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Da 1058 Example Form

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USES: To identify the applicant as a Reserve Component member and to issue active duty for special work or active duty for training orders. DISCLOSURE: Completing this form is mandatory for individuals applying for active duty for special work and active duty for training. If not completed, you will be ineligible for the requested tour. PART I - APPLICANT (Read instructions in AR 135-200 before completing this form.) 1. TO (Include ZIP Code) IMCOM G9 All Army Sports Fort Sam Houston, TX...

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What is the DA Form 1058?

The DA Form 1058, also known as the DA 1058, is a critical document used by the United States Army. It serves as a request for a soldier to be placed on the Temporary Disability Retired List (TDRL) or the Permanent Disability Retired List (PDRL). This form is essential for soldiers who are undergoing medical evaluation and need to formalize their status regarding military retirement due to disability. Understanding the purpose and implications of the DA Form 1058 is vital for service members navigating the disability retirement process.

How to Use the DA Form 1058

Using the DA Form 1058 involves several steps to ensure proper submission and processing. First, soldiers must accurately fill out the form, providing all required personal and medical information. It is crucial to review the form for completeness and accuracy before submission. Once completed, the form should be submitted to the appropriate military personnel office or medical evaluation board. Soldiers may also need to gather supporting documentation, such as medical records, to accompany the form. Ensuring that all information is correct and all necessary documents are included can expedite the processing of the request.

Steps to Complete the DA Form 1058

Completing the DA Form 1058 requires careful attention to detail. Here are the steps to follow:

  • Begin by entering personal information, including name, rank, and service number.
  • Provide details regarding the medical condition prompting the request for disability retirement.
  • Attach any necessary medical documentation that supports the claim.
  • Review the form for accuracy, ensuring all fields are filled out correctly.
  • Submit the completed form to the designated military office for processing.

Following these steps can help ensure a smooth submission process and may contribute to a quicker resolution of the disability retirement request.

Legal Use of the DA Form 1058

The DA Form 1058 is legally binding and must be filled out in accordance with military regulations. It is important for service members to understand that inaccuracies or omissions can lead to delays or denials in processing their disability retirement requests. The form must be signed by the service member and may require additional signatures from medical personnel or commanding officers. Compliance with all legal requirements is essential to ensure that the request is valid and recognized by the military.

Key Elements of the DA Form 1058

Several key elements must be included in the DA Form 1058 to ensure its validity. These include:

  • Personal identification information, such as name and service number.
  • Details of the medical condition affecting the service member.
  • Signatures from both the service member and relevant military personnel.
  • Supporting medical documentation that verifies the disability claim.

Including these elements helps to establish the legitimacy of the request and facilitates the review process by military officials.

Form Submission Methods

The DA Form 1058 can be submitted through various methods, depending on the specific military branch's requirements. Common submission methods include:

  • In-person delivery to the appropriate military personnel office.
  • Mailing the completed form and supporting documents to the designated address.
  • Some branches may allow electronic submission through secure military portals.

It is advisable for service members to confirm the preferred submission method with their unit or personnel office to ensure compliance with current procedures.

Quick guide on how to complete da 1058 example

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How to create an eSignature for the da 1058 example

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Follow the step-by-step instructions listed below to electronically sign your da 1058 example:

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  2. Hit the My Signature button.
  3. Choose what type of electronic signature to make. You can find 3 variants; a drawn, uploaded or typed eSignature.
  4. Make your e-autograph and then click Ok.
  5. Choose Done.

After that, your da 1058 example is ready. All you must do is download it or send it via e-mail. airSlate SignNow can make eSigning simpler and a lot more hassle-free as it provides users with numerous additional features like Merge Documents, Invite to Sign, Add Fields, and many others. And due to its multi-platform nature, airSlate SignNow can be used on any gadget, personal computer or mobile, irrespective of the operating system.

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