DD Form 220 Active Duty Report

DD Form 220 - also known as the "Active Duty Report" - is a United States Military form issued by the Department of Defense.

The form - often incorrectly referred to as the DA form 220 - was last revised on August 1, 1989. Download an up-to-date fillable PDF version of the DD 220 below or request a copy through the chain of command.

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ACTIVE DUTY REPORT
Privacy Act Statement
AUTHORITY:
10 USC 275, EO 9397, November 1943 (SSN).
PRINCIPAL
Used to report items of information to individuals reporting for active duty. Also used to compute date of rank for officers and
PURPOSE:
warrant officers ordered to active duty for 12 or more months.
Information is used to report periods of active duty and physical condition upon entry and release from active duty. Medical
ROUTINE USES:
statement is used to identify defects or conditions which have arisen since the member was last medically examined. If any
significant changes are noted, the member is given a medical examination. The SSN is used to identify the member.
Voluntary; however, if an individual refuses to complete ITEM 15, he/she will be scheduled for a medical examination.
1. RESERVE COMPONENT (X one)
2. DATE (YYMMDD)
ARNGUS
ANGUS
USAR
AFRES
3. TO (Appropriate Military Department)
4. FROM (Initial Active Duty Station)
5. NAME (Last, First, MI)
6. SSN
7. GRADE OR
8. BRANCH OF
9. RETIREMENT
RANK
ARMED SVC
YR ENDING
10. EFFECTIVE DATE OF ENTRY ON ACTIVE DUTY (Determined by personnel officer at
YEAR
MONTH
DAY
first duty station IAW criteria outlined in AR 37-104 or AFR 35-3)
11. REPORTING DATE (Date specified in orders or the actual reporting date if later than
date specified)
12. DATE DEPARTED FROM DUTY STATION TO HOME
13. AUTHORITY FOR ACTIVE DUTY
14. LENGTH OF TOUR (Less than
90 days if ARNGUS or USAR)
ORDERS NO.
PARAGRAPH NO.
DATED
(YYMMDD)
HQ
(Designation and location of HQ issuing orders)
15. STATEMENT OF PHYSICAL CONDITION (In lieu of medical examination)
I, the undersigned, underwent a complete medical examination for military service on or about
which was accomplished at
(YYMMDD)
(Name and location of hospital or medical treatment facility)
and since that time:
I have not been treated by clinics, physicians, healers or other practitioners.
I have been treated by
during the period from
(Name of physician) (Last, First, MI)
(YYMMDD)
to
for
(YYMMDD)
(Description of injury or illness)
I was hospitalized in
(Name and location of hospital or medical treatment facility)
The attending physician was
(Last, First, MI)
Diagnosis was
(Description of injury or disease)
I do
do not believe that I am now medically qualified to perform satisfactory military service.
Date
Signed
(YYMMDD)
16.
Upon mobilization this item will be filled in for members of units of reserve components of the Army and
(ARMY USE ONLY)
copies of orders will be attached to this form.
Entered on active duty as a member of
(Unit and unit home station)
Ordered to active duty from
(Home of record or home address) (Include ZIP code)
DD Form 220, AUG 89
Previous editions may be used until supply is exhausted.
Adobe Professional 8.0
ACTIVE DUTY REPORT
Privacy Act Statement
AUTHORITY:
10 USC 275, EO 9397, November 1943 (SSN).
PRINCIPAL
Used to report items of information to individuals reporting for active duty. Also used to compute date of rank for officers and
PURPOSE:
warrant officers ordered to active duty for 12 or more months.
Information is used to report periods of active duty and physical condition upon entry and release from active duty. Medical
ROUTINE USES:
statement is used to identify defects or conditions which have arisen since the member was last medically examined. If any
significant changes are noted, the member is given a medical examination. The SSN is used to identify the member.
Voluntary; however, if an individual refuses to complete ITEM 15, he/she will be scheduled for a medical examination.
1. RESERVE COMPONENT (X one)
2. DATE (YYMMDD)
ARNGUS
ANGUS
USAR
AFRES
3. TO (Appropriate Military Department)
4. FROM (Initial Active Duty Station)
5. NAME (Last, First, MI)
6. SSN
7. GRADE OR
8. BRANCH OF
9. RETIREMENT
RANK
ARMED SVC
YR ENDING
10. EFFECTIVE DATE OF ENTRY ON ACTIVE DUTY (Determined by personnel officer at
YEAR
MONTH
DAY
first duty station IAW criteria outlined in AR 37-104 or AFR 35-3)
11. REPORTING DATE (Date specified in orders or the actual reporting date if later than
date specified)
12. DATE DEPARTED FROM DUTY STATION TO HOME
13. AUTHORITY FOR ACTIVE DUTY
14. LENGTH OF TOUR (Less than
90 days if ARNGUS or USAR)
ORDERS NO.
PARAGRAPH NO.
DATED
(YYMMDD)
HQ
(Designation and location of HQ issuing orders)
15. STATEMENT OF PHYSICAL CONDITION (In lieu of medical examination)
I, the undersigned, underwent a complete medical examination for military service on or about
which was accomplished at
(YYMMDD)
(Name and location of hospital or medical treatment facility)
and since that time:
I have not been treated by clinics, physicians, healers or other practitioners.
I have been treated by
during the period from
(Name of physician) (Last, First, MI)
(YYMMDD)
to
for
(YYMMDD)
(Description of injury or illness)
I was hospitalized in
(Name and location of hospital or medical treatment facility)
The attending physician was
(Last, First, MI)
Diagnosis was
(Description of injury or disease)
I do
do not believe that I am now medically qualified to perform satisfactory military service.
Date
Signed
(YYMMDD)
16.
Upon mobilization this item will be filled in for members of units of reserve components of the Army and
(ARMY USE ONLY)
copies of orders will be attached to this form.
Entered on active duty as a member of
(Unit and unit home station)
Ordered to active duty from
(Home of record or home address) (Include ZIP code)
DD Form 220, AUG 89
Previous editions may be used until supply is exhausted.
Adobe Professional 8.0
17. (ARMY USE ONLY) DA FORM 67-8 (US Army Officer Evaluation Report) OR DA FORM 1059 (Academic Evaluation Report)
PREPARED AND FORWARDED:
YES, FORWARDED TO
DATE
(Address of Reserve or NG unit) (Include ZIP Code)
(YYMMDD)
NO, REPORT WILL BE FORWARDED ON OR ABOUT
(YYMMDD)
NOT APPLICABLE
18. (ARMY USE ONLY) DATE OF RANK (YYMMDD) (For officers and warrant officers ordered to active duty for 12 or more months, enter
computation below)
19a. TYPED NAME OF ADJUTANT OR OTHER OFFICER
b. GRADE OR
c. SIGNATURE
REPRESENTING COMMANDER (Last, First, MI)
RANK
20. ENCLOSURES (List enclosures, if any)
21. REMARKS (Explain reason for delay, if any, in complying with orders)
DD Form 220 Reverse, AUG 89
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