Get the free DA Form 1622 - armypubs army

BOND FOR SAFEKEEPING OF GOVERNMENT PROPERTY ISSUED TO EDUCATIONAL INSTITUTIONS DATE For use of this form, see AR 735-5, the proponent agency is DIALOG PRINCIPAL: SURETY: AMOUNT OF BOND (in words and

How to fill out da form 1622

How to fill out DA Form 1622:

1. Begin by obtaining the necessary information. DA Form 1622 is used to request support for non-Department of Defense (DoD) medical care. Ensure that you have all the details required to accurately fill out the form, such as the patient's personal information, medical condition, and the specific medical care needed.
2. Start filling out the form by entering the patient's full name, Social Security number, and date of birth in the designated sections. Provide accurate and up-to-date information to avoid any confusion or delays in processing the request.
3. Proceed to the next section where you will indicate the patient's current medical condition or the reason for seeking non-DoD medical care. Clearly describe the ailment or injury, providing as much detail as possible to facilitate a proper evaluation and decision by the approving authorities.
4. In the subsequent sections, provide information regarding the desired course of medical care. Specify the type of treatment, medical facility, and location where the patient wishes to receive the non-DoD medical care. Include any additional details or special requests if necessary.
5. If applicable, fill out the sections related to travel arrangements and accommodations. This includes indicating the method of transportation, preferred dates of travel, and any specific needs for lodging or special arrangements during the travel period.
6. The final section of the form requires the patient or the submitting authority's signature, indicating that all the information provided is accurate and complete to the best of their knowledge. Review the form thoroughly before signing to ensure its accuracy and completeness.

Who needs DA Form 1622:

1. Service members or their dependents who require non-DoD medical care may need to fill out DA Form 1622. This form is typically used when seeking medical treatment or services that are not available or not authorized through the Department of Defense healthcare system.
2. It is important to consult with the appropriate military healthcare provider or authorized personnel to determine if the use of DA Form 1622 is required for a particular situation. They can provide guidance on when and how to properly complete the form based on individual circumstances.
3. Additionally, it's essential to familiarize oneself with the specific policies and regulations of the military branch or service regarding non-DoD medical care. Understanding the eligibility criteria, approval process, and any supporting documentation requirements can help ensure a smooth and timely submission of DA Form 1622.

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What is da form 1622?

Da form 1622 is a form used by the United States Department of the Army for reporting potential incidents of mishandled classified information.

Who is required to file da form 1622?

Any individual who has knowledge of a potential mishandling of classified information is required to file da form 1622.

How to fill out da form 1622?

Da form 1622 must be filled out with details of the potential mishandling of classified information, including the date, time, location, and individuals involved.

What is the purpose of da form 1622?

The purpose of da form 1622 is to ensure that potential incidents of mishandled classified information are reported and investigated in a timely manner.

What information must be reported on da form 1622?

Da form 1622 must include details of the incident, such as the nature of the mishandling, the individuals involved, and any relevant circumstances.