FAX: Official correspondence from your command, SS Card FAX:
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1 ODC blank form: Degrees/Courses info for ODC: Note 1: All addresses except as noted for blocks 47, 66, 67, 68 Note 2: All Commercial Number prefixes: (901) 874; DSN prefix: 882 except for blocks 47, 66, 67, 68 Note 3: All Commercial Number prefixed (504) 697; DSN prefix: 647 BLOCK BLOCK NAME POC POC ADDRESS POC PHONE # INFORMATION REQUIRED TO MAKE CHANGE 1 SSN NSIPS Information Technology Center Official correspondence from your command, SS Card 2 Name NSIPS Information Technology Center 3 Sex NSIPS Information Technology Center Designator (4 th digit for augumentation only) Grade Year Group Your Detailer p911c (for reserves) (P801G) p8021 p861c7 (for TAR) p8021 p861c7 (for TAR) PERS-your detailer's code/811/921 PERS-XXX PERS-XXX (Detailer) (fax) 4937 (PERS-851) 2751 (851 fax) 4537 (PERS-861c7) 4937 (PERS-851) 2751 (851 fax) 4537 (PERS-86) Official correspondence from your command, legal documents Birth Certificate Official correspondence from your command Signed A & O Officer Appointment and Oath of Office (NAVCRUIT )
2 7 Precedence Number p851 p861c7 (for TAR) PERS-851/861 8 Birth Date NSIPS Information Technology Center 9 Promotion List Service Date 10 Previous Military Service p8021 p822 PERS-8021 Millington, TN PERS-822 Millington, TN Submarine Qual p421e PERS-421E Millington, TN Heavier than Air Qual 13 Naval Flight Officer Qual 14 Projected Rotation Date Your Detailer 15 Activity Estimated Loss Your Detailer Sep/Ret P (PERS-851) 2751 (851 fax) 4537 (PERS-86) (fax) (fax) (fax) IAW MILPERSMAN NAVPERS 1070/26
3 Code/Date 16 Pay Entry Base Date p822 PERS Service Date p822 p861c7 (for TAR) Millington, TN PERS-822/86 18 Eligible to Retire Date p822 PERS-822 Millington, TN Active Commission Base Date 20 Active Duty Service Date p822 p822 PERS-822 Millington, TN PERS-822 Millington, TN Current Gain Date NSIPS Information Technology Center Professional Service Date Minimum Service Required p822 Your Detailer PERS-822 Millington, TN (fax) 3180 (PERS-822) 2622 (822 fax) 4537 (PERS-86) (fax) (fax) (fax) (fax) Official correspondence from your command 24 Source Code P
4 PERS-312G Millington, TN Dependents NSIPS Information Technology Center 26 Aviation Commission Date 27 Aviation Service Entry Date 28 Months of Operational Flying 29 Months to Gate 30 Months of Operations Flying Required 31 Aviation Gate 32 Aviation Status Indicator 2660 (fax) Current Page 2 (NAVPERS 1070/602)
5 Aviation Billet Indicator Primary Aeronautical Designator 34a. Service Group Aviation Status Indicator Effective Date Promotion History Promotion Status Spot Grade 39 Spot Grade Date of Rank Permanent Grade Nuclear Commission Date p8021 p861c7 (for TAR) p8021 p861c7 (for TAR) p8021 p861c7 (for TAR) p8021 p861c7 (for TAR) p8021 p861c7 (for TAR) p421e PERS-XXX PERS-XXX PERS-XXX PERS-XXX PERS-XXX PERS-421E Millington, TN (PERS-851) 2751 (851 fax) 4537 (PERS-86) 4937 (PERS-851) 2751 (851 fax) 4537 (PERS-86) 4937 (PERS-851) 2751 (851 fax) 4537 (PERS-86) 4937 (PERS-851) 2751 (851 fax) 4537 (PERS-86) 4937 (PERS-851) 2751 (851 fax) 4537 (PERS-86) (fax) Appointment Letter (NAVPERS 1421/7) Appointment Letter (NAVPERS 1421/7) Appointment Letter (NAVPERS 1421/7) Appointment Letter (NAVPERS 1421/7) Appointment Letter (NAVPERS 1421/7)
6 Nuclear Service Control Date Nuclear Status Indicator Submarine Service Entry Date Submarine Status Indicator Submarine Service Control Date p421e p421e p421e p421e p421e 47 Academic Profile Code mil (Naval Postgraduate School) 48 Aviation Officer Continuation Pay/Years Extention PERS-421E Millington, TN PERS-421E Millington, TN PERS-421E Millington, TN PERS-421E Millington, TN PERS-421E Millington, TN Director of Admissions Code 01B3 Naval Postgraduate School 589 Dyer Road Room 103C Monterey, CA Designator History P822 PERS-822 Millington, TN (fax) (fax) (fax) (fax) (fax) (831) DSN prefix: /2640 (fax) (fax) Original transcripts from all undergraduate and any graduate schools attended. 52 Service Schools NSIPS Information Technology Center Course title, school location, completion date, course
7 p45j (for all joint service schools and NWC) 53 Service College Bank p440a/c PERS-440A/C Millington, TN Formal Education NSIPS Information Technology Center 55 Year Completed NSIPS Information Technology Center 56 Navy-Sponsored Postgraduate Education NSIPS Information Technology Center 57 Block 56 Codes NSIPS Information Technology Center 58 Level of Education NSIPS Information Technology Center 59 Major Field of Study NSIPS Information Technology Center (fax) duration, and diploma/certificate of completion. Degree Degree Certificate of completion for Navy-sponsored postgraduate courses. Certificate of completion for Navy-sponsored postgraduate courses. Degree Degree
8 60 Specialization Within Block 59 NSIPS Information Technology Center 61 >18 hrs Postgraduate NSIPS Information Technology Center Education Completed 62 Language Proficiency NSIPS Information Technology Center Year DLPT Administered 65 Proficiency in More Than Two Languages 66 Subspecialty Code NSIPS NSIPS p440e2 *all Medical Medical Corps: jrdevoll Information Technology Center Information Technology Center PERS-440E2 Millington, TN BUMED MED-x (see below) 2300 E. Street NW 4057 (PERS-440E2) 2676 (440E2 fax) Medical Corps: (202) fax: Nurse Corps: Degree Transcripts of completed graduate education. Defense Language Proficiency Test results; Language Proficiency Questionnaire (if selfevaluated).
9 67 68 Subspecialty Code Subspecialty Code Nurse Corps: adlambert Dental Corps: rdfoss Medical Service Corps: awbarrow p440e2 *all Medical Medical Corps: jrdevoll Nurse Corps: adlambert Dental Corps: rdfoss Medical Service Corps: awbarrow p440e2 *all Medical Washington, D.C Medical Corps: 00MCB4 Nurse Corps: 00NCB3 Dental Corps: 00DCB Medical Service Corps: 00MSC PERS-440E2 Millington, TN BUMED MED-x (see below) 2300 E. Street NW Washington, D.C Medical Corps: 00MCB4 Nurse Corps: 00NCB3 Dental Corps: 00DCB Medical Service Corps: 00MSC PERS-440E2 Millington, TN (202) fax: 3727 Dental Corps: (202) fax: 3023 Medical Service Corps: (202) fax: (PERS-440E2) 2676 (440E2 fax) Medical Corps: (202) fax: Nurse Corps: (202) fax: 3727 Dental Corps: (202) fax: 3023 Medical Service Corps: (202) fax: (PERS-440E2) 2676 (440E2 fax) Medical Corps:
10 Additional Qualification Designations Medical Corps: jrdevoll Nurse Corps: adlambert Dental Corps: rdfoss Medical Service Corps: awbarrow Your Detailer BUMED MED-x (see below) 2300 E. Street NW Washington, D.C Medical Corps: 00MCB4 Nurse Corps: 00NCB3 Dental Corps: 00DCB Medical Service Corps: 00MSC 73 Primary Duty NSIPS Information Technology Center Accounting Category Code NSIPS Information Technology Center 76 Date Reported NSIPS Information Technology Center (202) fax: Nurse Corps: (202) fax: 3727 Dental Corps: (202) fax: 3023 Medical Service Corps: (202) fax: 1626 Official correspondence from your command; FITREPs. Official correspondence from your command. Official correspondence from your command.
11 77 Present Duty Station NSIPS Information Technology Center 78 Type of Assignment NSIPS Information Technology Center 79 Subspecialty Utilization p440e2 PERS-440E2 Millington, TN Homeport NSIPS Information Technology Center 81 Ship/Station Code NSIPS Information Technology Center 82 Present Billet NSIPS Information Technology Center 83 Navy Officer Billet Classification NSIPS Information Technology Center (fax) FITREPs
12 84 Date of Block 83 NSIPS Information Technology Center 85 Previous Billet NSIPS Information Technology Center 86 NOBC for Block 85 NSIPS Information Technology Center 87 Months for Block 85 NSIPS Information Technology Center 88 Previous Billet NSIPS Information Technology Center 89 NOBC for Block 88 NSIPS Information Technology Center 90 Months for Block 88 NSIPS Information Technology Center FITREPs FITREPs; letters of appointment. FITREPs; letters of appointment. FITREPs; letters of appointment. FITREPs; letters of appointment.
13 91 Chronological History/Navy Officer Classification/Number of Months Experience NSIPS Information Technology Center 92 Security Clearance p8311 PERS-8311 Millington, TN Security Clearance Date Postgraduate Choice Information P8311 Your Detailer PERS-8311 Millington, TN Race Self Service on BOL PERS-312G Millington, TN Ethnic Group Self Service on BOL PERS-312G Millington, TN Occupation Code for LDO/CWO Your Detailer 98 UIC NSIPS Information Technology Center 99 Billet Sequence Code NSIPS Information Technology Center (fax) (fax) (fax) (fax) FITREPs; letters of appointment. Official correspondence from your command.
14 Gain/Loss Indicator Your Detailer 103 Command and Operational Screen Results Your Detailer 104 Detailer's Remarks Your Detailer Placement Cogizance Code/Assignment Officer Code Your Detailer Information to be included for Blocks 4, 14, 15, 23, 72, 97, 102, 103, 107 (regarding Detailers) Note 1: All addresses except as noted for blocks 47, 66, 67, 68 Note 2: All Commercial Number prefixes: (901) 874; DSN prefix: 882 except as noted for blocks 47, 66, 67, 68 Note 3: All Commercial Number prefixed (504) 697; DSN prefix: 697 Community POC POC Address POC POC Phone # Fax # Surface Warfare p41a
15 PERS-41A Millington, TN Submarine Warfare p421e PERS-421E Millington, TN Aviation Warfare Engineering Duty Officer p445f PERS-445F Millington, TN Aerospace Engineering/Aviation Maintenance Duty Officer p446b1 PERS-446B1 Millington, TN Professional Acquisition p447 PERS-447 Millington, TN Public Affairs p448b PERS-448B Millington, TN Meterology/Oceanography p449b PERS-449B Millington, TN Cryptology p4410a PERS-4410A Millington, TN Intelligence p4411a
16 PERS-4411A Millington, TN Supply Corps p4412q PERS-4412Q Millington, TN Civil Engineering Corps p4413s PERS-4413S Millington, TN Chaplain Corps p4414s PERS-4414E1 Millington, TN Medical (including Medical Service, Dental, and Nurse Corps) p4415a1 PERS-4415A1 Millington, TN Judge Advocate General Corps p4416b PERS-4416B Millington, TN TAR (including Surface and Aviation) p4417f PERS-4417F Millington, TN Fleet Support p4419s PERS-4419S Millington, TN
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