Dd Form 93 - Record For Emergency Data

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RECORD OF EMERGENCY DATA
PRIVACY ACT STATEMENT
AUTHORITY: 5 USC 552, 10 USC 655, 1475 to 1480 and 2771, 38 USC 1970, 44 USC 3101, and EO 9397 (SSN).
PRINCIPAL PURPOSES: This form is used by military personnel and Department of Defense civilian and contractor personnel, collectively referred to
as civilians, when applicable. For military personnel, it is used to designate beneficiaries for certain benefits in the event of the Service member's
death. It is also a guide for disposition of that member's pay and allowances if captured, missing or interned. It also shows names and addresses of
the person(s) the Service member desires to be notified in case of emergency or death. For civilian personnel, it is used to expedite the notification
process in the event of an emergency and/or the death of the member. The purpose of soliciting the SSN is to provide positive identification. All items
may not be applicable.
ROUTINE USES: None.
DISCLOSURE: Voluntary; however, failure to provide accurate personal identifier information and other solicited information will delay notification and
the processing of benefits to designated beneficiaries if applicable.
INSTRUCTIONS TO SERVICE MEMBER
INSTRUCTIONS TO CIVILIANS
This extremely important form is to be used by you to show the names and
This extremely important form is to be used by you to show the
addresses of your spouse, children, parents, and any other person(s) you
names and addresses of your spouse, children, parents, and any
would like notified if you become a casualty (other family members or fiance),
other person(s) you would like notified if you become a casualty.
and, to designate beneficiaries for certain benefits if you die. IT IS YOUR
Not every item on this form is applicable to you. This form is used
RESPONSIBILITY to keep your Record of Emergency Data up to date to show
by the Department of Defense (DoD) to expedite notification in
your desires as to beneficiaries to receive certain death payments, and to
the case of emergencies or death. It does not have a legal impact
show changes in your family or other personnel listed, for example, as a result
on other forms you may have completed with the DoD or your
of marriage, civil court action, death, or address change.
employer.
IMPORTANT: This form is divided into two sections: Section 1 - Emergency Contact Information and Section 2 - Benefits Related
Information. READ THE INSTRUCTIONS ON PAGES 3 AND 4 BEFORE COMPLETING THIS FORM.
SECTION 1 - EMERGENCY CONTACT INFORMATION
1. NAME
2. SSN
(Last, First, Middle Initial)
b. REPORTING UNIT CODE/DUTY STATION
3a. SERVICE/CIVILIAN CATEGORY
MARINE CORPS
AIR FORCE
ARMY
NAVY
DoD
CIVILIAN
CONTRACTOR
4a. SPOUSE NAME
(If applicable) (Last, First, Middle Initial)
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
SINGLE
DIVORCED
WIDOWED
5. CHILDREN
c. DATE OF BIRTH
b. RELATIONSHIP
d. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
a. NAME (Last, First, Middle Initial)
(YYYYMMDD)
6a. FATHER NAME
(Last, First, Middle Initial)
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
7a. MOTHER NAME
(Last, First, Middle Initial)
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
8a. DO NOT NOTIFY DUE TO ILL HEALTH
b. NOTIFY INSTEAD
N/A
9a. DESIGNATED PERSON(S)
(Military only)
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
10. CONTRACTING AGENCY AND TELEPHONE NUMBER
(Contractors only)
DD FORM 93, JAN 2008
PREVIOUS EDITION IS OBSOLETE.
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