Download the form
Treat DD Form 2828 as Department-level, which changes how you look for it. Title: DD Form 2828, Physician Certificate for Child Annuitant, November 2006. Function: Physician Certification for Child Annuitant. Because the number carries DD rather than a service prefix, the same edition covers all military departments and the defense agencies at once. Nobody issues a Navy copy or an Air Force copy.
Requirement traces to not stated; the form belongs to not stated. Everything about schedule sits below that in local instruction, which is where to ask if a date matters.
Current edition is not stated, carried as not stated. Check that against any copy you already hold before doing anything else — Department-level revisions land everywhere simultaneously, so a stale file is stale across the whole Department.
The set is PDF. Size: 1 pages, about 24 fields. Everything below refines that choice.
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
- 1. Deceased member's Social Security Number.
- 2. Annuitant's Name, Last, First, Middle Initial
- 3. Date of birth: 4 digit year, 2 digit month, 2 digit day
- 4. Annuitant's Social Security Number.
- 6. Date condition began: 4 digit year, 2 digit month, 2 digit day
- 5. Brief description of medical or psychiatric diagnosis
- 7. Physician's statement. a. I have attended the patient for: enter number of years.
- Enter number of months.
- 7.b. I last examined the patient on: Enter date.
- 7.c. In my opinion the patient is: X one or both. 1. Incapable of self-support
- For the period of time: Enter time period.
- 7.c.2. Mark X if Incapable of handling his/her own financial affairs
- For the period of time: Enter time period.
- d. In my opinion the incapacity is: X first box if permanent, second box if temporary.
- If temporary, expected recovery date: 4 digit year, 2 digit month, 2 digit day
- Mark X if Psychiatrist authorized to practice medicine in the state of.
- 7.e. I am a licensed: Mark X if Physician or practitioner authorized to practice medicine in the state of
- Enter state.
- Enter state.
- 8. I hereby certify that the information above is correct to the best of my knowledge. a. Phsician's Name, Last, First, Middle Initial
- b. Address, Include zip code
- c. Signature
- d. Date: 4 digit year, 2 digit month, 2 digit day
- Press this Reset button to clear the data from all fields.
Start by matching the printed date to not stated. Old blanks accumulate in shared folders for years. Because the Department reissues to all services in one action, nobody is still accepting the previous layout by local custom.
Unclear entries — read the form face, then not stated; the directive prevails.
Send it as not stated or local guidance specifies. Save a copy. Cross-service and cross-agency routing is normal for Department forms, and a lost original outside your own organization is harder to chase down.
Look up cross-referenced forms by series and number. DD numbering is unified across the Department, which removes the usual step of identifying which service issued the thing.
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.
Three drivers of revision: directive reissue, altered collection requirements, updated statutory notice text. No notification accompanies any of them, so download fresh and confirm not stated rather than reusing an archived file.
This page publishes a Defense document and explains its contents. It does not advise, does not rule on applicability, and determines nothing about how a completed form will be treated. Direct such questions to not stated, to the servicing personnel office, or to the office designated in not stated.
Questions and answers
- What is DD Form 2828?
- DD Form 2828, Physician Certificate for Child Annuitant, November 2006
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?