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The DD Form 2828 serves as a critical document within the framework of the U.S. military’s Survivor Benefit Plan (SBP) and the Retired Serviceman's Family Protection Plan (RSFPP). Its primary purpose is to provide a physician's certification regarding the incapacity of a child annuitant, specifically when that child is unmarried and unable to support themselves due to mental or physical limitations. This form captures crucial information, including the child’s date of birth and Social Security Number, as well as a brief description of their medical condition. It requires a licensed physician to attest to their ongoing incapacity and includes sections for the physician's statement, which delineates the duration of care and the anticipated recovery, if applicable. Notably, while the completion of this form is voluntary, it is imperative for the maintenance of annuity payments, as failure to submit it can result in the cessation of those payments. The form also contains essential privacy statements and routine uses for the provided information, ensuring compliance with legal expectations and safeguarding personal data. As the deadline for the OMB approval looms, understanding the nuances of this form becomes all the more critical for those navigating the benefits of military service. Ultimately, grasping the requirements and implications of the DD Form 2828 is essential for families who rely on such vital military benefits.

Dd 2828 Example

CUI (when filled in)

PHYSICIAN CERTIFICATE FOR CHILD ANNUITANT

OMB No. 0730-0011

OMB approval expires

 

20230630

The public reporting burden for this collection of information is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate, Directives Division, Information Management Branch, 4800 Mark Center Drive, East Tower, Suite 03F09, Alexandria, VA 22350-3100 (0730-0011). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO: Defense Finance and Accounting Service, U.S. Military Annuitant Pay, 8899 E 56th Street, Indianapolis IN 46249-1300.

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C., “Armed Forces,” Section 1435, “Eligible Beneficiaries,” Section 1447, “Definitions,” DoDFMR, Vol 7B, Ch 46, “Survivor Benefit Plan - Annuity Amount and Offsets,” and Executive Order 9397, as amended, “Numbering System for Federal Accounts Relating to Individual Persons.”

PRINCIPAL PURPOSE(S): The Survivor Benefit Plan (SBP) and the Retired Serviceman's Family Protection Plan (RSFPP), provide for the coverage of children who are unmarried and incapable of self-support because of mental and/or physical incapacitation. If the incapacitation is temporary, recertification of this incapacitation is required every 2 years when the child annuitant is age 18 or over.

ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records, or information contained

therein, may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: to Internal Revenue Service for tax administration; Department of Veterans Affairs for pay entitlements; Social Security Administration for pay entitlements; American Red Cross for locator service; military aid societies for family assistance; Office of Personnel Management for pay entitlements and DoD Blanket Routine Uses at: http://dpcld.defense.gov/ Privacy/SORNsIndex/Blanket-Routine-Uses/. SORN T7347b, Defense Retiree and Annuitant Pay System at: http://dpcld.defense.gov/Privacy/ SORNsIndex/DOD-wide-SORN-Article-View/Article/570196/t7347b/. PIA, Defense Retiree and Annuitant Pay System at: https://www.dfas.mil/dam/ jcr:5cf8a068-89c7-47eb-b844-1e2020ed5f73/Defense%20Retiree%20and%20Annuitant%20Pay%20System%20(DRAS)%202016.pdf.

DISCLOSURE: Voluntary; however, if DFAS does not receive this information, the annuity payments will stop.

NOTE: Penalty for presenting false claims or making false statements in connection with claims is a fine of not more than $10,000 or imprisonment for not more than 5 years, or both (18 U.S.C. 1001).

1. DECEASED MEMBER SSN

2. ANNUITANT'S NAME (Last, First, Middle Initial) 3. DATE OF BIRTH (YYYYMMDD) 4. ANNUITANT'S SSN

6. DATE CONDITION BEGAN (YYYYMMDD)

5. BRIEF DESCRIPTION OF MEDICAL/PSYCHIATRIC DIAGNOSIS

 

7. PHYSICIAN'S STATEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. I have attended the patient for

 

 

years

 

 

 

 

months

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. I last examined the patient on:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c. In my opinion the patient is (X one or both)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1) Incapable of self-support for the period

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2) Incapable of handling his/her own financial affairs for the period

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. In my opinion the incapacity is (X one)

permanent

 

temporary

If temporary, expected recovery date (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

e. I am a licensed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

physician or practitioner authorized to practice medicine in the state of

 

 

 

 

 

 

 

 

 

 

psychiatrist authorized to practice medicine in the state of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. I HEREBY CERTIFY THAT THE INFORMATION ABOVE IS CORRECT TO THE BEST OF MY KNOWLEDGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. PRINT PHYSICIAN'S NAME (Last, First, Middle Initial)

 

 

b. ADDRESS (Include ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

c. SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. DATE (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DD FORM 2828, NOV 2006

 

 

 

CUI (when filled in)

Controlled by: DFAS

 

 

 

 

 

 

 

 

 

 

Reset

 

 

 

 

 

 

 

CUI Category: PRVCY

 

 

 

PREVIOUS EDITION IS OBSOLETE.

 

 

 

 

 

 

 

 

 

 

 

LDC: FECON

 

 

 

 

 

POC: dfas.indianapolis-in.zed.mbx.info-management-control-officer@mail.mil

File Breakdown

Fact Name Details
Form Purpose The DD 2828 form is used to certify a child's incapacity for purposes of receiving survivor benefits.
OMB Approval The form has an OMB control number 0730-0011, with approval expiring on June 30, 2023.
Response Time On average, it takes about 2 hours to complete this form, including gathering and reviewing information.
Submission Instructions Completed forms should be submitted to the Defense Finance and Accounting Service at their Indianapolis office.
Privacy Act Statement The collection of information is governed by the Privacy Act and various U.S. Code sections including 10 U.S.C. and Executive Order 9397.
Routine Uses Information may be disclosed to agencies such as the IRS or Social Security Administration for benefits administration.
Disclosure Voluntariness While providing information is voluntary, failure to do so may result in the cessation of annuity payments.
Penalties Submitting false information can lead to fines up to $10,000 or imprisonment of up to 5 years, according to federal law.
Recertification Requirement For temporary incapacity, recertification is required every two years for annuitants aged 18 or older.
Physician Role The form must be completed and signed by a licensed physician, confirming the patient's incapacity status.

Guide to Using Dd 2828

Completing the DD Form 2828 requires careful attention to detail. This form collects vital information regarding a child's incapacity and must be filled out accurately to avoid delays in processing. Follow these steps to ensure you provide the necessary information correctly.

  1. At the top of the form, enter the deceased member's social security number (SSN) in the first field.
  2. In the second field, write the annuitant's full name (last name, first name, middle initial).
  3. In the third field, input the annuitant's date of birth in the format YYYYMMDD.
  4. Fill in the annuitant's social security number (SSN) in the fourth field.
  5. In the sixth field, note the date the condition began in the format YYYYMMDD.
  6. In the fifth field, provide a brief description of the medical or psychiatric diagnosis.
  7. In the physician's statement section, indicate how long you have attended the patient by filling in the number of years and months in the designated box.
  8. State the date of the last examination in the appropriate field.
  9. Check the appropriate box to confirm whether the patient is: (1) incapable of self-support for the specified period or (2) incapable of handling their own financial affairs for the specified period.
  10. Indicate whether the incapacity is permanent or temporary by checking the respective box. If the incapacity is temporary, provide the expected recovery date in the format YYYYMMDD.
  11. Confirm that you are a licensed physician or practitioner authorized to practice medicine in the state, including whether you are a psychiatrist.
  12. Certify that the information is correct by printing your name (last, first, middle initial) in the designated area.
  13. Provide your address, including the ZIP code.
  14. Sign and date the form in the last two fields, entering the date in the format YYYYMMDD.

Once the form is completed, review it for accuracy. Remember to send the filled-out DD Form 2828 to the Defense Finance and Accounting Service as indicated. Proper submission ensures that the necessary actions can be taken regarding the child's annuity payments.

Get Answers on Dd 2828

What is the purpose of the DD Form 2828?

The DD Form 2828, known as the Physician Certificate for Child Annuitant, is primarily used to certify the incapacity of a child annuitant who is unmarried and unable to support themselves due to mental or physical conditions. This form plays a crucial role in determining eligibility for benefits under the Survivor Benefit Plan and the Retired Serviceman's Family Protection Plan. If a child is deemed temporarily incapacitated, they must undergo a recertification every two years once they reach the age of 18.

Who needs to complete the DD Form 2828?

The form must be completed by a licensed physician who has been responsible for the care of the child in question. This physician should provide detailed information regarding the child's diagnosis, the duration of their incapacity, and their ability to manage their own financial affairs. Additionally, the physician's credentials must be noted to assure that the information provided is credible.

Where should the completed DD Form 2828 be sent?

Once the form has been completed and signed, it should not be returned to the organization that supplied the form. Instead, it must be mailed to the Defense Finance and Accounting Service at the following address:

U.S. Military Annuitant Pay
8899 E 56th Street
Indianapolis, IN 46249-1300

What happens if the DD Form 2828 is not submitted?

If the Defense Finance and Accounting Service (DFAS) does not receive the completed DD Form 2828, the child's annuity payments will be halted. This underscores the importance of timely submission of the form to ensure that benefits continue uninterrupted.

What are the privacy considerations associated with the DD Form 2828?

The DD Form 2828 is subject to privacy laws, specifically those outlined in the Privacy Act of 1974. The information collected is used to determine eligibility for benefits and may be shared with certain agencies, such as the Internal Revenue Service or the Social Security Administration. It is crucial that all personal information is filled out accurately and maintained securely to protect the privacy of the individual involved.

Common mistakes

Completing the DD Form 2828 is critical for ensuring that eligible children receive their benefits, but mistakes can lead to serious delays or denials. One common error occurs when individuals fail to provide complete and accurate personal information for the annuitant. This includes missing social security numbers or incorrect birth dates. Omitting these details can result in the form being returned for correction, further prolonging the benefits process.

An additional mistake involves the physician's section. When a physician fails to detail their credentials or provide necessary context about their relationship with the patient, it can undermine the validity of the application. Inaccuracy in the diagnosis or condition dates can also lead to questions regarding the annuitant's eligibility. Submission of vague or incomplete descriptions can create significant challenges.

Another frequent issue arises when the form is submitted without the requisite signatures. Without the physician's certification indicating that the information is correct, the entire application may be disqualified. This step is non-negotiable. Ensure that the physician's name is printed clearly, the address is complete, and that dates are provided as required.

People often overlook the importance of indicating whether the incapacity is permanent or temporary. Misclassification may result in additional requirements, such as the need for future recertification. Furthermore, if temporary status is chosen, failing to provide an expected recovery date can create confusion for the evaluating office.

Moreover, applicants sometimes neglect to verify that the correct form is being used. Outdated versions of the form could lead to delays in processing the application. It is crucial to use the latest version of the DD Form 2828 to avoid complications.

Another common oversight is the failure to return the completed form to the correct address. Submitting to the wrong location can cause administrative delays and missed deadlines. Review the instructions carefully to ensure the form reaches the appropriate department without unnecessary delays.

Finally, individuals may not fully grasp the consequences of providing false information. Penalties for inaccuracies can be severe, including fines or imprisonment. Every detail on the form must be truthful and verifiable to avoid repercussions.

In conclusion, attention to detail is critical when completing the DD Form 2828. Take the time to review all information thoroughly and ensure accuracy. By avoiding these common pitfalls, applicants can help ensure a smoother process and timely receipt of benefits.

Documents used along the form

The DD 2828 form, known as the Physician Certificate for Child Annuitant, plays a critical role in documenting the medical condition of a child annuitant who may be incapable of self-support due to mental or physical incapacitation. Several other forms and documents often accompany the DD 2828 to facilitate the Survivor Benefit Plan (SBP) and the Retired Serviceman's Family Protection Plan (RSFPP). Below are four essential documents that may be used in conjunction with the DD 2828.

  • DD Form 1172-2: This form is used to apply for identification cards for military dependents. It provides necessary information for verifying eligibility for benefits and services, and must be filled out to issue dependent identification cards.
  • DD Form 1300: The Report of Casualty form is essential for documenting the death of a service member. This form initiates the process for survivors to claim benefits and assists in the proper reporting of the casualty for military records.
  • SF 2801: This is the Application for Death Benefits form, used by survivors to apply for benefits based on the service member’s retirement plan. It gathers essential information about the deceased and the claimant to help determine the entitlements available.
  • DFAS-CL 1100/1: This document pertains to a change of beneficiary for the Survivor Benefit Plan. It must be completed to ensure that the correct beneficiaries are identified and that benefits are distributed according to the service member's wishes.

Understanding these associated documents can streamline the process of securing benefits for child annuitants and their families. Each form serves a specific purpose and plays a vital role in ensuring that the necessary benefits are provided to eligible individuals.

Similar forms

The DD 2828 form serves a specific purpose for child annuitants in the context of military benefits. Several other documents are similar in their intent to provide verification or certification for benefits or entitlements. Here’s a list of ten such documents:

  • DD Form 214: This document serves as a certificate of release or discharge from active duty. Like the DD 2828, it provides essential information needed for veterans’ benefits.
  • VA Form 21-534EZ: This application for Dependency and Indemnity Compensation (DIC) benefits also supports claims for dependents. Both forms require detailed information about the beneficiary’s relationship to the service member.
  • SF 2809: This form is used for health benefits election and requires similar information regarding dependents for enrollment in government health plans.
  • DD Form 1173: This identification card application for dependents of military members requires details to verify eligibility for benefits, akin to the processes seen in the DD 2828.
  • Form SSA-827: This request for release of information is related to Social Security disability benefits. It also assesses the incapacity of the applicant, mirroring the health assessments found in the DD 2828.
  • VA Form 21P-534: This application for survivor's benefits is similar in requiring medical documentation and evidence of incapacity for dependents.
  • DD Form 1513: Known for applying for Reserve Components Survivor Benefit Plan payments, this form likewise evaluates dependents’ eligibility based on specified criteria.
  • Form 22-5552: This form, which claims educational assistance for dependents of service members, parallels the DD 2828's focus on ensuring benefits for eligible individuals.
  • VA Form 21-530: This claim for burial benefits requires documentation of the deceased's military service and dependent status, similar to requirements outlined in the DD 2828.
  • DD Form 2656-6: This survivor benefit form for the military retirement system assesses eligibility and requires medical insights similar to those on the DD 2828.

Each of these documents plays a vital role in securing benefits for service members and their families. They require similar processes and types of information to ensure that applicants meet the necessary eligibility criteria.

Dos and Don'ts

When completing the DD 2828 form, it's essential to navigate the process carefully to ensure that all information is accurate and complete. Here are four important dos and don'ts to keep in mind.

  • Do double-check all personal information for accuracy, such as the annuitant's name and Social Security number.
  • Do provide a clear and concise description of the medical or psychiatric diagnosis, ensuring it aligns with the requirements.
  • Do include the physician's credentials and ensure that the signature is dated appropriately before submission.
  • Do send the completed form to the correct address, which is listed in the instructions for the DD 2828 form.
  • Don't leave any sections blank. Fill out all required fields to prevent delays in processing.
  • Don't provide vague or overly technical descriptions of medical conditions. Be straightforward for clarity.
  • Don't ignore the deadline for submission. Timely filing is crucial to ensure that benefits remain uninterrupted.
  • Don't return the form to the Department of Defense, as specified. Always follow the correct submission guidelines.

Misconceptions

Misconceptions about the DD 2828 form can lead to confusion and delays in processing benefits. Below are some common misconceptions, along with clarifications to help individuals understand the form better.

  • Misconception 1: The DD 2828 form is only for children under 18.
  • This form is utilized for children over the age of 18 who are unmarried and unable to support themselves due to a medical condition. It is important for maintaining their eligibility for benefits.

  • Misconception 2: The physician's statement is optional.
  • In fact, this statement is crucial for verifying the child's incapacity. Without it, the Defense Finance and Accounting Service (DFAS) will not process the annuity payments.

  • Misconception 3: Any medical professional can fill out the form.
  • The form must be completed by a licensed physician or practitioner authorized to practice medicine. It is essential that the individual examining the child meets these criteria to ensure the form's validity.

  • Misconception 4: There is no consequence for submitting false information.
  • Submitting inaccurate information is a serious offense. Penalties include fines and potential imprisonment. It is vital to provide accurate and truthful information on the form.

  • Misconception 5: Once submitted, the form does not require updates.
  • If the child's incapacity is deemed temporary, updates may be required every two years or sooner if circumstances change. Staying on top of this is essential for maintaining benefits.

  • Misconception 6: The DD 2828 form can be sent directly to the physician.
  • The completed form should be returned to DFAS at the specified address. It is not designed to be sent to the physician after completion.

  • Misconception 7: There is no need to keep a copy of the form.
  • It is advisable to keep a copy for personal records. This may assist in future communications or verification if questions arise.

  • Misconception 8: The form can be submitted at any time without impact on payments.
  • Failure to submit the information will result in the suspension of annuity payments. Timely submission is essential to ensure continuous benefit coverage.

Key takeaways

When filling out the DD Form 2828, it’s essential to be thorough and precise. Below are key takeaways to ensure the form is completed correctly and used effectively.

  • Understand the Purpose: The form is designed for submitting a physician's certificate regarding a child's incapacity for the Survivor Benefit Plan. This is crucial for continuing annuity payments.
  • Know the Requirements: Annuitants must be unmarried and incapable of self-support due to physical or mental incapacitation.
  • Regular Certification Needed: If incapacity is temporary, expect to provide recertification every two years once the child annuitant turns 18.
  • Accurate Information is Key: Fill in the child's Social Security Number, name, and date of birth carefully to avoid delays.
  • Physician's Role: The attending physician must confirm the incapacity and include their credentials. Their statement about the condition is vital.
  • Return Instructions: Send the completed form to the Defense Finance and Accounting Service, not to the address listed for comments and suggestions.
  • Be Aware of Privacy: Information is protected under the Privacy Act. However, it may be shared with other agencies for necessary administrative purposes.

Fill out the form thoughtfully to ensure that all necessary information is included. This helps in maintaining uninterrupted benefits for your child.