Dear Mr./Mrs. The enclosed "Former Spouse Information/Application ...

Former Spouse Information/Application Packet Page 3To make these determinations we ask that you send us the following:1. A copy of your marriage certificate;2. A copy of the final divorce decree;3. A completed certification sheet with your signature (keeping a copy for your records); and4. A completed Form DD-1172, "Application for Uniformed Services Identification andPrivilege Card," (keeping a copy for your records).If your eligibility for benefits is verified by these documents, you will be issued a UniformedServices Identification and Privilege Card (ID card) which will show the benefits to which you areentitled. If you qualify as a URFS02 (20-20-20), you may use the identification card for allbenefits as you did while married to your former spouse.If you qualify as a URFS04 (post 4/1/85 20-20-15), you will be issued an ID card which will showthat you are eligible for medical benefits only and not eligible for commissary and exchangeprivileges.If you qualify as a URFS02 or URFS03, your ID card will be issued for 4 years, or until your 65thbirthday, whichever is earliest. If you qualify as a URFS04 your card will be issued for 1 yearfrom the effective date of your final divorce decree or until your 65th birthday, whichever isearliest.Your medical benefits will include use of all Uniformed Services medical treatment facilities.You will also be eligible for benefits under TRICARE (formerly the Civilian Health and MedicalProgram for the Uniformed Services (CHAMPUS)) until you reach age 65.We must review the requested documents and find you eligible for benefits before we canauthorize the issuance of an ID card to you.Please send the documents requested above to:Division of Commissioned Corps Officer Support, OCCOAttn: DEERS1101 Wootton Parkway, PL, Ste 100Rockville, MD 20857If you have any questions or need assistance please call this office at (240) 453-6131.Enclosures