Download the form
DD Form 2828 — a Department of Defense document. Title of record: DD Form 2828, Physician Certificate for Child Annuitant, November 2006. Stated purpose: Physician Certification for Child Annuitant. Edition date 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.
Users include uniformed members of any branch, DoD civilian employees, contractor personnel where authorized, and the administrative staff who process the completed record.
Submission follows the schedule set by not stated and by local implementing procedures. This page provides the blank form for download and general orientation only.
The download set covers PDF. Document length is 1 pages with about 24 entry fields.
The pdf is the primary distribution format. A fillable pdf accepts typed entries in defined field boxes and stores them in the file; a printable pdf is a flat image of the blank, meant for pen entry after printing. The distinction matters for legibility and for records that pass between offices.
What the form asks for
- 1. Deceased member's Social Security Number.
- 2. Annuitant's Name, Last, First, Middle Initial
- 3. Date of birth: 4 digit year, 2 digit month, 2 digit day
- 4. Annuitant's Social Security Number.
- 6. Date condition began: 4 digit year, 2 digit month, 2 digit day
- 5. Brief description of medical or psychiatric diagnosis
- 7. Physician's statement. a. I have attended the patient for: enter number of years.
- Enter number of months.
- 7.b. I last examined the patient on: Enter date.
- 7.c. In my opinion the patient is: X one or both. 1. Incapable of self-support
- For the period of time: Enter time period.
- 7.c.2. Mark X if Incapable of handling his/her own financial affairs
- For the period of time: Enter time period.
- d. In my opinion the incapacity is: X first box if permanent, second box if temporary.
- If temporary, expected recovery date: 4 digit year, 2 digit month, 2 digit day
- Mark X if Psychiatrist authorized to practice medicine in the state of.
- 7.e. I am a licensed: Mark X if Physician or practitioner authorized to practice medicine in the state of
- Enter state.
- Enter state.
- 8. I hereby certify that the information above is correct to the best of my knowledge. a. Phsician's Name, Last, First, Middle Initial
- b. Address, Include zip code
- c. Signature
- d. Date: 4 digit year, 2 digit month, 2 digit day
- Press this Reset button to clear the data from all fields.
The document is filled from the top down. Identification precedes substance, substance precedes certification. Fields lower on the page are commonly keyed to entries made above them.
Edition in use: not stated. Because DD forms are revised at Department level and distributed to all services at once, an obsolete printing may not match the fields an office expects. The date is printed on the form face.
Certification requires a signature in the designated block — ink on paper, or a digital signature where the receiving office supports one. Typing a name into the field does not constitute execution. CAC-based signing is the usual digital method for Defense forms.
Where personal information is collected, a Privacy Act Statement appears on or with the form. It names the collection authority, the purpose, the routine uses of the data and the consequence of withholding it. Reading it precedes filling the form.
Errors seen most often involve edition mismatch, empty mandatory fields, illegibility after scanning, date formats inconsistent with the printed instruction, and unsigned or undated certification.
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.
Related documents are located by series and number. DD forms sit in a single Department-wide sequence, so a form referenced inside DD Form 2828 is normally found by its number alone, without regard to service.
A DD number and a DA number may appear in the same instruction without being related. DA forms belong to the Army alone; DD forms belong to the Department and are administered at Department level. The sequences are independent.
Forms are reissued for several reasons: directive revision, changed data requirements, updated notice language. Confirming not stated at the moment of download covers the risk.
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 2828?
- DD Form 2828, Physician Certificate for Child Annuitant, November 2006
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?