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Department of Defense form 2570. Official designation: DD Form 2570, Third Party Collection Program - Report on Program Results, June 2001.. Purpose: Third Party Collection Program - Report on Program Results. Current edition not stated, status not stated.
Prescribing authority: not stated. Proponent: not stated. Unlike service-specific publications, DD forms carry Department-level authority and apply across the Army, Navy, Air Force, Marine Corps, Space Force and Coast Guard when operating under Defense jurisdiction.
Common users: service members regardless of branch, Defense civilian staff, and the offices that file, verify or retain the finished document.
Timing of submission is fixed by not stated and by the implementing guidance of the submitting organization. What follows describes the blank document, not agency procedure.
The download set covers PDF. Document length is 1 pages with about 95 entry fields.
Pdf serves as the base format. In the fillable variant, each box is an interactive field that holds typed text inside the document. In the flat printable variant, no fields exist — the page prints as a blank to be completed by hand. Typed entries survive transmission; handwriting does not always survive scanning.
What the form asks for
- Segment reported. Press space bar to mark X in first box if inpatient, second box if outpatient.
- 1. Quarter ending. Four digit year, two digit month.
- 2. Reporting medical treatment facility (MTF).
- 3. Defense Medical Information System (D M I S) identification number.
- 4. Reporting period. (1) a. Current fiscal year. (2) Number of non-active duty inpatient dispositions or visits.
- (3) Number of claims.
- (4) Number of collections.
- (5) Number of claims divided by dispositions or visits, expressed as percentage.
- (6) Total dollar amount billed/charges.
- (1) b. First prior fiscal year. (2) Number of non-active duty inpatient dispositions or visits.
- (3) Number of claims.
- (4) Number of collections.
- (5) Number of claims divided by dispositions or visits, expressed as percentage.
- (6) Total dollar amount billed/charges.
- (1) c. Second prior fiscal year. (2) Number of non-active duty inpatient dispositions or visits.
- (3) Number of claims.
- (4) Number of collections.
- (5) Number of claims divided by dispositions or visits, expressed as percentage.
- (6) Total dollar amount billed/charges.
- 4.a. Current fiscal year. Column 7. Dollar adjustments and refunds. Note 2. Amounts reported for each fiscal year shall equal the subtotal for reasons codes 8 through 16 in Part 2 for the respective fiscal years.
- Current fiscal year. Column 10. Dollar amount collected current fiscal year.
- (11) Dollar amount remaining uncollected. (Column (6) minus (7) plus (8), (9), and (10).)
- (9) Amount collected, PY 1.
- (10) Amount collected current FY.
Order of completion: identification block first, substantive entries second, certification and signature last. The blank is laid out in that sequence and the sequence is not arbitrary — later entries often depend on data established in the header.
Verify the edition date against not stated before entry. Department-level revisions replace the blank across every service simultaneously, so an old copy in a desk drawer may no longer correspond to current field numbering.
Instructions printed on the form or in not stated govern individual field entries. Where the two differ, the governing publication controls.
After completion, the copy goes to the office designated by not stated or by local procedure. Retention of a personal copy is ordinary practice and costs nothing.
Cross-referenced forms are found through the numbering system. The DD sequence is Department-level and unified, which means a number cited on the page identifies one document across the whole Department.
Some procedures pair a DD form with a service form. The two numbering systems are separate — service forms answer to a service proponent, DD forms to not stated or another Department office — and a matching number in each system means nothing.
Editions change because the underlying directive changes, because collection requirements are revised, or because Privacy Act language is updated. Checking the edition date at the point of download is the practical response.
Scope of this page: distribution of a published form and description of its contents. It offers no legal guidance and no assurance regarding any particular submission. Direct procedural questions to not stated, to the servicing personnel office, or to the office designated in not stated.
Questions and answers
- What is DD Form 2570?
- DD Form 2570, Third Party Collection Program - Report on Program Results, June 2001.
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?