DD Form 67 "Form Processing Action Request"

What Is DD Form 67?

DD Form 67 also known as the Form Processing Action Request is a document used to request a revision, cancellation or creation of a completely new Department of Defense (DoD) form. The form is initiated by Action Officers (AO) and Component Forms Management Officers (FMO), signed by AO Approving Officials and approved by DoD FMO. A fillable up-to-date DD Form 67 can be downloaded below.

The DD Form 67 released in June 2014 was replaced by the May 2016 edition. All previous editions are obsolete and should not be used. The latest version includes the option to file digitally and can be secured by an electronic signature.

When initiated, the Action Request is submitted along with a draft of the form being proposed. In case of need, additional elements - such as print specifications or a list of required data elements - can be featured in the proposal. The draft must be as close to final form as possible since it will be put to use right away. Contact your FMO organization for assistance in compiling the draft.

This form is often incorrectly referred to as DA Form 67, which is a short name for the DA 67-9 and DA 67-10 series. These DA 67 forms are part of officer evaluation processes; the series includes several reports and supporting documentation.

ADVERTISEMENT

Download DD Form 67 "Form Processing Action Request"

2317 times
Rate
4.8(4.8 / 5) 229 votes
FORM PROCESSING ACTION REQUEST
1. DATE OF REQUEST
(YYYYMMDD)
(Read Instructions on back and in DoD 7750.07-M before completing this form.)
2. FROM
3. THRU
4. TO
(DoD Component OPR Organization)
(DoD Component FMO Organization)
(Organization)
Email:
Email:
Email:
5. FORM DESIGNATION AND NUMBER
6. EDITION DATE
7. FORM TITLE
(Enter
only if cancelling a form)
8. ACTION TYPE
9. FORM TYPE
10. SUBJECT GROUP
11. PRESCRIBING ISSUANCE(S)
(Select one)
(Select one)
(Leave blank if a new form)
12. FORM DISPOSITION
13. PROPOSED FORM DESIGN CONSIDERATIONS
(List all forms to be replaced by proposed form)
a. FORM NUMBER (Enter "N/A" if none)
b. EDITION DATE
c. DISPOSITION
a. DESIGN TYPE
b. SUGGESTED SIZE
c. PRINTING SPECIFICATIONS
d. CLASSIFIED
e. CONTROLLED FORM f. DIGITAL SIGNATURE FIELD
g. AVAILABILITY (Select one)
h. SOCIAL SECURITY NUMBER COLLECTED
(Select one. If YES, attach justification)
14. PURPOSE AND DESCRIPTION OF USE
(Attach continuation page if necessary.)
15. EXTERNAL COORDINATION AND CONCURRENCE
(Not required for SD, DoD Component, or Command forms. Attach continuation page if necessary.)
b. COORDINATOR
a. DOD
NAME
OFFICE SYMBOL
TELEPHONE NO.
EMAIL ADDRESS
INITIALS
COMPONENT
(Include area code/DSN)
16. INTERNAL COORDINATION AND CONCURRENCE
(3) COORDINATOR
(1) APPLI-
(2) REMARKS
(Enter applicable remarks related to
NAME
EMAIL ADDRESS
TELEPHONE NO.
INITIALS
coordination, and attach appropriate documentation.)
CABLE?
(Incl. area code/DSN)
(Yes/No)
a. PRIVACY ACT
b. POSTAL
c. DATA ELEMENTS
d. RECORDS MGMT
e. OTHER
f. COLLECTIONS
RCS
OMB
CERTIFICATION OF DOD COMPONENT OPR AND/OR ACTION OFFICER, APPROVING OFFICIAL, AND FMO
I hereby certify that all of the above coordinations have been completed as indicated.
17. DOD COMPONENT OPR AND/OR ACTION OFFICER
a. TYPED NAME AND TITLE
b. TELEPHONE NUMBER
c. SIGNATURE
(Include area code/DSN)
18. DOD COMPONENT APPROVING OFFICIAL
19. DOD COMPONENT OR COMMAND FORMS MANAGEMENT OFFICER
a. EMAIL ADDRESS
a. EMAIL ADDRESS
b. DATE SIGNED
c. TYPED NAME, TITLE, AND SIGNATURE
b. DATE SIGNED
c. TYPED NAME, TITLE, AND SIGNATURE
(YYYYMMDD)
(YYYYMMDD)
20. APPROVING FORMS MANAGEMENT OFFICER
a. TYPED NAME AND TITLE
b. DATE SIGNED (YYYYMMDD)
c. SIGNATURE
DD FORM 67, MAY 2016
PREVIOUS EDITION IS OBSOLETE.
LiveCycle Designer 11.0
FORM PROCESSING ACTION REQUEST
1. DATE OF REQUEST
(YYYYMMDD)
(Read Instructions on back and in DoD 7750.07-M before completing this form.)
2. FROM
3. THRU
4. TO
(DoD Component OPR Organization)
(DoD Component FMO Organization)
(Organization)
Email:
Email:
Email:
5. FORM DESIGNATION AND NUMBER
6. EDITION DATE
7. FORM TITLE
(Enter
only if cancelling a form)
8. ACTION TYPE
9. FORM TYPE
10. SUBJECT GROUP
11. PRESCRIBING ISSUANCE(S)
(Select one)
(Select one)
(Leave blank if a new form)
12. FORM DISPOSITION
13. PROPOSED FORM DESIGN CONSIDERATIONS
(List all forms to be replaced by proposed form)
a. FORM NUMBER (Enter "N/A" if none)
b. EDITION DATE
c. DISPOSITION
a. DESIGN TYPE
b. SUGGESTED SIZE
c. PRINTING SPECIFICATIONS
d. CLASSIFIED
e. CONTROLLED FORM f. DIGITAL SIGNATURE FIELD
g. AVAILABILITY (Select one)
h. SOCIAL SECURITY NUMBER COLLECTED
(Select one. If YES, attach justification)
14. PURPOSE AND DESCRIPTION OF USE
(Attach continuation page if necessary.)
15. EXTERNAL COORDINATION AND CONCURRENCE
(Not required for SD, DoD Component, or Command forms. Attach continuation page if necessary.)
b. COORDINATOR
a. DOD
NAME
OFFICE SYMBOL
TELEPHONE NO.
EMAIL ADDRESS
INITIALS
COMPONENT
(Include area code/DSN)
16. INTERNAL COORDINATION AND CONCURRENCE
(3) COORDINATOR
(1) APPLI-
(2) REMARKS
(Enter applicable remarks related to
NAME
EMAIL ADDRESS
TELEPHONE NO.
INITIALS
coordination, and attach appropriate documentation.)
CABLE?
(Incl. area code/DSN)
(Yes/No)
a. PRIVACY ACT
b. POSTAL
c. DATA ELEMENTS
d. RECORDS MGMT
e. OTHER
f. COLLECTIONS
RCS
OMB
CERTIFICATION OF DOD COMPONENT OPR AND/OR ACTION OFFICER, APPROVING OFFICIAL, AND FMO
I hereby certify that all of the above coordinations have been completed as indicated.
17. DOD COMPONENT OPR AND/OR ACTION OFFICER
a. TYPED NAME AND TITLE
b. TELEPHONE NUMBER
c. SIGNATURE
(Include area code/DSN)
18. DOD COMPONENT APPROVING OFFICIAL
19. DOD COMPONENT OR COMMAND FORMS MANAGEMENT OFFICER
a. EMAIL ADDRESS
a. EMAIL ADDRESS
b. DATE SIGNED
c. TYPED NAME, TITLE, AND SIGNATURE
b. DATE SIGNED
c. TYPED NAME, TITLE, AND SIGNATURE
(YYYYMMDD)
(YYYYMMDD)
20. APPROVING FORMS MANAGEMENT OFFICER
a. TYPED NAME AND TITLE
b. DATE SIGNED (YYYYMMDD)
c. SIGNATURE
DD FORM 67, MAY 2016
PREVIOUS EDITION IS OBSOLETE.
LiveCycle Designer 11.0
INSTRUCTIONS FOR COMPLETING DD FORM 67
1. DATE OF REQUEST. As stated.
13. PROPOSED FORM DESIGN CONSIDERATIONS
(Continued).
2. FROM. Enter the DoD Component Office of Primary
g. Availability. Select the availability of the form to users:
Responsibility (OPR) Organization.
- Electronic Form - DoD Forms Management Program web site
- Electronic Form - Component Forms Program web Site
3. THRU. Enter the DoD Component Forms Management Officer's
- Electronic Form - Distributed by OPR, no web.
Organization.
- Electronic Form - Distributed by FMOs for release, no web.
4. TO. As stated
- Electronic Form - Other, state in item 14.
- Physical Product - Stocked by using DoD Components.
5. FORM DESIGNATION AND NUMBER. Enter form number
- Physical Product - Stocked and issued by OPR.
if it is known, including temporary form numbers, e.g. DD Form
- Physical Product - Stocked by other, state in item 14.
67 or DD Form X123.
- Controlled Form - Availability stated in item 14.
h. Social Security Number Collected.
6. EDITION DATE. As stated.
Mark "No" or "Yes." If "Yes," attach justification and select
one of the following from the drop-down list:
7. FORM TITLE. Enter the title of the form exactly as it
- No SSN Collected
appears on the form. Do not use acronyms in the title.
- Full SSN
Do not use the word "form."
- Masked or Truncated
- Partially Masked or Truncated
8. ACTION TYPE. Select one:
- Encrypted or Disguised.
"New" - Proposed new form.
"Revised" - Existing form being revised.
14. PURPOSE AND DESCRIPTION OF USE. State purpose
and description of use. If canceled, state reason for
"Cancellation" - Existing form being canceled.
cancellation. Other remarks may be entered here.
"Other" - If "Other," indicate whether the request is for a
"Test," "Reinstatement," etc. Specify in item 14.
15. EXTERNAL COORDINATION AND CONCURRENCE.
Obtain the coordination of each DoD Component expected to
9. FORM TYPE. Select one:
use the form or currently using the form.
"Prescribed" - form is prescribed for mandatory use by all
16. INTERNAL COORDINATION AND CONCURRENCE.
DoD Components to whom the form applies in a DoD
Component coordination of Component Program Manager
issuance.
for each program listed. Initials/coordination are signed
"Adopted" - form's use is optional by two or more DoD
with a digital signature using a DoD CAC.
Components and is prescribed in a DoD Component issuance.
a. Privacy Act - If form collects personal identifiable
information (PII), Privacy POC coordination is required.
10. SUBJECT GROUP. Leave blank if new form.
List the Systems of Records Notice Number and attach a
Revised or proposed canceled form, enter subject group listed
copy. Also attach a justification for collecting the SSN.
on the existing DD Form 67. The subject groups (major and
b. Postal. If form is used as a mailer or requires mail indicia,
subgroup) can be found on the DoD Issuance Web site,
the DoD Component Postal Official coordination is required.
http://www.dtic.mil/whs/directives/index.html.
c. Data Elements. If form is to be designed with specific data
field names, attach list.
11. PRESCRIBING ISSUANCE(S). Enter the document that
d. Records Management. Coordinate with the Records
prescribes the use of the form. The form should be called out
Manager and enter the records disposition schedule under
e.
in the issuanc
If the form is adopted for use, enter the
"Remarks".
document number of each using Component.
e. Other. If form requires coordination from an office not listed,
identify and coordinate here.
12. FORM DISPOSITION. Enter the form number and edition
f. Collections. If form is used as an instrument to collect informa-
date of form(s) being replaced. Determine if the form(s)
tion from subordinate commands within DoD Component,
being replaced are used or obsolete. If "Use," indicate in
other DoD Components, from other Federal agencies, or from
item 14 how long used. If not applicable, enter "N/A" in 12.a.
public, coordinate with the DoD Component Information
Management Control Officer (IMCO). Enter the Report Control
13. PROPOSED FORM DESIGN CONSIDERATIONS.
Symbol (RCS) and/or Office of Management Budget (OMB)
a. Design Type. Select how the form should be designed for use:
number in the Remarks column.
"Print and Fill" - To be printed and filled in by hand and
17. DOD COMPONENT OPR AND/OR ACTION OFFICER.
mailed for submission.
Enter the appropriate information and signature for the action
"Fill and Print" - To be filled in on-line and printed for
officer.
submission.
"Fill and Submit" - To be filled in and submitted on-line,
18. DOD COMPONENT APPROVING OFFICIAL.
perhaps by e-mail.
Enter the appropriate information and signature of the DoD
"Fill, Submit, and Process" - Part of a system or workflow.
Component Approving Official. This official must be at the
"Physical Product" - Hardcopy output possibly by commercial
Division Director level or above.
printer for stocking, e.g. tags, labels.
19. DOD COMPONENT OR COMMAND FORMS
"Non-Form Item" - An item that may bear a form number.
MANAGEMENT OFFICER. Enter appropriate information
b. Suggested Size. Enter the suggested size for the form.
and signature of the DoD Component or Command FMO.
c. Printing Specifications. Enter "Yes" if the form will be
The FMO signature certifies the DD Form 67 is correct and
designed for commercial printing and attach the printing
complete and recommends approval.
specifications.
20. APPROVING FORMS MANAGEMENT OFFICER.
d. Classified. Select the appropriate drop-down choice.
Enter the appropriate information for the FMO responsible
e. Controlled. Select the appropriate drop-down choice.
for approving the form request. Leave blank on DD and SD
f. Digital Signature Field. If Yes is selected, the signature
Forms.
fields will be enabled as digital signature fields.
DD FORM 67, MAY 2016
PREVIOUS EDITION IS OBSOLETE.
LiveCycle Designer 11.0
ADVERTISEMENT

DD Form 67 Instructions

  1. Fill in the date of the request, DoD Component Office of Primary Responsibility (OPR) Organization and the DoD Component Forms Management Officer's Organization in Boxes 1, 2 and 3 respectively.
  2. Fill in the information about the form being revised or proposed in Boxes 5 through 11. Enter the form number, existing or proposed title, designation, and type. Box 10 should be left blank for new forms.
  3. Box 12 is for listing and describing any forms being replaced by the proposed form.
  4. Enter proposed form design considerations in Box 13. Design choices include filing choices, suggested size, printing and distribution specifications, availability and data collection.
  5. Describe the purpose and use of the new form or the changes to the existing form in Box 14.
  6. Obtain the coordination of each Department of Defense Component expected to use the form in Box 15.
  7. Box 16 is signed by Component Program Managers of each applicable program out of the six options listed.
  8. Boxes 17 through 20 are for the information and signatures of a DoD Component OPR or Action Officer, a DoD Component Approving Official, a DoD Component or Command Forms Management Officer and an Approving Forms Management Officer.
  9. If approved, the DoD FMO will complete Box 6, Edition Date and sign the DD Form 67 in Box 20.

The approved draft form will be forwarded to the Forms Designer to be finalized and added to the Department of Defense forms inventory. If the package is incomplete, it will be returned to the Military Service or DoD Component FMO.

Fill PDF online
Page of 2