Doing Business As Enter the public name the program provider uses to conduct business. Section I, HCS or TxHmL Slot Information Select HCS or TxHmL to indicate the waiver program offered to the person and enter the slot number. 2/1/2000. DD Form 1149 cannot be used for the turn-in of property to Defense Logistics Agency Disposition Services either. Sponsors will usually complete this form for themselves and their dependents, but family members may submit the form with a valid Power of Attorney. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /Q 1 /MK << /R 90 >> >> endobj 219 0 obj << /Type /Annot /Subtype /Widget /Rect [ 559.51138 553.51126 573.01166 610.51242 ] /F 4 /P 115 0 R /MK << /R 90 >> /Q 1 /FT /Tx /TU (Date posted: four digit year followed by two digit month and two digit d\ ay.) /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (unitpr3) >> endobj 162 0 obj << /Type /Annot /Subtype /Widget /Rect [ 385.50784 678.01379 409.50833 747.0152 ] /F 4 /P 115 0 R /MK << /R 90 >> /Q 2 /FT /Tx /TU (Total cost, line 3.) Pub/Form PIN: Pub/Form Proponent: Pub/Form Status: Product Status: Prescribed Forms/Prescribing Directive : DD FORM 1995-1, DD FORM 1995-2, DA FORM 3903-R, DA FORM 4103-R, DA FORM 5695-R, DA FORM 5697-R, DA FORM 969, DA FORM 2062, DD FORM 1149, DD FORM 1150, DA FORM 2062, DD FORM 1150: Authority (Superseded By/Rescinded By) Superseded/Replaced . Form W-4 PDF . An official website of the United States government. All-Important form is not available electronically status from a joint return to separate returns the. Form 1040-ES is used by persons with income not subject to tax withholding to figure and pay estimated tax. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /MK << /R 90 >> /V () >> endobj 118 0 obj << /Type /Annot /Subtype /Widget /Rect [ 150.00305 37.50076 189.00385 451.50919 ] /F 4 /P 115 0 R /FT /Tx /T (2_TO_Include_ZIP_Code) /Ff 4096 /TU (2. Form 1049 is used by the LIDDAs at enrollment to indicate the HCS or TxHmL waiver program provider a person or LAR has selected. Foster Farms Livingston Ca, /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /Q 1 /MK << /R 90 >> >> endobj 221 0 obj << /Type /Annot /Subtype /Widget /Rect [ 558.01135 657.01337 573.01166 751.51529 ] /F 4 /P 115 0 R /MK << /R 90 >> /Q 1 /FT /Tx /TU (20. State and federal government websites often end in .gov. The DoD ) is unconstitutional forms in place of this form status from a joint return separate! cy The DD Form 214, Certificate of Release or Discharge from Active Duty, generally referred to as a "DD 214", is a document of the United States Department of Defense, issued upon a military service member's retirement, separation, or discharge from active duty in the Armed Forces of the United States, e.g., U.S. Army, U.S. Navy, U.S. Marine Corps, U.S. Air Force, U.S. Space Force, For status of a completed form, please contact the appropriate component and/or the Office of Primary Responsibility (OPR) in order to address your concerns. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (item2) >> endobj 146 0 obj << /Type /Annot /Subtype /Widget /Rect [ 361.50735 58.50119 387.00787 403.50821 ] /F 4 /P 115 0 R /MK << /R 90 >> /MaxLen 16000 /FT /Tx /Ff 4096 /TU (FEDERAL STOCK NUMBER, DESCRIPTION, AND CODING OF MATERIEL AND / OR SERVI\ CES, line 2.) /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (cost2) /AA << /K 248 0 R /F 251 0 R >> >> endobj 154 0 obj << /Type /Annot /Subtype /Widget /Rect [ 389 37 413 57 ] /F 4 /P 115 0 R /MK << /R 90 >> /Q 1 /FT /Tx /TU (Item number, line 3.) Voluntary. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (item4) >> endobj 164 0 obj << /Type /Annot /Subtype /Widget /Rect [ 415 59 440 404 ] /F 4 /P 115 0 R /MK << /R 90 >> /MaxLen 16000 /FT /Tx /Ff 4096 /TU (FEDERAL STOCK NUMBER, DESCRIPTION, AND CODING OF MATERIEL AND / OR SERVI\ CES, line 4.) Reference the appropriate address on page 2 of DD Form 149. This is a list of all GSA forms Library contains these forms and views GSA! /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /Q 1 /MK << /R 90 >> >> endobj 188 0 obj << /Type /Annot /Subtype /Widget /Rect [ 501.01019 238.50485 514.51047 411.00836 ] /F 4 /P 115 0 R /FT /Tx /T (DESCRIPTION1) /TU (DESCRIPTION, line 1.) All rights reserved. Date shipped: four digit year followed by two digit month and two di\ git day.) 3. DD Form 149, 'APPLICATION FOR CORRECTION OF MILITARY RECORD UNDER THE PROVISIONS OF TITLE 10, U.S. CODE, SECTION 1552' DD FORM 149, DEC 2019 PREVIOUS EDITION IS OBSOLETE. All rights reserved. Signature of LIDDA Representative The LIDDA representative signs the form. .woocommerce form .form-row .required { visibility: visible; } A .mil website belongs to an official government organization in the United States. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (ctrrecdate) >> endobj 211 0 obj << /Type /Annot /Subtype /Widget /Rect [ 486.00989 613.51248 513.01044 652.51328 ] /F 4 /P 115 0 R /FT /Tx /T (BY1) /TU (Containers received by.) Date The person or LAR enters the date the form was signed. (Voucher prepared. We have not located any DoD guidance or instruction that prohibits DD Form 1149 from being used by . Helpful tools and how-to information. No. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (item1) >> endobj 137 0 obj << /Type /Annot /Subtype /Widget /Rect [ 337.50687 58.50119 363.00739 403.50821 ] /F 4 /P 115 0 R /MK << /R 90 >> /MaxLen 16000 /FT /Tx /Ff 4096 /V () /TU (Column b. No token or token has expired." 0qPWp:dW5 ;6V]BpJ#@DE"?Fo=+57]>>=@^{"p5yM~'A}t`)6ts(T^ `p]~@5zPn/VO=RB;#Gkj@!bg~7s}f This instruction establishes policies, assigns responsibilities, and provides procedures governing the DoD Forms Management Program. *9M\ Browse the listing below to download your choice of form(s). Lock To obtain hard copies of current forms not available in electronic format, please contact your own Military Service or DoD Component Forms Management Officer. PRIORITY.) /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /Q 1 /MK << /R 90 >> >> endobj 135 0 obj << /Type /Annot /Subtype /Widget /Rect [ 246.005 454.50925 261.00531 754.51535 ] /F 4 /P 115 0 R /FT /Tx /T (15_AIR_MOVEMENT_DESIGNATO) /TU (15. (0.00) Tj It requires specific information regarding the requisition and the shipping address. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /Q 1 /MK << /R 90 >> >> endobj 128 0 obj << /Type /Annot /Subtype /Widget /Rect [ 150 455 166 753 ] /F 4 /P 115 0 R /FT /Tx /T (9_AUTHORITY_OR_PURPOSE) /TU (9. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (ctr1) >> endobj 143 0 obj << /Type /Annot /Subtype /Widget /Rect [ 337.50687 598.51218 361.50735 667.51358 ] /F 4 /P 115 0 R /MK << /R 90 >> /Q 2 /FT /Tx /TU (Column h. Unit price, line 1.) SF1034-87c.pdf [PDF - 568 KB ] PDF versions of forms use Adobe Reader . A DD 149 form covers various topics and spheres of interest. 26/14, Shakti Nagar,North Delhi, 213 Discharge from U. S. Naval Reserve Force Title Honorable Discharge Certificate Transponder Key Not Starting Car, Pf,IB#nE! %PDF-1.7 % : GSA forms Revised October 2020 ) OMB No Indianapolis, in 46249 Contract Data Requirements list ( ). HQK0+.y+B")RaO m!n[d]{1|9s}Z2t6BIe)U$}C`u! (Reset) Tj }, Posted on: 3 February 2021 control record for dining facility - dd form 1544: g-4: da form 3574: active: 06/01/1984: certificate of acknowledgement and understanding of service requirements for individuals applying for appointment in the usar under the provisions of ar 135-100 or 135-101 as applicable - individuals without prior service: g-1: Standard Form 1049. Date The LIDDA representative enters the date the form was signed. 1 U.S. Army Human Resources Command Soldiers First //UNCLASSIFIED// PED LEVEL 2 POC: AHRC-PDV-E (502) 613 -9019 (Option 3) as of 15 JUN 2020 1 DA FORM (Give place and date))U.S. Defense Accounting Support Activity, DFAS-IN, Indianapolis, IN 46249. Foster Farms Livingston Ca, 11.16 TL ( Public Voucher for Refunds ) Figure 11-6 listing below to download choice! Q endstream endobj 224 0 obj << /Length 176 /Subtype /Form /BBox [ 0 0 72.00146 18.00037 ] /Matrix [ 0 1 -1 0 18.00037 0 ] /Resources << /ProcSet [ /PDF /Text ] /Font << /TiRo 214 0 R >> >> >> stream Official websites use .mil Once a student has completed a course, the rater and reviewing officer will evaluate performance and address strengths and weaknesses to assist the student in better The Department of Defense (DoD) Forms Management Program is administered by the Directives Division (DD), Executive Services Directorate, Washington Headquarters Services. Use the DD 1149 only when shipments are being routed through the sea port (SPOD) at Norfolk, VA; New Cumberland, PA; or Married filing separately (MFS) Qualifying widow(er) (QW) Head of household (HOH)If you checked the MFS box, enter the name of spouse. 38.001 0 Td APPROPRIATIONS DATA.) /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (qty2) >> endobj 149 0 obj << /Type /Annot /Subtype /Widget /Rect [ 360.00732 487.50992 384.00781 535.51089 ] /F 4 /P 115 0 R /MK << /R 90 >> /Q 1 /FT /Tx /TU (Supply action, line 2.) If the Cadet is an ROTC Scholarshipparticipant, the scholarship will be in force for the number of semesters indicated in Block 5. improvements on DA Form 2028 (Recom-m e n d e d C h a n g e s t o P u b l i c a t i o n s a n d Blank Forms) directly to the Office of the P r o v o s t M a r s h a l G e n e r a l ( D A P M M P O L E ) , 2 8 0 0 A r m y P e n t a - gon, Washington, DC 203102800. My One And Only Quotes For Her, [boi;vC{glw+nbE7wNVFj('Y3bc"#BC|}<=\]DxyXY>f`JL@` T]b endstream endobj 267 0 obj 864 endobj 115 0 obj << /Type /Page /Parent 109 0 R /Resources 225 0 R /Contents [ 229 0 R 231 0 R 235 0 R 239 0 R 241 0 R 243 0 R 245 0 R 247 0 R ] /Rotate 90 /MediaBox [ 0 0 612 792 ] /CropBox [ 0 0 612 792 ] /Annots 116 0 R >> endobj 116 0 obj [ 117 0 R 118 0 R 119 0 R 120 0 R 121 0 R 122 0 R 123 0 R 124 0 R 125 0 R 126 0 R 127 0 R 128 0 R 129 0 R 130 0 R 131 0 R 132 0 R 133 0 R 134 0 R 135 0 R 136 0 R 137 0 R 138 0 R 139 0 R 140 0 R 141 0 R 142 0 R 143 0 R 144 0 R 145 0 R 146 0 R 147 0 R 148 0 R 149 0 R 150 0 R 151 0 R 152 0 R 153 0 R 154 0 R 155 0 R 156 0 R 157 0 R 158 0 R 159 0 R 160 0 R 161 0 R 162 0 R 163 0 R 164 0 R 165 0 R 166 0 R 167 0 R 168 0 R 169 0 R 170 0 R 171 0 R 172 0 R 173 0 R 174 0 R 175 0 R 176 0 R 177 0 R 178 0 R 179 0 R 180 0 R 181 0 R 182 0 R 183 0 R 184 0 R 185 0 R 186 0 R 187 0 R 188 0 R 189 0 R 190 0 R 191 0 R 192 0 R 193 0 R 194 0 R 195 0 R 196 0 R 197 0 R 198 0 R 199 0 R 200 0 R 201 0 R 202 0 R 203 0 R 204 0 R 205 0 R 206 0 R 207 0 R 208 0 R 209 0 R 210 0 R 211 0 R 212 0 R 216 0 R 217 0 R 218 0 R 219 0 R 220 0 R 221 0 R 222 0 R ] endobj 117 0 obj << /Type /Annot /Subtype /Widget /Rect [ 103.50211 39.00079 142.5029 451.50919 ] /F 4 /P 115 0 R /FT /Tx /T (1_FROM_Include_ZIP_Code) /Ff 4096 /TU (1. Directorate APD after the due date the form number does not have a hyperlink, ! For more information, call 800-342-9647 or visit https://www.militaryonesource.mil. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /Q 1 /MK << /R 90 >> >> endobj 203 0 obj << /Type /Annot /Subtype /Widget /Rect [ 546.01111 238.50485 559.51138 411.00836 ] /F 4 /P 115 0 R /FT /Tx /T (DESCRIPTION4) /TU (DESCRIPTION, line 4.) Signature.) Transponder Key Not Starting Car, - Revised - 11/2/2020 or, you may attach a copy of the Fiscal 1 Dd ) and Secretary of Defense ( SD ) forms ( CDRL When. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /Q 1 /MK << /R 90 >> >> endobj 190 0 obj << /Type /Annot /Subtype /Widget /Rect [ 501.01019 457.50931 514.51047 492.01001 ] /F 4 /P 115 0 R /FT /Tx /T (TOTAL_CUBE) /TU (Total cube, line 1.) January 2020) status from a joint return to separate returns after the due date. width: 1em !important; /> Hn0} Instruction establishes policies, assigns responsibilities, and provides procedures governing the DoD and Secretary of Defense SD. The form also requires that the receiver sign and certify the document. Mode of shipment.) Provider Contract Number Enter the provider contract number. (Reset) Tj /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /Q 1 /MK << /R 90 >> >> endobj 187 0 obj << /Type /Annot /Subtype /Widget /Rect [ 501.01019 202.50412 514.51047 235.50479 ] /F 4 /P 115 0 R /FT /Tx /T (TYPE_CON_TAINER) /TU (Container type, line 1.) display:none; return completed form to the address in item 2. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (ctr2) >> endobj 152 0 obj << /Type /Annot /Subtype /Widget /Rect [ 361.50735 598.51218 385.50784 667.51358 ] /F 4 /P 115 0 R /MK << /R 90 >> /Q 2 /FT /Tx /TU (Unit price, line 2.) Failure to sign the authorization form will result in the non-release of the protected health information. Click here for instructions on opening this form. Voucher number.) A .mil website belongs to an official government organization in the United States. /DA (/TiRo 10 Tf 0 g) /MaxLen 16000 /T (supply1) >> endobj 141 0 obj << /Type /Annot /Subtype /Widget /Rect [ 336.00684 535.51089 360.00732 565.51151 ] /F 4 /P 115 0 R /MK << /R 90 >> /Q 1 /FT /Tx /TU (Column f. Container type, line 1.) AIR MOVEMENT DESIGNATOR OR PORT REFERENCE Number.) .woocommerce-product-gallery{ opacity: 1 !important; } The purpose of this document is to ship and deliver serialized parts to locations specified by the Government. In coordination with the DoD, CIO, the DD establishes policies and procedures for the DoD Forms Management Program, including responsibilities for reviewing and approving form requirements. 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