEAS ASSIGNEMENT
32. ELIGIBILITY EFFECTIVE DATE
33. ELIGIBILITY EXPIRATION DATE
BEGIN DATE (YYYYMMDD)
END DATE (YYYYMMDD)
(YYYYMMDD)
(YYYYMMDD)
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
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.
40. VERIFYING OFFICIAL NAME (Last, First, Middle Initial)
41. SITE IDENTIFICATION
42. TELEPHONE NUMBER
43. SIGNATURE
(Include Area Code/DSN)
SECTION V - DEPENDENT INFORMATION (Attach additional pages if necessary)
45. GENDER
47. RELATIONSHIP
48. SSN OR DoD ID NO.
44. NAME (Last, First, Middle)
46. DATE OF BIRTH (YYYYMMDD)
Permission to use for benefits
50. PRIMARY EMAIL
51. TELEPHONE NUMBER
49. CURRENT HOME ADDRESS
notifications (18 and above)
A
ADDRESS
(Include Area Code/DSN)
52. CITY
53. STATE
54. ZIP CODE
55. COUNTRY
56. ELIGIBILITY EFFECTIVE DATE
57. ELIGIBILITY EXPIRATION DATE
(YYYYMMDD)
(YYYYMMDD)
58. NAME (Last, First, Middle)
59. GENDER
60. DATE OF BIRTH (YYYYMMDD)
61. RELATIONSHIP
62. SSN OR DoD ID NO.
Permission to use for benefits
63. CURRENT HOME ADDRESS
64. PRIMARY EMAIL
65. TELEPHONE NUMBER
notifications (18 and above)
B
ADDRESS
(Include Area Code/DSN)
66. CITY
67. STATE
68. ZIP CODE
69. COUNTRY
70. ELIGIBILITY EFFECTIVE DATE
71. ELIGIBILITY EXPIRATION DATE
(YYYYMMDD)
(YYYYMMDD)
SECTION VI - RECEIPT
Receipt of new card is acknowledged.
72. SIGNATURE
73. DATE ISSUED (YYYYMMDD)
This form is valid for issue of DoD ID Card for 90 days
DD FORM 1172-2, APRIL 2020
PREVIOUS EDITION IS OBSOLETE.
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.
This form is valid for issue of DoD ID Card for 90 days
DD FORM 1172-2, APRIL 2020
PREVIOUS EDITION IS OBSOLETE.
from date of verification.
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