Start here if you have been told to submit DD Form 2215. First, know what you are filling: Reference Audiogram. The document is titled DD Form 2215, Reference Audiogram, January 2000.
Your second step is the edition, not stated, listed as not stated. Your third is scope. Because the number carries a DD prefix, you use the same blank as every other military department and defense agency; no service-specific version exists for you to hunt down.
Once you know the form fits, find out when you file it. not stated sets the requirement, and not stated maintains the form itself. Your own command or agency adds local timing on top of that, so ask your administrative office if the deadline matters to you.
Last in this stage, choose your method: complete it on screen, or print the blank form and fill it out in pen. The sections below take each route step by step.
Begin at the top and move down. Enter your identifying data first, then the body of the form, then the signature block. The sequence is printed in that order because entries below frequently follow from entries above.
Check the edition before you type a word. The date appears on the face of the form; it should read not stated. When it does not, discard the file and take a fresh copy from this page. Department-level revisions replace the blank across all services simultaneously, which means an old printout can be out of step everywhere.
If a particular field puzzles you, read the instructions printed on the form first, then go to not stated. When the two disagree, follow the directive.
Download the form
First, look at what you can download. The set covers PDF, the form runs 2 pages, and you will complete roughly 50 fields.
Choose pdf as your default. Next, click inside a box. A fillable pdf responds by outlining the field and letting you type; the text stays in the document when you save it. A printable pdf does not respond, which tells you to print the page and complete it by hand.
Go with the typed route whenever the choice is yours. Consider what happens after you submit: the copy gets scanned, forwarded and filed, and each pass costs handwriting some legibility. Block letters help if you are stuck with a pen.
Before you take the xfdl file, make sure you can open it. Install IBM Lotus Forms Viewer or an equivalent client first, because your pdf reader will refuse the file. Then download and complete it as normal.
All of it downloads free. When you are ready to work, do this: save the file locally, then open it in a full pdf application. Browsers often ignore field properties, and you can lose everything you typed.
What the form asks for
- Press this reset button to clear the data from all fields
- 1. Zip code, A. P. O., F. P. O., P. A. S.
- 2. D. O. D. component. Enter A. for army, F. for air force, N. for navy, M. for marine corps
- 3. Service component. Enter R for Regular, V for Reserve, G for National Guard, or 1 for other.
- 4. Social security number. Do not include dashes.
- 5. Name (last, first, middle initial).
- 6. Date of birth. (4 digit year, 2 digit month, 2 digit day)
- 7. Sex. Enter M if male, F if female.
- 8. Pay grade, uniformed services.
- 9. Pay grade, civilian.
- 10. Service duty occupation code.
- 11. Mailing address of assignment.
- 12. Location - place of work.
- 13. Major command.
- 14. Duty telephone (include area code).
- Audiometry Section. Item 15. Reason for conducting audiogram. Enter number in box for reason to complete reference audiogram. Enter 1 for individual has not yet worked in hazardous noise duty areas, and no reference audiogram has been accomplished. Enter 2 for individual has worked in hazardous noise duty areas but reference audiogram has been lost or was never accomplished. Enter 3 for individual has worked in hazardous noise duty areas and requires revised reference audiogram following completion of hearing conservation follow up program.
- 17. Date of audiogram (4 digit year, 2 digit month, 2 digit day).
- 16. Audiometric data. Left, 500.
- Left, 1000
- Left, 3000
- Left, 4000
- Left, 6000
- Left, 2000
- Right, 500
Now that it is complete, send it where not stated or your local procedure says it goes. Before you do, make yourself a copy — scan it or save the file elsewhere. It costs you nothing and saves you the whole exercise if the original goes missing.
If the form points you to another document, you can find it by number alone. DD numbering runs across the whole Department, so you do not need to work out which service issued it — one number, one form, everywhere.
Here is where people go wrong. They see a number in an instruction and download whichever form matches it. But DA and DD are separate systems — Army-specific in one case, Department-wide under not stated in the other — so check which series you were sent to before you take the file.
Do not archive this file and reuse it in a year. Forms are reissued as directives are revised, as data requirements shift, and as statutory notice text is amended. Your protection is simple: download fresh each time and confirm the edition date.
Finally, understand the limits of what you have read. This page distributes a published Department of Defense form and describes how to fill it out. It does not give legal or procedural advice, and it cannot promise any outcome for your particular case. For that, contact not stated, your administrative office, or the authority identified in not stated.
Questions and answers
- What is DD Form 2215?
- DD Form 2215, Reference Audiogram, January 2000
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?