Bupersinst 1900.8A Block Numbers

Front 1

This goes in block 1.

Back 1

What is the member's name?

Front 2

These three elements go in block 2.

Back 2

What is department, component, and branch?

i.e., NAVY - USNR

Front 3

This goes in block 3.

Back 3

What is the social security number?

Front 4

This goes in block 4a.

Back 4

What is grade, rank, or rate?

i.e., PS3

Front 5

This goes in block 4b.

Back 5

What is paygrade?

i.e., E4

Front 6

This goes in block 5.

Back 6

What is date of birth?

Front 7

This goes in block 6.

Back 7

What is reserve obligation terminal date?

Front 8

This goes in block 7a.

Back 8

What is place of entry into active duty?

Front 9

This goes in block 7b.

Back 9

What is the Home Of Record at time of entry?

Front 10

This goes in block 8a.

Back 10

What is the last duty assignment and major command?

Front 11

This goes in block 8b.

Back 11

What is the station where separted?

Front 12

This goes in block 9.

Back 12

What is the command to which transferred?

Front 13

This goes in block 10.

Back 13

What is the Servicemen's Group Life Insurance Coverage?

Front 14

This goes in block 11.

Back 14

What is the primary specialty?

Front 15

This goes in block 12a.

Back 15

What is date entered active duty this period?

Front 16

This goes in block 12b.

Back 16

What is separation date this period?

Front 17

This goes in block 12c.

Back 17

What is net active service this period?

Front 18

This goes in block 12d.

Back 18

What is total prior active service?

Front 19

This goes in block 12e.

Back 19

What is total prior inactive service?

Front 20

This goes in block 12f.

Back 20

What is foreign service?

Front 21

This goes in block 12g.

Back 21

What is sea service?

Front 22

This goes in block 12h.

Back 22

What is effective date of pay grade?

Front 23

This goes in block 13.

Back 23

What are decorations, medals, badges, citations, and campaign ribbons awarded or authorized?

Front 24

This goes in block 14.

Back 24

What is military education?

Front 25

The "x" in block 15a indicates this.

Back 25

What is whether they contributed to the post Vietnam era veterans' educational assistance program?

Front 26

The "x" in block 15b indicates this.

Back 26

What is whether they are a high school graduate or equivalent?

Front 27

This goes in block 16.

Back 27

What is days of accrued leave paid?

Front 28

And "x" in block 17 indicates this.

Back 28

What is whether they completed all needed dental services within 90 days of separation?

Front 29

These goes in block 18.

Back 29

What are remarks?

Front 30

This goes in block 19a.

Back 30

What is mailing address after separation?

Front 31

This goes in block 19b.

Back 31

What is the nearest relative?

Front 32

An "x" in block 20 indicates this.

Back 32

What is whether the member would like a copy sent to the Department Of Veterans Affairs?

Front 33

This goes in block 21.

Back 33

What is the signature of the member?

Front 34

These 4 items go in block 22.

Back 34

What is the typed name, grade, title, and signature of the official authorized to sign?

Front 35

This goes in block 23.

Back 35

What is type of separation?

i.e., discharge, released from active duty, etc.

Front 36

This goes in block 24.

Back 36

What is character of service?

Front 37

This goes in block 25.

Back 37

What is separation authority?

Front 38

This goes in block 26.

Back 38

What is separation code?

Front 39

This goes in block 27.

Back 39

What is re-entry code?

Front 40

This goes in block 28.

Back 40

What is narrative reason for separation?

Front 41

These go in block 29.

Back 41

What are the dates of time lost during this period?

Front 42

The member's initials in block 30 indicate this.

Back 42

What is that they would like to receive copy 4?