For use of this form, see PAM 600-8; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, USC, Section 3013, E.O. 9397 (SSN), as amended
PRINCIPAL PURPOSE: To request or record personnel actions for or by Soldiers in accordance with DA PAM 600-8.
The DoD Blanket Routine Uses that appear at the beginning of the Army's compilation of systems of records may
apply to this system.
Voluntary; however failure to provide Social Security Number may result in a delay or error in processing the
request for personnel action.
1. THRU (Include ZIP Code)
3. FROM (Include ZIP Code)
2. TO (Include ZIP Code)
SECTION I - PERSONAL IDENTIFICATION
5. GRADE OR RANK/PMOS/AOC
4. NAME (Last, First, MI)
6. SOCIAL SECURITY NUMBER
SECTION II - DUTY STATUS CHANGE (AR 600-8-6)
7. The above Soldier's duty status is changed from
SECTION III - REQUEST FOR PERSONNEL ACTION
8. I request the following action: (Check as appropriate)
Service School (Enl only)
Special Forces Training/Assignment
ROTC or Reserve Component Duty
On-the-Job Training (Enl only)
Volunteering For Oversea Service
Retesting in Army Personnel Tests
Reassignment Married Army Couples
Leave - Excess/Advance/Outside CONUS
Reassignment Extreme Family Problems
Change of Name/SSN/DOB
Exchange Reassignment (Enl only)
Officer Candidate School
Asgmt of Pers with Exceptional Family Members
9. SIGNATURE OF SOLDIER (When required)
10. DATE (YYYYMMDD)
SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet)
SECTION V - CERTIFICATION/APPROVAL/DISAPPROVAL
11. I certify that the duty status change (Section II) or that the request for personnel action...