Incap (Incapacitation Status)

DOD Guard and Reserve Family Member Identification Card and Selected
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time. Upon mobilization of the sponsor, a dependency review must be made by the

sponsor's parent Uniformed Service to establish eligibility based on the level of support

the sponsor is providing at the time.

BLOCK 51. MEDICARE. Leave blank.

BLOCK 52. COLOR EYES. Enter the dependent's correct eye color as prescribed in Block 23.

BLOCK 53. COLOR HAIR. Enter the dependent's correct hair color as prescribed in Block 24.

BLOCK 54. HEIGHT. Enter the dependent's height in inches. The valid range is 00-96 inches.

(Use 2 characters.)

BLOCK 55. WEIGHT. Enter the dependent's weight in pounds as prescribed in Block 26.

BLOCK 56. DATE OF MARRIAGE (YYYYMMMDD). If the dependent's relationship is SP,

enter the date of marriage. (Use 9 characters.)

BLOCK 57. ELIG ST/MC EFF DATE (YYYYMMMDD) (ELIGIBILITY START

DATE//CIVILIAN HEALTH CARE EFFECTIVE DATE//MEDICARE, PART A, HOSPI-

TAL INSURANCE EFFECTIVE DATE). Leave blank.

BLOCK 58. CARD EX/ELIG END DATE (YYYYMMMDD) (CARD EXPIRA-

TION/ELIGIBILITY END DATE). Enter a maximum of 4 years from the date of verification of

DD Form 1172, sponsor's expiration of service date, or dependent's 21st birthday, whichever is

earliest. For Reserve retirees entitled to pay at age 60, but who have not reached age 60, enter a

maximum of 4 years from date of verification of DD Form 1172, dependent's 21st birthday, or

sponsor's both birthday, whichever is earlier.

BLOCK 59. PRIVILEGES AUTHORIZED. Leave blank.

BLOCK 60. END ELIG REASON (END ELIGIBILITY REASON). For Guard/Reserve

Enrollment Program dependents, only the following codes apply:

ACD

Dependent entered active duty

DIV

Divorce/Annulment

DMG

Dependent married

DTH

Death