DD 2642 2024-2025 free printable template

Prescribed by: TRICARE Reimbursement Manual 6010.61M, April 2015 & TRICARE Operations Manual 6010.59M, April 2015CUI (when filled in)TRICARE DoD/CHAMPUS MEDICAL CLAIM PATIENT'S REQUEST FOR MEDICAL

How to fill out dd form 2642 download

How to fill out DD 2642

1. Obtain the DD Form 2642 from the appropriate military or government website.
2. Enter your personal information in the designated fields, including name, Social Security Number (SSN), and contact details.
3. Fill out the section describing the type of payment or allowance you are requesting.
4. Provide details of your military service, including branch, rank, and duty status.
5. Attach any required supporting documentation to substantiate your claim.
6. Review the form for accuracy and completeness before signing.
7. Submit the completed DD 2642 to the designated authority as instructed.

Who needs DD 2642?

1. The DD 2642 is primarily needed by military personnel, veterans, and their family members who are requesting payment or allowances related to their service.

Video instructions and help with filling out and completing dd form 2642

Instructions and Help about tricare for life claim submission

This is a demonstration on how to properly fill out a DD Form 1351 tattoo we will cover each block on the form let us begin block one payment electronic funds transfer will always be checked reason being dispersing no longer issues hard checks if you owe on your government travel charge card for more admin 216 / 13 it is mandatory to input the split is person it for the amount charged blocks 2 through 4 in these blocks print your lasts first and middle initial of your name pay grade and your full social security number block 5 type of payment if this is a deity trip ensure that the TRY and member employee box is checked block 6 address here you will provide your house number and Street along with the city state and zip code this address must match the address on the front page of your orders also provide an email address to be best contacted block 7 day time telephone number for this block and put the best day time telephone number so that you may be reached in case of any questions regarding your claim block 8 travel order / authorization number this can be found on the top right-hand side of your orders the standard document number SC n can be located in paragraph 3 of your orders block 9 leave blank this is use for PCs claims only block 10 for dispersing office only this block is used for the dispersing office only however 10 D can be used for extra computations and notes for your travel claim such as leave drills in conjunction back to back orders or to specify a partial claim block 11 organization in station this will be the parent command that authorized your orders block 12 to Penn check on a company reason being your dependents are only authorized for your travel on PCs orders block 13 leave blank this is used for our PCs claim block 14 have household goods been shipped and sure to click now this portion is also used for PCs claims explanation is also for a PCs clean block 15 itinerary please scan forward to the following subtype demonstrations you block 15 is the itinerary it is considered the most important portion of your 1351 tattoo this must be completed accurately we will go over filling out annual training in active-duty PME and a Doss claims as they all resemble each other within the itinerary block 15 eight this is the date you started your travel block 15 B these are the lives of travel in which you executed this should tell the story of your trip block 15 C and D this is the mode of travel this can be located in the second page of your 1351 tattoo Lock 15e this is where you will input the lodging costs this needs to be annotated next to the TD period in which the cost was occurred block 15fps e miles if you drove your personal auto or if you were dropped off by your spouse and put the mileage in the Block next to the PA period you can also utilize 1351 tech to Charlie for more room if needed for blocks 15 A through F for example we will use the dates from 1 September to 12 September 2014 — CamJejunene North Carolina government...

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What is DD 2642?

DD Form 2642 is a military form used for the payment of travel expenses incurred by military members and their dependents.

Who is required to file DD 2642?

Military service members and their dependents who have incurred travel expenses associated with duty assignments, relocations, or authorized travel are required to file DD 2642.

How to fill out DD 2642?

To fill out DD 2642, provide personal identification information, details of travel, itemized expenses, and any required supporting documentation as outlined in the form's instructions.

What is the purpose of DD 2642?

The purpose of DD 2642 is to facilitate the reimbursement of travel expenses for military personnel and their dependents, ensuring proper record-keeping and approval of expenditures.

What information must be reported on DD 2642?

DD 2642 requires the reporting of travel dates, locations, personal identification details, itemized travel expenses, and any necessary backup documentation to substantiate the claimed expenses.