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The DD Form 2766, also known as the Adult Preventive and Chronic Conditions Worksheet, is typically completed by military personnel who are on active duty. It is used to assess the health and medical history of the individual, and to identify any preventive or chronic conditions that require treatment or monitoring.
DD 2766 is available through the Navy supply system using S/N 0102-LF-984- 8400 and the DD 2766C is available using S/N 0102-LF-984-9600 ordering through the Navy Forms OnLine Web site at: , these forms may not be reproduced; they must be used in the card stock format.
A NOTARY PUBLIC OR SBP COUNSELOR MUST WITNESS THE MEMBERS SIGNATURE. The witness cannot be the members spouse, or beneficiary.
PRINCIPAL PURPOSE(S): To establish a Survivor Benefit Plan election for the eligible former spouse of a servicemember. ROUTINE USE(S): To former spouses for purposes of providing information, consistent with the requirements of 10 U.S.Code, Section 1450(f)(3), regarding Survivor Benefit Plan coverage.
If your NOE is dated on or after January 1, 2001, you will receive automatic RCSBP coverage if you have a dependent Spouse and or children and fail to properly complete the DD Form 2656 -5 within 90 days of receiving your NOE.
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RETIRING MEMBERS must complete required section of DD Form 2656 to elect coverage for former spouse or former spouse and child(ren).
AUTHORIZATION TO START, STOP OR CHANGE AN ALLOTMENT PRIVACY ACT STATEMENT. AUTHORITY: 37 U.S.C. Section 701, Members of the Army, Navy, Air Force, and Marine Corps; contract surgeons. PRINCIPAL PURPOSE: To permit starts, changes, or stops to allotments.
The DD Form 2656-7 is used to establish the Survivor Benefit Plan after the passing of an active, reserve, or retired military service member. This checklist is designed for use by the spouse (widow or widower), eligible former spouse, or child of a deceased military member/retiree.