Na Form 13075 - Questionnaire About Military Service printable pdf download

OMB No. 3095-0039 Expires 7/31/2017

QUESTIONNAIRE ABOUT MILITARY SERVICE

1. WHY WE ARE SENDING YOU THIS FORM: We are unable to locate a record with the information provided in your original

inquiry OR the record needed to answer your inquiry was lost in the July 1973 fire that destroyed millions of records at the National

Personnel Records Center. The records stored in the area which suffered the most damage in the fire were those of Army veterans

discharged or deceased between November 1, 1912, and December 31, 1959, AND Air Force veterans discharged, deceased, or

retired before January 1, 1964, whose names come alphabetically after Hubbard, James E.

The information you provide on page 2 of this form may help locate the record, if it is available; or, if the record is not available, it

may enable the Center to make use of various alternate sources to reconstruct some of the basic service record data. Please note

that if the only document you need is the Report of Separation (DD Form 214, WDAGO Form 53-55, etc.), it may be available from a

former employer or from the recorder’s office of the city or county where the veteran lived just after separation/discharge.

2. WHAT YOU NEED TO DO:



Fill out page 2 of this form (NA Form 13075) as completely as possible, as well as any other form(s) you may have

received with this one, such as Standard Form (SF) 180 and NA Form 13055;



Attach copies of any papers you have that relate to the requested military service, such as military orders, award

citations, and military addresses as shown on letters mailed home; and



Send the above item(s) to the National Personnel Records Center at the address shown below or fax to (314) 801-9195.

If we do not receive this information from you within 30 days, your request will be closed without further reply.

3. FEE FOR ARCHIVAL RECORDS: A fee is often required for copies of documents from an archival record. An archival record is

one that was transferred to the legal custody of the National Archives and Records Administration (NARA) 62 years after the subject

of the record was discharged or retired, or died in service. Archival records are open to the public. Access to archival records does

not require written authorization from the veteran or next-of-kin. You will be notified if there is a charge associated with information

from the record you are requesting.

4. MEDALS INFORMATION: Are you requesting military service medals only? If so, do you have a copy of the Report of

Separation (DD Form 214, WDAGO Form 53-55, etc.) and other military papers that show which medals were earned? If you send

such information about medals, you do not need to fill out this NA Form 13075; however, you must return page 2 (with the barcode)

so that we can locate your original request. Finally, if possible, please send a list of the names and locations of all military units or

“outfits” to which the veteran was assigned, including dates, while on active duty. This may help determine eligibility for “unit”

awards.

Special provisions when a record is archival: Only requests from veterans for replacements of awards will be processed without

a fee. All other requesters will be given the opportunity to purchase copies of available archival records in the custody of the

National Archives and Records Administration (NARA). We will not verify entitlement to medals, provide specific documents, or

extract awards information for anyone other than the veteran when the record is archival.

PRIVACY ACT OF 1974 COMPLIANCE INFORMATION

The following information is provided in accordance with 5 U.S.C. 552a(e) (3) and applies to this form. Authority for collection of the information is 44

U.S.C. 2907, 3101, and 3103, and Public Law 104-134 (April 26, 1996), as amended in title 31, section 7701. Disclosure of the information is

voluntary. If the requested information is not provided, it may delay servicing your inquiry because the National Personnel Records Center may not

have all of the information needed to locate the record(s) sought. The purpose of the information on this form is to assist the National Personnel

Records Center in locating the correct military service record(s) or information to answer your inquiry. This form is then filed in the requested military

service record as a record of disclosure. The form may be disclosed to the Department of Defense components or the Department of Homeland

Security (DHS, U.S. Coast Guard), if the National Personnel Records Center transfers all or part of those records to such agency.

If the service

member was a member of the National Guard, the form may be disclosed to the Adjutant General of the appropriate state, District of Columbia, or

Puerto Rico, where he or she served. The form may also be disclosed when the military service member or, in the case of a deceased service

member, the military service department, authorizes a specific individual or organization to have access to the military service record.

PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT

You are not required to provide the information requested on a form that is subject to the Paperwork Reduction Act unless the form displays a valid

OMB control number. The information requested on this form is being collected and used by the National Personnel Records Center to identify and

locate military service records that could not be identified and located in response to the original inquiry. Public burden reporting for this collection of

information is estimated to be five minutes per response, including time for reviewing instructions and completing and reviewing the collection of

information. Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing

this burden, to National Archives and Records Administration (NHP), 8601 Adelphi Road, College Park, MD 20740-6001. DO NOT SEND

COMPLETED FORMS TO THIS ADDRESS. SEND COMPLETED FORMS TO THE ADDRESS BELOW.

Date

Prepared by

AFN-M

NATIONAL PERSONNEL RECORDS CENTER

(Military Personnel Records)

1 Archives Drive

St. Louis, MO 63138-1002

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION