INSTRUCTIONS FOR COMPLETION OF DD FORM 1172-2, “APPLICATION FOR

IDENTIFICATION CARD/DEERS ENROLLMENT”

The DD Form 1172-2 shall be used to apply for issuance of a DD Form 2 (Reserve, Retired, and
Reserve Retired), a DD Form 1173, a DD Form 1173-1, a DD Form 2764, a DD Form 2765, and
a Common Access Card (CAC) for eligible individuals who are not enrolled in the Defense
Enrollment Eligibility Reporting System (DEERS). The DD Form 1172-2 shall also be used to
enroll eligible individuals in DEERS or to update an eligible individual’s DEERS record by
submitting the form to a Verifying Official (VO) at any Real-time Automated Personnel
Identification System (RAPIDS) Site. Retention and disposition of the DD Form 1172-2 shall be
in accordance with uniformed services' regulatory instructions.

Notes:

 DoD sponsors enrolling their dependents in DEERS should complete Sections I, II, and V.
o For dependents already enrolled in DEERS, CAC-enabled sponsors may logon to the
RAPIDS Self-Service (RSS) Portal to verify their dependents online and digitally create
and sign DD Form 1172-2. Once the CAC-enabled sponsor verifies the dependent via
RSS portal, the DD Form 1172-2 is saved under the dependent’s DEERS record, and
must be printed and submitted to a VO at a RAPIDS Site to support card issuance.

 DoD sponsors updating their own status or adding a personnel condition impacting benefits
(e.g., overseas assignment) should complete Sections I and II.

 Eligible employees applying for a CAC should complete Sections I and II (and Section IV if
a Foreign Affiliate on orders to the U.S. with authorized dependents). The DD Form 1172-2
should then be provided to a DoD sponsor for authorization and completion of Section III.

 DoD personnel sponsoring an eligible individual for a CAC should complete Section III.

 For certain populations, a paper form will not be required (e.g., populations entered into
RAPIDS via the Trusted Associate Sponsorship System (TASS)).

 A DD Form 577 (signature card) for DoD personnel completing Section III must be on file at
the issuing site for CAC applicants using the DD Form 1172-2 for enrollment. The DD Form
577 may be completed with either a wet or digital signature, selecting the format which will
be used to sign the DD Form 1172-2. If both signature formats will be used, a DD Form 577
for each format must be completed and on file at the issuing site.

SECTION I – SPONSOR/EMPLOYEE INFORMATION

Block 1. Name. Enter the sponsor/employee’s LAST name first, enter the FIRST name, and
then enter the MIDDLE initial or the full MIDDLE name. Use no more than 51 characters.
 The name field can include a designation of JR, SR, ESQ, or the Roman numerals I
through X. To include that designation, enter the appropriate data after the middle initial.
 The name cannot contain any special characters nor is any punctuation permitted.

DD Form 1172-2 Instructions (September 2018) 1

 Block 2. Gender. Enter the sponsor/employee’s gender from the valid codes listed in Table
1. Use one character.

Table 1. Gender Abbreviations

CODE GENDER
M Male
F Female

Block 3. Social Security Number (SSN) or DoD Identification (ID) Number. Enter the
sponsor/employee’s SSN or DoD ID Number.
 In cases where an employee has not been issued an SSN or DoD ID Number, an ITIN or
Foreign National Identification Number (FNIN) can be provided.
 If neither number is available, a Foreign Identification Number (FIN) will be generated
by the system. A FIN (assigned as 900-00-0000F and up) will be assigned and
automatically generated for eligible foreign nationals who do not have an SSN.
 An SSN or ITIN is the preferred identifier for initial enrollment. Only in cases where
neither is available should an alternate be used.

For Verifying Officials (VOs): If an SSN or DoD ID Number is already registered in

DEERS for another individual, STOP processing and verify the number. If
verification confirms duplication of the SSN by the Social Security Administration,
continue processing and the system shall automatically generate a duplicate control
number for the additional sponsor/employee.

Block 4. Status. Enter the sponsor/employee’s status from the valid codes listed in Table 2.
If unsure of status, leave blank. Use no more than six characters.

Table 2. Status Codes

CODE STATUS
ACADMY Academy or Navy Officer Candidate School (OCS) Student
AD Active duty (excluding Guard and Reserve on extended active duty for more than 30 days)
AD-DEC Active duty deceased
CIV Civilian
CONTR Contractor
DAVDEC 100-percent disabled veteran deceased (either temporary (TMP) or permanent (PRM)
DAVPRM 100-percent disabled veteran, permanent disability
DAVTMP 100-percent disabled veteran, temporary disability
FP Foreign military personnel
Former member who is in receipt of retired pay for non-regular service but who has been
FMRMR
discharged from the Service and maintains no military affiliation
A former member who qualified for retired pay for non-regular service at his or her sixtieth
FMRDEC
birthday, before his or her discharge from the Service, but died while in receipt of retired pay
GRD National Guard (all categories)
GRDDEC National Guard deceased

DD Form 1172-2 Instructions (September 2018) 2

 CODE STATUS
GRD-AD Guard on extended active duty for more than 30 days
MH Medal of Honor recipient
MH-DEC Medal of Honor recipient deceased
Non-DoD eligible beneficiaries (including credit union employees, and other civilians employed in
OTHER
support of U.S. forces overseas, who are authorized benefits and privileges)
PDRL Retired member, on the Permanent Disability Retired List (PDRL)
PR-APL Prisoner or Appellate leave
RCL-AD Recalled to active duty
RES Reserve (all categories)
RES-AD Reserve members on extended active duty for more than 30 days
RESDEC Reserve deceased
RESRET National Guard and Reserve members who retire, but are not entitled to retired pay until age 60
RET Retired member entitled to retired pay
Deceased retired member entitled to retired pay. Code applies to active duty retired, Retired
RETDEC
Reserve beginning on their 60th birthday, the TDRL, and the PDRL.
Special Separation Benefits (SSB) recipient member with 120 days medical benefits
SSB
(CHAMPUS/TRICARE and MTF)
TDRL Retired member, on the TDRL
TA-RES Selected Reserve Transition Assistance Management Program members and their eligible
dependents
TA-30 Involuntarily separated member of Reserve or Guard Component entitled to 30 days medical
benefits (CHAMPUS/TRICARE and MTF)
TA-60 Involuntarily separated member with 60 days medical benefits (CHAMPUS/TRICARE and MTF)
TA-120 Involuntarily separated member with 120 days medical benefits (CHAMPUS/TRICARE and MTF)
TA-180 Involuntarily separated member with 180 days medical benefits (CHAMPUS/TRICARE and MTF).
VSI Voluntary Separation Incentive (VSI) recipient with 120 days medical benefits
(CHAMPUS/TRICARE and MTF)

Block 5. Organization. Enter the sponsor/employee’s organization, branch, or service from

the valid codes listed in Table 3. Use no more than five characters.

Table 3. Organization/Branch/Service Codes

CODE ORGANIZATION/BRANCH/SERVICE
USA U.S. Army
USAF U.S. Air Force
USN U.S. Navy
USMC U.S. Marine Corps
USCG U.S. Coast Guard
USPHS U.S. Public Health Service
NOAA National Oceanic and Atmospheric
Administration
DoD Department of Defense
FED Employee of an Agency other than DoD
OTHER Used when the sponsor/employee is not
affiliated with one of the uniformed services
listed above

Block 6. Pay Grade. Enter the sponsor/employee’s pay grade from the valid codes listed in
Table 4. Use no more than four characters.

DD Form 1172-2 Instructions (September 2018) 3

 Table 4. Pay Grade Codes

CODE PAY GRADE

El-E9 Enlisted pay grades 1 through 9
W1-W5 Warrant officer pay grades 1 through 5
STDT Academy and/or Navy OCS student (ENTER PAY GRADE IF
STDT RECEIVING PAY)
001-011 Officer pay grades 1 through 11 (011 is reserved)
GS01-GS18 Federal employees with General Schedule pay grades
NF1-NF6 Federal employees with Nonappropriated Fund pay grades
OTHER Other (non-uniformed service) pay grades not defined above,
to include all contractors
N/A Not applicable. Use this code with the Block 4 status codes of
“FMRMR” or FMRDEC”

Block 7. GEN. CAT (Geneva Convention Category). Leave this block blank. This block is
automatically generated by DEERS/RAPIDS with the valid codes listed in Table 5.

Table 5. GEN CAT

CODE GEN CAT

I Category I (pay grades E1 through E4)
II Category II (pay grades E5 through E9)
III Category III (pay grades W1 through 003 and/or
Cadets and/or Midshipmen)
IV Category IV (pay grades 004 through 006)
V Category V (pay grades 007 through 011)
N/A Not applicable (non-protected personnel)

Block 8. Citizenship. Enter the sponsor/employee's appropriate country of citizenship from

the valid codes listed in Table 6. Use three characters.

Table 6. Country Abbreviations

Afghanistan AFG Aruba ABW Belarus BLR

Akrotiri XQZ Ashmore and Cartier Belgium BEL
XAC
Albania ALB Islands Belize BLZ
Australia AUS
Algeria DZA Benin BEN
Austria AUT
American Samoa ASM Bermuda BMU
Azerbaijan AZE
Andorra AND Bhutan BTN
Bahamas, The BHS
Angola AGO Bolivia BOL
Bahrain BHR Bonaire, Sint
Anguilla AIA BES
Baker Island XBK Eustatius, and Saba
Antarctica ATA
Bangladesh BGD Bosnia and
Antigua and Barbuda ATG BIH
Barbados BRB Herzegovina
Argentina ARG Botswana BWA
Bassas da India XBI
Armenia ARM Bouvet Island BVT

DD Form 1172-2 Instructions (September 2018) 4

 Brazil BRA El Salvador SLV Howland Island XHO
British Indian Ocean Equatorial Guinea GNQ Hungary HUN
IOT
Territory Eritrea ERI Iceland ISL
Brunei BRN
Estonia EST India IND
Bulgaria BGR
Ethiopia ETH Indonesia IDN
Burkina Faso BFA Etorofu Habomai Iran IRN
Burma MMR Kunashiri and XQP Iraq IRQ
Burundi BDI Shikotan Islands
Ireland IRL
Cambodia KHM Europa Island XEU
Falkland Islands (Islas Isle of Man IMN
Cameroon CMR FLK
Malvinas) Israel ISR
Canada CAN
Faroe Islands FRO Italy ITA
Cape Verde CPV
Fiji FJI Jamaica JAM
Cayman Islands CYM
Finland FIN Jan Mayen XJM
Central African
CAF France FRA Japan JPN
Republic
Chad TCD French Guiana GUF Jarvis Island XJV
Chile CHL French Polynesia PYF Jersey JEY
China CHN French Southern and Johnston Atoll XJA
ATF
Antarctic Lands
Christmas Island CXR Jordan JOR
Gabon GAB
Clipperton Island CPT Juan de Nova Island XJN
Gambia The GMB
Cocos (Keeling) Kazakhstan KAZ
CCK Gaza Strip XGZ
Islands Kenya KEN
Colombia COL Georgia GEO
Kingman Reef XKR
Comoros COM Germany DEU
Kiribati KIR
Congo (Brazzaville) COG Ghana GHA
Korea, North PRK
Congo (Kinshasa) COD Gibraltar GIB
Korea, South KOR
Cook Islands COK Glorioso Islands XGL
Kosovo XKS
Coral Sea Islands XCS Greece GRC
Kuwait KWT
Costa Rica CRI Greenland GRL
Kyrgyzstan KGZ
Cote DIvoire CIV Grenada GRD
Laos LAO
Croatia HRV Guadeloupe GLP
Latvia LVA
Cuba CUB Guam GUM
Lebanon LBN
Curacao CUW Guantanamo Bay
AX2 Lesotho LSO
Naval Base
Cyprus CYP Liberia LBR
Guatemala GTM
Czech Republic CZE Libya LBY
Guernsey GGY
Denmark DNK Liechtenstein LIE
Guinea GIN
Dhekelia XXD Lithuania LTU
Guinea-Bissau GNB
Diego Garcia DGA Luxembourg LUX
Guyana GUY
Djibouti DJI Macau MAC
Haiti HTI
Dominica DMA Heard Island and Macedonia MKD
HMD
Dominican Republic DOM McDonald Islands Madagascar MDG
Ecuador ECU Honduras HND
Malawi MWI
Egypt EGY Hong Kong HKG
Malaysia MYS

DD Form 1172-2 Instructions (September 2018) 5

 Maldives MDV Peru PER Sudan SDN
Mali MLI Philippines PHL Suriname SUR
Malta MLT Pitcairn Islands PCN Svalbard XSV
Marshall Islands MHL Poland POL Swaziland SWZ
Martinique MTQ Portugal PRT Sweden SWE
Mauritania MRT Puerto Rico PRI Switzerland CHE
Mauritius MUS Qatar QAT Syria SYR
Mayotte MYT Reunion REU Taiwan TWN
Mexico MEX Romania ROU Tajikistan TJK
Micronesia, Federated Russia RUS Tanzania TZA
FSM
States of Rwanda RWA Thailand THA
Midway Islands XMW
Saint Barthelemy BLM Timor-Leste TLS
Moldova MDA Saint Helena, Togo TGO
Monaco MCO Ascension, and Tristan SHN Tokelau TKL
Mongolia MNG da Cunha
Tonga TON
Montenegro MNE Saint Kitts and Nevis KNA
Trinidad and Tobago TTO
Montserrat MSR Saint Lucia LCA
Tromelin Island XTR
Morocco MAR Saint Martin MAF
Saint Pierre and Tunisia TUN
Mozambique MOZ SPM
Miquelon Turkey TUR
Namibia NAM Saint Vincent and the
VCT Turkmenistan TKM
Nauru NRU Grenadines Turks and Caicos
Navassa Island XNV Samoa WSM TCA
Islands
Nepal NPL San Marino SMR Tuvalu TUV
Netherlands NLD Sao Tome and Uganda UGA
STP
Principe
New Caledonia NCL Ukraine UKR
Saudi Arabia SAU
New Zealand NZL United Arab Emirates ARE
Senegal SEN
Nicaragua NIC United Kingdom GBR
Serbia SRB
Niger NER United States USA
Seychelles SYC
Nigeria NGA Unknown AX1
Sierra Leone SLE
Niue NIU Uruguay URY
Singapore SGP
Norfolk Island NFK Uzbekistan UZB
Sint Maarten SXM
Northern Mariana Vanuatu VUT
MNP Slovakia SVK
Islands Vatican City VAT
Norway NOR Slovenia SVN
Venezuela VEN
Oman OMN Solomon Islands SLB
Vietnam VNM
Pakistan PAK Somalia SOM
Virgin Islands. British VGB
Palau PLW South Africa ZAF
Virgin Islands, U.S. VIR
Palestinian Territory PSE South Georgia and
South Sandwich SGS Wake Island XWK
Palmyra Atoll XPL
Islands Wallis and Futuna WLF
Panama PAN South Sudan SSD West Bank XWB
Papua New Guinea PNG Spain ESP Western Sahara ESH
Paracel Islands XPR Spratly Islands XSP Yemen YEM
Paraguay PRY Sri Lanka LKA

DD Form 1172-2 Instructions (September 2018) 6

 Zambia ZMB
Zimbabwe ZWE

Block 9. Date of Birth. Enter the sponsor/employee's date of birth, four-digit year, three
alpha-character month, and two-digit day format (YYYYMMMDD). Use nine characters.

Block 10. Place of Birth. Enter the sponsor/employee's place of birth, including city, state,
and country, if outside the United States.
 Enter the state of the sponsor/employee’s place of birth from the valid codes listed in
Table 7.
 If place of birth is a foreign country, enter the country from the valid codes listed in Table
6.

Table 7. State Abbreviations

Alabama AL Kentucky KY Oklahoma OK

Alaska AK Louisiana LA Oregon OR
American Samoa AS Maine ME Pennsylvania PA
Arizona AZ Maryland MD Puerto Rico PR
Arkansas AR Massachusetts MA Rhode Island RI
California CA Michigan MI South Carolina SC
Colorado CO Minnesota MN South Dakota SD
Connecticut CT Mississippi MS Tennessee TN
Delaware DE Missouri MO Texas TX
District of Columbia DC Montana MT Utah UT
Florida FL Nebraska NE Vermont VT
Georgia GA Nevada NV Virginia VA
Guam GU New Hampshire NH Virgin Islands VI
Hawaii HI New Jersey NJ Washington WA
Idaho ID New Mexico NM West Virginia WV
Illinois IL New York NY Wisconsin WI
Indiana IN North Carolina NC Wyoming WY
Iowa IA North Dakota ND
Kansas KS Ohio OH
 
Block 11. Current Home Address. Enter the number and street of the sponsor/employee's
current home address. Use no more than 27 characters.
 If sponsor is deceased or if address is unknown, leave blank.

Block 12. City. Enter the sponsor/employee's current city of residence. Use no more than
18 characters.
 If the sponsor/employee's address is an Army Post Office (APO) or a Fleet Post Office
(FPO), enter the designation APO or FPO.
 If the sponsor is deceased or city is unknown, leave blank.

DD Form 1172-2 Instructions (September 2018) 7

 Block 13. State. Enter the correct U.S. postal code for the state of the sponsor/employee’s
residence from the valid codes listed in Table 7. Use two characters.
 If the sponsor/employee's address is an APO or FPO, enter the correct APO or FPO State.
 If the sponsor/employee lives outside of the 50 United States, the District of Columbia, or
one of the listed territories and possessions, leave blank.
 If the sponsor is deceased or if the state is unknown, leave blank.

Block 14. ZIP Code. Enter the correct nine-digit ZIP code of the sponsor/employee's current
residence address in the following format: “123456789.” Use no more than nine characters.
 If the last four digits are unknown, enter four zeros (0000); e.g., “123450000.”
 If the sponsor/employee does not reside in one of the 50 states, the District of Columbia,
or one of the territories or possessions, enter the applicable foreign ZIP code, or APO or
FPO number.
 If the sponsor is deceased or if the ZIP code is unknown, leave blank.

Block 15. Country. Enter the sponsor/employee’s correct country of residence from the
valid abbreviations listed in Table 6. Use three characters.
 If the sponsor/employee’s address is an APO or FPO, the country must be “US.”
 If country is unknown, enter AXI.

Block 16. Primary E-mail Address. Enter the sponsor/employee's home/personal e-mail
address as applicable.
 This block may be left blank.
 The “Permission to use for benefits notifications” checkbox can be checked to verify
permission for DoD to contact the included email address with DoD- and Department of
Veterans Affairs (VA)-related benefits notifications.

Block 17. Telephone Number. Enter the sponsor/employee's current residence, duty, or
business telephone number beginning with the area code. Use no more than 10 characters.
 Do not use punctuation to separate area code, prefix, and basic number.
 This block may be left blank.

Block 18. City of Duty Location. Enter the city of the sponsor/employee's duty location.

Block 19. State of Duty Location. Enter the correct U.S. postal code for the state of the
sponsor/employee’s duty location from the valid codes listed in Table 7. Use two characters.
 If the sponsor/employee's address is an APO or FPO, enter the correct APO or FPO State.
 If the sponsor/employee lives outside of the 50 United States, the District of Columbia, or
one of the listed trust territories, leave blank.
 If the sponsor is deceased or if the state is unknown, leave blank.

Block 20. Country of Duty Location. Enter the correct country of the sponsor/employee’s
duty location from the valid codes listed in Table 6. Use three characters.
 If the country is not listed, enter AXI.

DD Form 1172-2 Instructions (February 2014) Page |8

SECTION II – SPONSOR/EMPLOYEE DECLARATION AND REMARKS

Block 21. Remarks. Enter the method of verification and further explanation of qualifying
status.
 Qualifying status may include SF 52, sponsoring agency, and period of DEERS
enrollment, or other appropriate comments, such as particular work assignment.
 This section may be left blank, or prepopulated by the VO.

Block 22. Sponsor/Employee Signature. Block must contain the sponsor/employee’s

signature.
 When the DD Form 1172-2 is not signed in the presence of the VO at the time of DEERS
enrollment, the signature must be notarized. The notary seal and signature should be
placed in the right margin of Block 21.
 The following exceptions to this requirement are authorized:
1. Unremarried or unmarried former spouses shall sign for themselves.
2. When the sponsor is deceased, the survivors shall sign for themselves.
3. When the sponsor is unavailable for signature, the VO shall ensure that the
dependency between the sponsor and family member exists. The VO shall follow the
guidance provided in the applicable Uniformed Service regulation.

Block 23. Date Signed. Enter the date, four-digit year, three alpha-character month, and
two-digit day format (YYYYMMMDD), that the DD Form 1172-2 Block 22 was signed.

SECTION III – AUTHORIZED BY (DoD CAC Sponsors Only)

Block 24. Sponsoring Office Name. Enter the name of the organization the employee works
for or is assigned to.
 The sponsoring official shall be a uniformed service member or civilian employee
working for the sponsoring organization.

Block 25. Contract Number. Enter the contract number for the purposes of entry into the
TASS.

Block 26. Sponsoring Office Address. Enter the number and street, city, state, and zip code
of the employee's sponsoring office address. See Table 7 for state abbreviations.

Block 27. Sponsoring Office Telephone Number. Enter the sponsoring office telephone
number beginning with the area code. Use no more than 14 characters.
 Do not use punctuation to separate area code, prefix, and basic number.

Block 28. Office Email Address. Enter the employee's office e-mail address, as applicable.

DD Form 1172-2 Instructions (February 2014) Page |9

 Block 29. Overseas Assignment. Enter the employee’s country of assignment. See Table 6
for country codes.
 Obtain this information from the employee’s Travel Authorization.

Block 30. Overseas Assignment Begin Date. Enter the employee’s effective begin date,
four-digit year, three alpha-character month, and two-digit day format (YYYYMMMDD),
for the overseas assignment.
 Obtain this information from the employee’s Travel Authorization.

Block 31. Overseas Assignment End Date. Enter the employee’s effective end date, four-
digit year, three alpha-character month, and two-digit day format (YYYYMMMDD), of the
overseas assignment.
 The period of employment may be obtained from the employee’s Travel Authorization.

Block 32. Eligibility Effective Date. Enter the date, four-digit year, three alpha-character
month, and two-digit day format (YYYYMMMDD), the employee’s qualifying status
begins.

Block 33. Eligibility Expiration Date. Enter the date, four-digit year, three alpha-character
month, and two-digit day format (YYYMMMDD), the employee’s qualifying status ends,
not to exceed three years.

Block 34. Sponsoring Official Name. Enter the name of the sponsoring official. Use no
more than 51 characters.

Block 35. Unit/Organization Name. Enter the unit and/or command name for the sponsoring
official. Use no more than 26 characters.

Block 36. Title. Enter the sponsoring official's title. Use no more than 24 characters.

Block 37. Pay Grade. Enter the sponsoring official’s pay grade. Use no more than four
characters.

Block 38. Signature. The sponsoring official must sign in that block.

Block 39. Date Verified. Enter the date, four-digit year, three alpha-character month, and
two-digit day format (YYYYMMMDD), that the DD Form 1172-2 Block 38 was signed.

SECTION IV – VERIFIED BY

Block 40. Verifying Official Name (Last, First, Middle Initial). Enter the VO’s LAST name
first, enter the FIRST name, and then enter the MIDDLE initial or the full MIDDLE name.
Use no more than 51 characters.

Block 41. Site Identification. Enter the VO’s 6-digit site ID.

DD Form 1172-2 Instructions (February 2014) P a g e | 10

 Block 42. Telephone Number (Include Area Code/DSN). Enter the VO’s duty-station or
business telephone number beginning with the area code. Use no more than 10 characters.
 Do not use punctuation to separate area code, prefix, and basic number.

Block 43. Signature. VO must sign in the block.

SECTION V – DEPENDENT INFORMATION

Section A (Blocks 40-51)

Block 44. Name. Enter the dependent’s LAST name first, enter the FIRST name, and then
enter the MIDDLE initial or the full MIDDLE name. Use no more than 51 characters.
 The name field can include a designation of JR, SR, ESQ, or the Roman numerals I
through X. To include that designation, enter the appropriate data after the middle initial.
 The name cannot contain any special characters nor is any punctuation permitted.

Block 45. Gender. Enter the dependent’s gender from the valid codes listed in Table 1. Use
one character.

Block 46. Date of Birth. Enter the dependent’s date of birth, four-digit year, three alpha
character month, and two-digit day format (YYYYMMMDD).

Block 47. Relationship. Enter the dependent’s relationship to the sponsor from the valid
abbreviations listed in Table 9.

Table 9. Relationship Codes

CODE RELATIONSHIP
CH Child
DB DoD Beneficiary
FC Foster Child
PAR Parent
PL Parent-in-law
PACH Pre-adoptive Child
SP Spouse
SC Stepchild
STP Stepparent
SPL Stepparent-in-law
UMW Unmarried Widow(er)
URW Unremarried Widow(er)
WARD Ward

Block 48. SSN or DoD ID Number. Enter the dependent’s SSN, DoD ID number, ITIN or
temporary identification number (TIN).

DD Form 1172-2 Instructions (February 2014) P a g e | 11

  A TIN will be automatically generated by RAPIDS and assigned for categories of
beneficiaries who do not yet have SSNs, such as newborns and foreign spouses, awaiting
an SSN, or for those who do not have and are not eligible for an SSN. Direct care at
military treatment facilities will be suspended if an SSN is not provided within 270 days.
 For initial enrollment an SSN, ITIN or TIN is preferred, and an alternate should not be
used unless the SSN, ITIN or TIN is unavailable.

Block 49. Current Home Address. Enter the number and street of the dependent’s current
home address.

Block 50. Primary E-mail Address. Enter the dependent’s preferred e-mail address as
applicable.
 This block may be left blank.
 For dependents aged 18 and older, check “Permission to use for benefits notifications (18
and above)” to verify permission for DoD to contact the included email address with
DoD- and Department of Veterans Affairs (VA)-related benefits notifications.

Block 51. Telephone Number. Enter the dependent’s primary telephone number beginning
with the area code. Use no more than 10 characters.
 Do not use punctuation to separate area code, prefix, and basic number.
 This block may be left blank.

Block 52. City. Enter the dependent’s current city of residence.

 If the dependent's address is an APO or FPO, enter the designation APO or FPO.

Block 53. State. Enter the correct U.S. postal code for the state of the dependent’s residence
from the valid codes listed in Table 7. Use two characters.

Block 54. Zip Code. Enter the correct nine-digit ZIP Code of the dependent's current
residence address in the following format: “123456789.”
 If the last four digits are unknown, enter four zeros (0000); e.g., “123450000.”
 If the dependent does not reside in one of the 50 United States, the District of Columbia,
or one of the listed trust territories, enter the applicable foreign ZIP Code, or APO or FPO
number.

Block 55. Country. Enter the dependent’s correct country of residence from the valid
abbreviations listed in Table 6. Use three characters.
 If the dependent’s address is an APO or FPO, the country must be “US.”
 If country is unknown, enter AXI.

Block 56. Eligibility Effective Date. Enter the date, four-digit year, three alpha-character
month, and two-digit day format (YYYYMMMDD), the when the dependent’s qualifying
status began.

Block 57. Eligibility Expiration Date. Leave blank.

DD Form 1172-2 Instructions (February 2014) P a g e | 12

Sections B (Blocks 58-71). Enter information following the instructions in Section A.

SECTION VI - RECEIPT

Block 72. Signature. Card recipient must sign in the block. If the recipient is incapable of
signing, the condition must be indicated in that block.

Block 73. Date Issued. Enter the date, four-digit year, three alpha-character month, and two-
digit day format (YYYYMMMDD), the recipient acknowledged receipt of the ID card. Use
nine characters.

DD Form 1172-2 Instructions (February 2014) P a g e | 13