Changes to Form

CHANGES TO FORM DD 1172-2

1. Include a permission box to use email address for benefits notification in block 16;
   
   

2. Add a section to capture Verifying Official (VO) name, Site ID, telephone number, and signature;
   
   

3. Add blocks to capture a dependent’s (aged 18 and over) primary email address and a permission box to use email address for benefits notification;
   
   

4. Add blocks to capture a dependent’s telephone number;

5. Agency Disclosure Notice – adjusted burden to 3 minutes.