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Appendix 4 COMMANDER S PERFORMANCE FUNCTIONAL STATEMENT AUTHORITY PURPOSE To provide information on the impact a medical impairment has on the ability of military personnel to perform their military duties and to document administrative actions. Section I SOLDIER DEMOGRAPHIC INFORMATION 1. DATE YYYYMMDD 2. LAST NAME FIRST NAME MIDDLE 3. SSN 4. PMOS / BASD INITIAL 4. COMPONENT 5. AGE 6. UNIT OF ASSIGNMENT Section II FUNCTIONAL STATEMENT Descriptio.

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How to fill out the Da Form 7652 online

Filling out the Da Form 7652 online is a crucial step for military personnel to document the impact of a medical impairment on their duties. This guide provides a clear and supportive walkthrough of the form's components to assist users in providing accurate information.

Follow the steps to complete the Da Form 7652 online

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Enter the date in the YYYYMMDD format in the first field. This indicates when the form is filled out.
  3. Fill in the soldier's last name, followed by the first name and middle initial in the designated fields.
  4. Provide the Social Security Number (SSN) in the SSN field, ensuring it is accurate for identification purposes.
  5. Indicate the Primary Military Occupational Specialty (PMOS) and Basic Active Service Date (BASD) accurately.
  6. Select the appropriate component from the dropdown menu to specify the user's military classification.
  7. Input the age of the soldier in the next field. This assists in demographic validation.
  8. Fill in the unit of assignment, clearly stating the current military unit to which the person is attached.
  9. Move to the functional statement section. For each question, select 'Yes' or 'No' and provide necessary comments as required.
  10. Continue to fill out the industrial capacity statement section in the same manner, selecting appropriate responses for each item.
  11. Complete the comments section in Section V if required, detailing any necessary observations or additions.
  12. In Section VI, enter the printed name, rank, title, unit address, phone number, email address, DSN, and fax number of the commander validating the form.
  13. Finally, the commander should sign the form, providing their signature to affirm the accuracy and authenticity of the information presented.
  14. Once all sections are completed, users can save changes, download, print, or share the completed form as needed.

Complete your Da Form 7652 online today for a streamlined documentation process.

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Equipment Receipt (DA Form 3749, Weapons Card) for 24 hours or less. Over 24 hours requires entry on the Weapons Control Log.

A fillable DA 3955 Form is used as a change of address form for Army soldiers. Also known as a Change of Address and Directory Card, the completed form helps soldiers ensure that their mail is delivered. The person completing the form can also request whether their new address should be kept private.

What is DA 31 form? The purpose of the DA 31 form is to authorize military leave; document the start and stop of such leave; record address and telephone number where a soldier may be contacted in case of an emergency during leave; and certify leave days chargeable to a soldier's leave account.

What form is the army weapon qualification card? A fillable DA 3595-R Form is used by the US Army as documentation of a soldier's ability to fire a weapon. this form is also known as a Record Fire Scorecard.

DA Form 7652, Disability Evaluation System (DES) Commander's Performance and Functional Statement, is a form used for recording information on the impact of medical impairment on the ability of a Soldier to perform their duties in the U.S. Army.

A fillable DA 3749 Form is a document used by the US Army. It is also known as an Equipment Receipt. It is completed when equipment is issued to an Army unit. The stock number and serial number for the equipment is listed on this form.

What is the new Army weapons qualification card? The new qualification, the rifle and carbine qualification, was developed with the same principle as the Army Combat Fitness Test. It more holistically assesses a soldier's ability to employ situational awareness, safe weapon handling, and core marksmanship competencies.

DA Form 2142, Pay Inquiry, is a document submitted by the service members when they have questions or concerns regarding their payments.

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