DD Form 2168 Application for Discharge of Member or Survivor of Member of Group Certified to Have Performed Active Duty With the Armed Forces of the United States

What Is DD Form 2168?

DD Form 2168, Application for Discharge of Member or Survivor of Member of Group Certified to Have Performed Active Duty with the Armed Forces of the United States is used to assist the Secretaries of the Armed Forces in determining if the applicant has ever performed active military service and in issuing a certificate of service after an affirmative finding.

The form was last released by the Department of Defense (DoD) in April 2010. The most recent DD Form 2168 fillable version can be downloaded through the link below.

Information on the DD 2168 can be released to the applicant's civilian employer, contractual group or the Department of Homeland Security to obtain support for a claim. The provided information may be disclosed to the Department of Veterans Affairs (VA) for purposes of determining eligibility for benefits.

Use the information below to determine where to send the DD Form 2168 if using it as proof of service when claiming benefits:

  1. If the applicant was employed at the U.S. Army Transport Service (ATS) they must send their paperwork to the Commander at the U.S. Army Human Resources Command Department 420 Ft. Knox, KY 40122-5402 ATTN: AHRC-PDR;
  2. If the alleged service was employment for the Naval Transportation Service the applicant must send their forms to the Commander at the U.S. Navy Personnel Command (PERS-312) 5720 Integrity Drive Millington, TN 38054-5045;
  3. If the applicant was allegedly employed at the War Shipping Administration or the Office of Defense Transportation they must send their paperwork to the National Maritime Center (ATTN: Records Management Branch (NMC-41) 100 Forbes Drive Martinsburg, WV 25404 Phone: (888) 427-5662).
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APPLICATION FOR DISCHARGE OF MEMBER OR SURVIVOR OF MEMBER
OF GROUP CERTIFIED TO HAVE PERFORMED ACTIVE DUTY
OMB No. 0704-0100
WITH THE ARMED FORCES OF THE UNITED STATES
OMB approval expires
Jun 30, 2011
(Read Instructions on back before completing form.)
The public reporting burden for this collection of information is estimated to average 30 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, Executive Services Directorate, Information Management Division, 4800 Mark Center
Drive, Alexandria, VA 22350-3100 (0704-0100). 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. SEND COMPLETED FORM TO THE APPROPRIATE SERVICE ADDRESS
ON THE BACK OF THIS PAGE.
PRIVACY ACT STATEMENT
AUTHORITY: Public Law 95-202, Sec. 401, and EO 9397.
PRINCIPAL PURPOSE(S): To assist the Secretaries of the Armed Forces in determining if applicant was member of a group which has been found to have performed
active military service, and, after an affirmative finding as to the applicant, to assist the Secretary of an Armed Force in issuing an appropriate certificate of service.
ROUTINE USE(S): The information may be released to the civilian employer or contractual group or the Department of Homeland Security (for Coast Guard applicants)
to support the member's claim. To the Department of Veterans Affairs to provide substantiation for benefit eligibility. To the Department of Justice in pending or potential
litigation to which the record is pertinent.
DISCLOSURE: Voluntary; however, failure to provide identifying information may impede processing of this application. The use of Social Security Number is strictly to
assure proper identification of the individual and appropriate records.
I. GROUP MEMBER PERSONAL DATA
1.a. MEMBER'S NAME
2. SSN
3. DATE OF BIRTH
b. ALIAS(ES)
(Last, First, Middle and Maiden, if any)
(YYYYMMDD)
4.a. PRESENT STREET ADDRESS
b. CITY
c. COUNTY
d. STATE
e. ZIP CODE
(Incl. apartment number)
II. SERVICE GROUP DATA TO SUPPORT CLAIM
5. NAME OF GROUP SERVED WITH
6. IDENTIFICATION NO. 7. HIGHEST GRADE/RANK/RATING HELD
8. HIGHEST PAY GRADE
(or actual pay)
9. ENTRY INTO SERVICE
10. ACTUAL MILITARY SERVICE BEFORE/AFTER THIS SERVICE
a. DATE (YYYYMMDD)
b. PLACE (Include City and State of Military Installation)
a. DATES (YYYYMMDD)
b. DEPARTMENT(S)
12. GRADE/RANK/RATING
11. HOME OF RECORD AT TIME OF ENTRY
AT TIME OF ENTRY
a. STREET ADDRESS (Incl. apartment number)
b. CITY
c. COUNTY
d. STATE e. ZIP CODE
13. MILITARY INSTALLATION WHERE ORDERED TO REPORT
14. SPECIALTY JOB TITLE(S)
(Include City and State)
15. DECORATIONS, MEDALS, BADGES, COMMENDATIONS, CAMPAIGN RIBBONS AWARDED/AUTHORIZED
16. TERMINATION OF GROUP SERVICE
(Separation, Discharge, Resignation, etc.)
a. TYPE OF
d. SERVICE COMMAND
e. DATE SERVICE
b. REASON
c. STATION BASE/LOCATION
TERMINATION
AFFILIATION
TERMINATED (YYYYMMDD)
III. APPLICATION INFORMATION
Applicant must sign in the space provided. If the record in question is that of a person who is deceased or incompetent, legal proof of death or
incompetency must accompany this application. If the application is signed by the spouse, widow, widower, next of kin, or legal representative, give
relationship or status in the appropriate box below.
a. SPOUSE
c. WIDOWER
e. LEGAL REPRESENTATIVE
17. RELATIONSHIP TO
APPLICANT
b. WIDOW
d. NEXT OF KIN
f. OTHER (Specify)
(X one)
I MAKE THE FOREGOING STATEMENTS, AS PART OF MY CLAIM, WITH FULL KNOWLEDGE OF THE PENALTIES INVOLVED FOR
WILLFULLY MAKING A FALSE STATEMENT OR CLAIM. (U.S. Code, Title 18, Sec. 287, 1001, provides a penalty of not more than $10,000 fine or
not more than five years imprisonment or both.)
18. APPLICANT
d. DATE SIGNED
a. NAME (Last, First, Middle)
b. SSN
c. SIGNATURE
(YYYYMMDD)
f. TELEPHONE
e. MAILING STREET ADDRESS (Incl. apartment number)
CITY
STATE
ZIP CODE
(Include area code)
IV. DISCLOSURE OF INFORMATION
19. I hereby authorize the release of copies of any official records
b. DATE SIGNED
a. SIGNATURE
maintained by the National Personnel Records Center to the
(YYYYMMDD)
appropriate military personnel office (listed on the reverse side) for the
purpose of processing my application for discharge under
Public Law 95-202.
DD FORM 2168, APR 2010 (CORRECTED)
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional X
APPLICATION FOR DISCHARGE OF MEMBER OR SURVIVOR OF MEMBER
OF GROUP CERTIFIED TO HAVE PERFORMED ACTIVE DUTY
OMB No. 0704-0100
WITH THE ARMED FORCES OF THE UNITED STATES
OMB approval expires
Jun 30, 2011
(Read Instructions on back before completing form.)
The public reporting burden for this collection of information is estimated to average 30 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, Executive Services Directorate, Information Management Division, 4800 Mark Center
Drive, Alexandria, VA 22350-3100 (0704-0100). 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. SEND COMPLETED FORM TO THE APPROPRIATE SERVICE ADDRESS
ON THE BACK OF THIS PAGE.
PRIVACY ACT STATEMENT
AUTHORITY: Public Law 95-202, Sec. 401, and EO 9397.
PRINCIPAL PURPOSE(S): To assist the Secretaries of the Armed Forces in determining if applicant was member of a group which has been found to have performed
active military service, and, after an affirmative finding as to the applicant, to assist the Secretary of an Armed Force in issuing an appropriate certificate of service.
ROUTINE USE(S): The information may be released to the civilian employer or contractual group or the Department of Homeland Security (for Coast Guard applicants)
to support the member's claim. To the Department of Veterans Affairs to provide substantiation for benefit eligibility. To the Department of Justice in pending or potential
litigation to which the record is pertinent.
DISCLOSURE: Voluntary; however, failure to provide identifying information may impede processing of this application. The use of Social Security Number is strictly to
assure proper identification of the individual and appropriate records.
I. GROUP MEMBER PERSONAL DATA
1.a. MEMBER'S NAME
2. SSN
3. DATE OF BIRTH
b. ALIAS(ES)
(Last, First, Middle and Maiden, if any)
(YYYYMMDD)
4.a. PRESENT STREET ADDRESS
b. CITY
c. COUNTY
d. STATE
e. ZIP CODE
(Incl. apartment number)
II. SERVICE GROUP DATA TO SUPPORT CLAIM
5. NAME OF GROUP SERVED WITH
6. IDENTIFICATION NO. 7. HIGHEST GRADE/RANK/RATING HELD
8. HIGHEST PAY GRADE
(or actual pay)
9. ENTRY INTO SERVICE
10. ACTUAL MILITARY SERVICE BEFORE/AFTER THIS SERVICE
a. DATE (YYYYMMDD)
b. PLACE (Include City and State of Military Installation)
a. DATES (YYYYMMDD)
b. DEPARTMENT(S)
12. GRADE/RANK/RATING
11. HOME OF RECORD AT TIME OF ENTRY
AT TIME OF ENTRY
a. STREET ADDRESS (Incl. apartment number)
b. CITY
c. COUNTY
d. STATE e. ZIP CODE
13. MILITARY INSTALLATION WHERE ORDERED TO REPORT
14. SPECIALTY JOB TITLE(S)
(Include City and State)
15. DECORATIONS, MEDALS, BADGES, COMMENDATIONS, CAMPAIGN RIBBONS AWARDED/AUTHORIZED
16. TERMINATION OF GROUP SERVICE
(Separation, Discharge, Resignation, etc.)
a. TYPE OF
d. SERVICE COMMAND
e. DATE SERVICE
b. REASON
c. STATION BASE/LOCATION
TERMINATION
AFFILIATION
TERMINATED (YYYYMMDD)
III. APPLICATION INFORMATION
Applicant must sign in the space provided. If the record in question is that of a person who is deceased or incompetent, legal proof of death or
incompetency must accompany this application. If the application is signed by the spouse, widow, widower, next of kin, or legal representative, give
relationship or status in the appropriate box below.
a. SPOUSE
c. WIDOWER
e. LEGAL REPRESENTATIVE
17. RELATIONSHIP TO
APPLICANT
b. WIDOW
d. NEXT OF KIN
f. OTHER (Specify)
(X one)
I MAKE THE FOREGOING STATEMENTS, AS PART OF MY CLAIM, WITH FULL KNOWLEDGE OF THE PENALTIES INVOLVED FOR
WILLFULLY MAKING A FALSE STATEMENT OR CLAIM. (U.S. Code, Title 18, Sec. 287, 1001, provides a penalty of not more than $10,000 fine or
not more than five years imprisonment or both.)
18. APPLICANT
d. DATE SIGNED
a. NAME (Last, First, Middle)
b. SSN
c. SIGNATURE
(YYYYMMDD)
f. TELEPHONE
e. MAILING STREET ADDRESS (Incl. apartment number)
CITY
STATE
ZIP CODE
(Include area code)
IV. DISCLOSURE OF INFORMATION
19. I hereby authorize the release of copies of any official records
b. DATE SIGNED
a. SIGNATURE
maintained by the National Personnel Records Center to the
(YYYYMMDD)
appropriate military personnel office (listed on the reverse side) for the
purpose of processing my application for discharge under
Public Law 95-202.
DD FORM 2168, APR 2010 (CORRECTED)
PREVIOUS EDITION IS OBSOLETE.
Adobe Professional X
INSTRUCTIONS
1. Use typewriter or print information when completing this form. Submit in original copy only. Complete all
items. If the question is not appropriate, write "NONE." Attach all documentation available to support
information you enter on the form.
2. The burden of proof is on the applicant to show he or she was part of the group that provided the
recognized services. List all attachments or enclosures. Use plain bond paper for additional explanation, if
needed.
3. Include any supporting documents which support your claim. Supporting material may include, but is not
limited to, separation discharge certificates, mission orders, identification cards, contracts or personnel action
forms, employment record, education certificates, diplomas, pay vouchers, certificates or awards, casualty
information, and any other supporting evidence of membership and character of service performed.
4. The appropriate service will not provide counsel representation for applicant, nor will it defray cost of such
counsel under any circumstances.
5. In the event the service decides information provided by the applicant is incomplete, the application will be
returned without prejudicing later information.
MAIL COMPLETED APPLICATION TO THE APPROPRIATE ADDRESS BELOW:
ARMY:
US Army Resources Command
ATTN: AHRC-PDR-VIB
1600 Spearhead Division Avenue Dept 420
Fort Knox, KY 40122-5402
NAVY:
Navy Personnel Command
(PERS-312)
Millington, TN 38054-5045
MARINE CORPS:
Commandant of the Marine Corps (Code: MMSB-12)
2008 Elliot Road, Suite 222
Quantico, VA 22134-0001
AIR FORCE:
AFPC/DPSOS
550 C Street West, Suite 3
Randolph AFB, TX 78150-4713
COAST GUARD:
United States Coast Guard
National Maritime Center (NMC)
100 Forbes Dr.
Martinsburg, WV 25401
DD FORM 2168 (BACK), APR 2010 (CORRECTED)

Download DD Form 2168 Application for Discharge of Member or Survivor of Member of Group Certified to Have Performed Active Duty With the Armed Forces of the United States

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How to Fill out DD Form 2168?

Procedural guidelines and additional information can be found in the Army Regulation 15-34, Department of the Army Individual Service Review Board, released in July 2017.

DD Form 2168 instructions are as follows:

  1. The applicant has to provide their full name - including their maiden name, if any - in Box 1. This section of the form also requires listing all aliases, the applicant's Social Security number, date of birth, current address (including ZIP code) and an apartment number;
  2. The second section requires information of the group the applicant served with. The applicant has to enter the name of the group and their identification number in Boxes 5 and 6. Box 7 requires their highest position in the group; the highest or actual pay grade within the group is indicated in Box 8;
  3. The date and place the applicant entered the military forces should be stated in Box 9. The employing departments and the time period of actual military service before the service period claimed should be indicated in Box 10;
  4. The applicant's home of record at the time of entry should be provided in Box 11. Their grade, rank or rating at the time of entry is entered in Box 12;
  5. The location of the military installation for reporting is given in Box 13. The speciality job titles are listed in Box 14. Any received awards should be specified in Box 15. Box 16 requires the date of group service termination. This includes the type and reason for termination, station base or location, service command affiliation and the date when service was terminated;
  6. The third section should contain the applicant's full name, social security number, phone number, date of completion of the form and signature. If the applicant is unable to sign the form due to any valid reason, the form can be signed by an authorized representative. In this case the relationship between the person signing the form and the applicant should be specified in Box 17;
  7. The application should be submitted with as much supporting documentation as possible. The evidence might include identification cards, contracts, employment records or anything else proving the applicant's service.

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