Download the form
The scope here is Department-wide. DD Form 2769 — DD Form 2769, Application for Annuity - Certain Military Surviving Spouses, October 2012 — exists to Application for Annuity - Certain Military Surviving Spouses, and it applies across the services rather than inside one. That is what the DD prefix encodes: joint issue, single edition, every branch and defense agency working from identical paper.
not stated is the prescribing publication and not stated the office responsible for the document. Deadlines belong to local implementing guidance, not to either of those, so a submission date is a question for the receiving office.
Use not stated, status not stated. Older printings circulate widely and lose their currency Department-wide the moment a new edition issues.
Available: PDF, across 2 pages, roughly 49 fields. That is the whole scope of the download decision.
Fillable pdf is the default choice. Its boxes hold typed entries inside the document; the printable release is a static image of the same page with no interactive layer. Since DD forms routinely cross between services and agencies before they are filed, typed entries matter more here than on a form that stays inside one office.
What the form asks for
- Section 1 - Information concerning deceased member. 1. Name of deceased retiree (last, first, middle).
- 2. Social security number or service number. Do not include dashes.
- 3. Date of birth (four digit year, two digit month, two digit day, no dividers).
- 4. Did the deceased member die before March 21, 1974, or, in the case of a reserve member, die before October 1, 1978? Press space bar to mark X in first box if no, second box if yes. If No, you are not eligible.
- If Yes, date of death (4 digit year, 2 digit month, 2 digit day).
- 5. Was the member retired, or in the case of a reserve member eligible for retirement by completing over 20 years of qualifying service? Mark X in first box if yes, second box if no. If no, you are not eligible.
- If Yes, date retired, or in the case of a reserve member, date of retirement eligibility (4 digit year, 2 digit month, 2 digit day).
- 6. Were you legally married to the deceased at the time of death? Mark X in first box if yes, second box if no. If no, you are not eligible.
- If Yes, date of marriage (4 digit year, 2 digit month, 2 digit day).
- 7. Have you ever remarried? Mark X in first box if yes, second box if no. If yes, your eligibility for accruing additional benefits ended on the date you remarried.
- If Yes, date of remarriage (4 digit year, 2 digit month, 2 digit day).
- 8.a. Are you receiving any other military survivor annuity of any kind on the record of this or any other deceased retiree? Mark X in first box if yes, second box if no.
- If yes, monthly amount:
- 8.b. Type of benefit. Mark X if SBP.
- Mark X if M I W.
- Mark X if D I C.
- Section 3 - Information concerning surviving spouse. 9. Name (last, first, middle initial).
- 10. Social security number. Do not include dashes.
- 11. Date of birth (four digit year, two digit month, two digit day).
- 12. Country of citizenship.
- 13. Address (Street, Apartment number, City, State, and Zip code).
- 14. Telephone number (Include area code).
- Section 4 - Electronic Funds Transfer. 15. Routing Transit Number (RTN) (9 digits).
- 16. Account number.
Verify the edition before the first keystroke. The date on the form face should read not stated. If it does not, discard the file. Field numbering shifts between editions, and on a DD form the new layout reaches every receiving office in every service at once — there is no lag during which the old version is still normal somewhere.
Field-level questions go to the printed instructions, then to not stated, which is authoritative.
Route it where not stated or local procedure directs, and keep a copy first. On a Department form the receiving office is frequently outside your own chain — another service, a defense agency, a joint command — which makes recovering a lost original slower than it would be internally.
A number is a complete address in the DD series. Because the sequence is Department-level and not duplicated per service, there is nothing further to specify.
Do not read across from a service number. DA numbering is Army-specific under an Army proponent; DD numbering is Department-wide under not stated or an equivalent Department office. The sequences are unrelated, so identical digits in each identify two different documents. Read the prefix, not the digits.
Editions change when the prescribing directive is reissued, when the data collected changes, or when notice language is amended. None of that reaches you. Checking not stated at download is the entire defence, and it is cheaper than repeating a submission.
What is here is the blank form and a description of it. What is not here is legal guidance or any assurance about a particular filing — this page is not the issuing authority and does not speak for one. Those questions go to not stated, to your servicing administrative office, or to the authority identified in not stated.
Questions and answers
- What is DD Form 2769?
- DD Form 2769, Application for Annuity - Certain Military Surviving Spouses, October 2012
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?