DA Form 3283 "Statements of Member Removed From the Temporary Disability Retired List"

What Is DA Form 3283?

This is a military form that was released by the U.S. Department of the Army (DA) on January 1, 2004. The form, often mistakenly referred to as the DD Form 3283, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

  • A 1-page document available for download in PDF;
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Download an up-to-date fillable DA Form 3283 down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 3283 "Statements of Member Removed From the Temporary Disability Retired List"

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DATE (YYYYMMDD)
STATEMENTS OF MEMBER
REMOVED FROM THE TEMPORARY DISABILITY RETIRED LIST
For use of this form, see AR 601-210; the proponent agency is DCS, G-1
I have been advised of my entitlement to be permanently retired/seperated
upon my removal from the Temporary Disability Retired List as provided
for under Sections 1201/1203, Title 10, United States Code.
I hereby waive my present entitlement to disability retirement/separation
compensation for the purpose of continuing on USAR duty despite my
physical disability.
I understand that at the time of my ultimate retirement/separation, my
disqualifying defect will be reevaluated under the physical standards in
effect at the time of the determination of the disqualifying defect and
under the standards in effect at the time of the evaluation. My
separation/retirement will proceed under standards which are most
advantageous to me. In voluntarily enlisting this date, I am aware that,
dependent upon my retention qualifications and the requirements of the
Service, it may be necessary to effect my retirement/separation prior to
the completion of the period for which I have enlisted.
TYPED NAME, GRADE, AND SSN OF MEMBER
SIGNATURE
Replaces DA Form 3283-R, Jan 1975, which is obsolete.
DA FORM 3283, JAN 2004
APD LC v2.00ES
DATE (YYYYMMDD)
STATEMENTS OF MEMBER
REMOVED FROM THE TEMPORARY DISABILITY RETIRED LIST
For use of this form, see AR 601-210; the proponent agency is DCS, G-1
I have been advised of my entitlement to be permanently retired/seperated
upon my removal from the Temporary Disability Retired List as provided
for under Sections 1201/1203, Title 10, United States Code.
I hereby waive my present entitlement to disability retirement/separation
compensation for the purpose of continuing on USAR duty despite my
physical disability.
I understand that at the time of my ultimate retirement/separation, my
disqualifying defect will be reevaluated under the physical standards in
effect at the time of the determination of the disqualifying defect and
under the standards in effect at the time of the evaluation. My
separation/retirement will proceed under standards which are most
advantageous to me. In voluntarily enlisting this date, I am aware that,
dependent upon my retention qualifications and the requirements of the
Service, it may be necessary to effect my retirement/separation prior to
the completion of the period for which I have enlisted.
TYPED NAME, GRADE, AND SSN OF MEMBER
SIGNATURE
Replaces DA Form 3283-R, Jan 1975, which is obsolete.
DA FORM 3283, JAN 2004
APD LC v2.00ES