DD Form 1172, which is known as an Application for Information Card and DEERS Enrollment used by the Department of Defense in the United States, will allow someone to enroll their dependent, such as a spouse or child, in Defense Enrollment and Eligibility Reporting System.
This from will require both the dependent and the government employee's personal information including their full name, address, social security or identification number and contact information.
When completed the DD 1172 Form, both parties must sign the form. Failure to include all the required information could lead to the application being delayed or denied.dd-1172
Block 1 to 20: Enter the sponsor or employee's name, gender, Social Security Number (SSN) or DoD Identification (ID) Number, status (if not sure the status, leave blank), organization, branch or service, pay grade, appropriate country of citizenship, date of birth, place of birth (include city, state, and country, if outside the United States), current home address, city of residence, US postal code of the state, zip code, country, primary email address, telephone number and city, state and country duty location;
Block 7: Leave this block blank;
Block 21 to 23: Enter method of verification and further explanation of qualifying status, signature and date;
Block 24 to 39: Enter the name of the organization the employee works for or is assigned to, contract number of the purposes of entry into TASSS, sponsoring office address, telephone number and email address, overseas assignment, begin date and end date, eligibility effective date and expiration date, sponsoring official name, unit or organization name, title, pay grade, signature and verified date;
Block 40 to 43: Verify official name, site identification, telephone number and signature;
Block 41 to 57: Enter dependent's name, gender, date of birth, relationship, SSN or DoD ID number, current home address, primary email address, telephone number, city, state, zip code, country and eligibility effective date and expiration date.
Blocks 58 to 71: Enter information following the instruction of Block 41 to 57.
Block 72 to 73: Card recipient must sign in the block and enter the date to acknowledge receipt of the ID card.
Step 1: Add DD Form 1172 PDF file
Download and install PDF Editing software for Windows - WidsMob ConvertPDF. Open the DD Form 1172 template by clicking the “Open” button or directly drag the form to the program.
Step 2: Convert DD Form 1172 PDF to Word Format for Editing
You will be in the default “PDF to Word” section. Choose “Settings” at the bottom. Later, you can see a popping-up window with the name of “Option”. Click “Word” in the left panel, and then set to convert PDF to word (*.docx) or word 2003-2007 (*.doc).
Step 3: Edit DA Form 1172
If you want to keep the original layout and preservation, choose “Same as Resource” at the bottom. Click the huge “Convert” button on the lower right corner. Few seconds later, you can get the converted word document successfully.Then you can edit this DD 1172 PDF according to your need.