You have arrived looking for DD Form 2828. Before you download, confirm this is the right document: Physician Certification for Child Annuitant. Full title: DD Form 2828, Physician Certificate for Child Annuitant, November 2006.
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.
After that, turn to timing. The requirement comes from not stated; the form is maintained by not stated. Local implementing instructions fill in the dates, so check with the office that will receive your copy.
Before you download, pick your approach — editable file or printed page. What follows covers the formats first, then the entries, then what you do afterward.
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.
Before your first entry, look at the corner of the page and compare the printed date with not stated. If they do not match, stop and download again. Old copies circulate in shared drives for years, and a DD form is revised centrally for every service at once, so a superseded blank may not carry the fields your reviewer expects.
Take the fields in order and answer all of them. Mark inapplicable items N/A instead of leaving white space. When you reach a date, copy the format shown on the form, since a reviewer reading a different convention may misread your entry entirely.
Do not skip past the Privacy Act Statement. It is placed ahead of the personal data fields on purpose: it explains under what authority you are being asked, what happens to the information, and what follows if you decline. Take the minute it costs.
Finish with the certification. Print the form and sign in ink, or apply a digital signature with your CAC if the receiving office accepts one. Do not type your name in the signature box and consider it done; that is a name, not a signature. Date the block immediately after signing.
Run a final pass over the form. The errors that send it back are the same ones every time: old edition, gaps in required fields, unreadable handwriting on a scan, non-conforming dates, no signature or no date.
Look up an unclear item on the form face before anywhere else, then in not stated. Should the two texts conflict, the directive is the one you follow.
Download the form
Begin by choosing a file. Available here: PDF. Plan for 1 pages and about 24 entries.
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
- 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.
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.
Should you need a related form, look it up by its number. The DD sequence is Department-wide, which makes your search simple: no service qualifier, no branch-specific variant to track down.
Watch out for one trap here. If your instructions cite a DA form as well, do not assume the numbers are connected. DA numbering belongs to the Army alone; DD numbering belongs to the Department and is administered by not stated or another Department office. The same number in each system means two unrelated forms, so read the prefix before you download.
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.
One thing this page does not do: tell you whether your submission will be accepted. We publish the document and explain how to complete it, and that is where our role ends. Nothing here is legal advice. Take questions about eligibility, applicability or procedure to not stated, to your servicing personnel office, or to the office named 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?