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APPLICATION FOR IDENTIFICATION CARD/DEERS …

PREVIOUS EDITION IS form is valid for issue of DoD ID Card for 90 days from date of FORM 1172-2, APRIL 2020 APPLICATION FOR IDENTIFICATION CARD/DEERS enrollment Please read Agency Disclosure Notice, Privacy Act Statement, and Instructions prior to completing this form. OMB No. 0704-0415 OMB approval expires 20230430 SECTION I - SPONSOR/EMPLOYEE INFORMATION1. NAME (Last, First, Middle)2. GENDER3. SSN OR DoD ID STATUS5. ORGANIZATION6. PAY GRADE7. GEN. CAT8. CITIZENSHIP9. DATE OF BIRTH (YYYYMMDD)10. PLACE OF BIRTH11. CURRENT HOME ADDRESS12. CITY13. STATE14. ZIP CODE15. COUNTRY16. PRIMARY EMAIL ADDRESS Permission to use for benefits notifications17. TELEPHONE NUMBER (Include Area Code/DSN)18.

PREVIOUS EDITION IS OBSOLETE. This form is valid for issue of DoD ID Card for 90 days from date of verification. DD FORM 1172-2, APRIL 2020 APPLICATION FOR IDENTIFICATION CARD/DEERS ENROLLMENT

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Transcription of APPLICATION FOR IDENTIFICATION CARD/DEERS …

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