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The DD 2828 form is a crucial document for families navigating the complex landscape of military annuities, specifically regarding child beneficiaries who may require special consideration due to incapacity. This form serves as a Physician Certificate for Child Annuitants, allowing families to certify that an unmarried child is either mentally or physically incapacitated and thus eligible for benefits under various military survivor plans. The form collects essential details such as the child's name, date of birth, and Social Security number, along with vital medical information, including a physician's evaluation and diagnosis. Thorough completion of this form not only helps determine the eligibility for continued benefits but also mandates recertification every two years for those aged 18 and older if the incapacity is deemed temporary. Importantly, the collection of this information is guided by federal regulations and is designed to respect the privacy of those involved while ensuring compliance with established benefit protocols. Adhering to the procedures outlined in the form is essential, as failure to do so could result in the cessation of annuity payments, adding further strain to families already facing hardship.

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

Form Characteristics

Fact Name Description
Purpose The DD Form 2828 is used to certify the medical or psychiatric condition of a child annuitant who is eligible for benefits due to incapacitation.
OMB Approval This form has been assigned OMB No. 0730-0011, and its approval will expire on June 30, 2023.
Estimated Response Time It typically takes an average of 2 hours for respondents to complete the DD Form 2828, including preparation and review.
Submission Guidelines Completed forms should be returned to the Defense Finance and Accounting Service at the specified address; they must not be sent to the OMB or other organizations.
Privacy Act Compliance The form is governed by the Privacy Act and discloses information only as permitted under relevant regulations.
Required Recertification If the child’s incapacitation is temporary, recertification is necessary every 2 years after the age of 18 to maintain annuity payments.
Legal Authority The governing laws include 10 U.S.C., focusing on “Eligible Beneficiaries,” “Definitions,” and details concerning the Survivor Benefit Plan.
Disclosure Policy Providing information is voluntary; however, failing to submit this form may halt annuity payments.
Penalties Penalties for false claims or statements include fines up to $10,000, imprisonment for up to 5 years, or both.

Guidelines on Utilizing Dd 2828

Completing the DD 2828 form is an essential step in the annuitant process for children who are incapacitated. This form requires specific information from a physician and should be filled out accurately to ensure there are no delays in receiving benefits. Below are step-by-step instructions to guide you through filling out this important document.

  1. Enter the Deceased Member's Social Security Number in the first box at the top of the form.
  2. Fill in the Annuitant's Name by writing the last name, first name, and middle initial in the second box.
  3. Provide the Annuitant's Date of Birth in the format YYYYMMDD in the third box.
  4. Input the Annuitant's Social Security Number in the fourth box.
  5. Fill in the Date Condition Began in the format YYYYMMDD in the sixth box.
  6. In the fifth box, write a brief description of the medical or psychiatric diagnosis affecting the annuitant.
  7. Complete the Physician's Statement section:
    • Specify how long the physician has attended to the patient in years or months.
    • Indicate the last examination date of the patient.
    • Choose one or both options to describe if the patient is incapable of self-support or handling financial affairs.
    • Select whether the incapacity is permanent or temporary. If temporary, provide an expected recovery date.
    • Ensure that the physician’s qualifications are noted, including whether they are a licensed physician or practitioner.
  8. Physician's Certification:
    • Print the physician’s name in the designated area.
    • Fill in the physician’s address, including ZIP code.
    • Sign the form and include the date in the format YYYYMMDD.
  9. Review the entire form to make sure all information is accurate and complete before submitting.

After filling out the form, it needs to be returned to the Defense Finance and Accounting Service at the address provided. Ensuring the form is completed thoroughly will help avoid any disruptions in benefit payments associated with the annuitant.

What You Should Know About This Form

What is the purpose of the DD 2828 form?

The DD 2828 form, officially known as the Physician Certificate for Child Annuitant, serves a specific purpose. It is used to certify the incapacity of a child annuitant who is unmarried and unable to support themselves due to physical or mental conditions. This form is an essential part of the process for ensuring that children who depend on certain benefits, such as the Survivor Benefit Plan, continue to receive them.

Who needs to complete the DD 2828 form?

This form must be completed by a licensed physician who has treated the child annuitant. It includes important details about the child's medical condition and confirms whether they are incapable of self-support. It is important that the physician provides an accurate and honest assessment to prevent potential penalties related to false claims.

How often do I need to submit the DD 2828 form?

If the child annuitant's incapacity is temporary, the DD 2828 form must be recertified every two years once the child reaches the age of 18. This means that the physician will need to reassess the child's condition and provide updated information on their ability to support themselves. If the incapacity is permanent, continuous certification may not be needed.

Where do I send the completed DD 2828 form?

Once you have filled out the DD 2828 form, do not return it to the organization that provided the instructions. Instead, it should be mailed to the Defense Finance and Accounting Service at U.S. Military Annuitant Pay, 8899 E 56th Street, Indianapolis, IN 46249-1300. Make sure to send it to the correct address to avoid delays in processing.

What happens if I do not submit the DD 2828 form?

If the Defense Finance and Accounting Service does not receive the DD 2828 form, the annuity payments for the child annuitant may stop. Compliance with this requirement is essential to ensure continuous receipt of benefits. It is crucial to submit the form in a timely manner to avoid interruptions in support.

Common mistakes

Filling out the DD Form 2828 can be a straightforward process, but several common mistakes often hinder its completion. First and foremost, many individuals overlook the importance of accuracy in the Social Security Number (SSN) of the deceased member. An incorrect SSN can delay processing and even result in the loss of benefits. Always double-check this information before submission.

Another frequent error involves the failure to provide a complete and clear description of the medical or psychiatric diagnosis in item 5. This section needs to be detailed yet concise. Providing vague or unclear descriptions can lead to questions or rejections, prolonging the process for financial assistance.

Many people also neglect to fill in the date when the condition began—required in item 6. This omission can cause significant complications, particularly if the annuitant's eligibility is questioned based on the timeline of their incapacity. Include this information clearly and accurately to facilitate processing.

Additionally, in item 7, the physician’s statement must provide specific details regarding their relationship with the patient. Some individuals forget to indicate how long they have attended to the patient. Clearly stating the duration not only helps clarify the physician's familiarity with the patient's condition but also strengthens the application.

An equally important mistake occurs when individuals select "temporary" in item 7 without providing an expected recovery date. If the incapacity is said to be temporary, the lack of a recovery date can create confusion. Always ensure this date is included, if applicable.

Incorrect designation of the physician's qualifications in item 7e is another issue. Some may inaccurately state their profession or qualifications in this section. It is essential to confirm that the physician is duly licensed and authorized to practice medicine as per the regulations of their state. Failure to do so can render the certification invalid.

Furthermore, individuals often forget to sign and date the form, which is crucial for its validity. The absence of a signature can lead to processing delays and can cause significant frustration for families in need of support.

Finally, be mindful of the submission guidelines. It is common for individuals to send the completed form to the wrong address. Always refer to the instructions provided within the form and ensure that it reaches the Defense Finance and Accounting Service at the correct location. This attention to detail can save time and prevent unnecessary complications in receiving benefits.

Documents used along the form

The DD Form 2828 is an essential document used for certifying a child's incapacity for the Survivor Benefit Plan (SBP) and the Retired Serviceman's Family Protection Plan (RSFPP). Along with this form, several other documents and forms often play a critical role in the application process. Here’s a brief overview of some commonly used forms that may accompany the DD Form 2828.

  • DD Form 214: This form provides a record of a service member's active duty service. It contains important information regarding the member's military history, which is fundamental for determining eligibility for benefits.
  • SF 180: This is the request for military records. Individuals may use this form to obtain copies of their military personnel file, which can help in verifying service details necessary for benefit claims.
  • VA Form 21-526EZ: This form is used to apply for disability compensation through the Department of Veterans Affairs. It is important for establishing any disability status and relevant benefits for the annuitant.
  • Social Security Form SSA-827: This is the authorization for the release of medical information. It allows the Social Security Administration to obtain medical records, which can support claims regarding the child's incapacitation.

Each of these forms serves a crucial purpose in the overall process of applying for or certifying benefits. Being prepared with the necessary documents ensures a smoother experience, allowing for timely processing of claims and entitlements.

Similar forms

  • DD Form 214: This form summarizes a service member's active duty service and character of discharge. Similar to the DD 2828, it requires verification of personal details and plays a crucial role in determining eligibility for benefits.
  • VA Form 21-2680: Also known as the Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, this document assesses an individual's need for assistance due to medical conditions. Like the DD 2828, it necessitates a physician's statement regarding the individual's health and capabilities.
  • SF 2809: The Health Benefits Election Form allows federal employees and retirees to enroll in health insurance plans. This form, similar to DD 2828, requires detailed personal information and is utilized to establish eligibility for benefits related to health care needs.
  • Form SSA-827: This is the Authorization to Disclose Information to the Social Security Administration. It typically involves medical information and patient details, akin to the DD 2828, which relies on a physician’s input regarding a child's incapacity for benefit determination.

Dos and Don'ts

When filling out the DD 2828 form, consider the following guidelines to ensure accuracy and compliance.

  • Review the Instructions: Always read the instructions thoroughly before starting the form. It can help prevent mistakes.
  • Provide Complete Information: Fill in every required section without leaving anything blank. Incomplete information can lead to delays.
  • Double-Check Social Security Numbers: Verify all SSNs for both the deceased member and the annuitant are accurate to avoid processing issues.
  • Maintain Professionalism: Ensure the physician's statement is detailed and written clearly. A vague statement may be questioned.
  • Use Required Dates: When entering dates, follow the YYYYMMDD format as specified. This consistency is important.
  • Sign and Date the Form: Make sure the physician who completed the form signs and dates it. An unsigned form may be rejected.
  • Avoid Returning to the Wrong Office: Remember to send the completed form to the correct address: Defense Finance and Accounting Service, U.S. Military Annuitant Pay.

Following these tips will help streamline the submission process and ensure that all necessary information is provided for the consideration of annuity payments.

Misconceptions

When it comes to the DD 2828 form, misconceptions can often lead to confusion and misunderstandings. Here are ten common misconceptions explained for better clarity.

  1. Only military members need to fill out the DD 2828 form. Many believe that only service members are required to complete this form. In fact, it is primarily used for child annuitants who are eligible for benefits.
  2. The DD 2828 form is optional. Some think that submitting this form is merely a suggestion. However, if the Defense Finance and Accounting Service (DFAS) does not receive the required information, benefits may be stopped.
  3. This form is only needed for children under 18. Although it's common for parents to think this form only applies to minors, it is also necessary for adult children with disabilities who require ongoing support.
  4. A physician's signature is not needed. Many may believe that self-certification is acceptable. However, the form specifically requires a licensed physician’s verification of the child annuitant's incapacity.
  5. Submitting the form will automatically continue benefits. A misconception exists that once the form is submitted, benefits are guaranteed. Regular recertification is required, especially every two years for adult child annuitants.
  6. Any doctor can complete the form. There is a belief that any healthcare provider can verify the incapacitation. However, the physician must be licensed and authorized to practice medicine in the relevant state.
  7. The DD 2828 form can be submitted to any military office. Many assume they can return the form to any military facility. It is crucial to send it directly to the address specified for DFAS, to ensure processing.
  8. The information provided is not confidential. Some may overlook the importance of privacy. The form contains sensitive information and is protected under the Privacy Act, ensuring confidentiality regarding the details provided.
  9. Filling out the form is a quick process. People often underestimate the time needed to complete the DD 2828. It can take approximately two hours to gather the necessary information and complete the form accurately.
  10. False statements won't have serious consequences. There is a belief that providing inaccurate information is inconsequential. However, making false claims can lead to severe penalties, including fines and possible imprisonment.

Understanding these misconceptions can help ensure that the DD 2828 form is completed accurately and efficiently, ultimately benefiting eligible child annuitants.

Key takeaways

Filling out the DD 2828 form is a key step for parents or guardians seeking benefits related to a child annuitant. Here are some essential takeaways to consider:

  • Purpose of the Form: The DD 2828 form is used to certify the medical status of a child annuitant who is unable to support themselves due to mental or physical incapacitation.
  • Recertification Requirements: If the incapacity is temporary, you must recertify every two years once the child annuitant turns 18.
  • Information Needed: Prepare to provide details such as the child annuitant's name, date of birth, SSN, and a brief description of their medical condition.
  • Physician's Role: A licensed physician must fill out the relevant sections, including their opinion on the child's ability to manage personal and financial affairs.
  • Submission Location: Do not send the completed form to the Department of Defense. Instead, submit it to the Defense Finance and Accounting Service at the designated address.
  • Importance of Accuracy: Ensure all information provided is accurate. Penalties for false statements can include fines and imprisonment.
  • Privacy Considerations: Understand that the information collected is protected under the Privacy Act. It may be shared with certain agencies as required.
  • Time Commitment: Completing the form generally takes about two hours. Be sure to allocate sufficient time for gathering necessary information and reviewing instructions.

Following these guidelines can help streamline the application process and ensure compliance with all necessary requirements.