What is DA Form 2675-R? It is the Department of the Army form titled CERTIFICATION OF WORK INCURRED INJURY OR DISABILITY (LRA), and it exists so that you can certification of work incurred injury or disability (lra). That single line covers most of what people arrive looking for. The rest of this page fills in the details.
Which edition is on this page? The one dated 05/01/1982, status ACTIVE. On army forms the edition date is the version, printed on the page itself so any copy can be checked.
Who fills it out, and how long does it take? The individual named in the entries fills it, or a records clerk fills it on that person's behalf. Length is 1 page(s) with about 123 entry fields, which is the honest measure of the work involved. Who owns the form and when it is raised comes from PMG and AR 190-8 respectively.
What the form asks for
- CIRCUMS
- ContentArea1
- DATE
- DATE_B
- DATE_C
- DATE_D
- DISEAS
- FINDINGS
- FROM
- GRADE
- INJRY
- INV_OFF
- ISATTR
- ISNATTR
- LABOR
- Line1
- Line2
- MED_OFF
- MED_TRTMT
- NAME
- NATION
- PLACE
- POWER
- Page1
Download the form
What can I download here? The formats available are PDF, XFDL. Each one reproduces the identical official layout. What separates them is the method of entry, nothing on the page itself.
Should I take the fillable pdf or the printable one? Take the fillable version if you will type, since its entry areas respond to the keyboard and hold what you enter. Take the printable version if you will write by hand — it is the same blank form as a flat page image. The finished result looks the same either way.
What do I open a pdf with? Any current browser will display one, and any dedicated reader will do better. For fillable use the reader is the safer choice, because some browser viewers accept typing and then discard it when the tab closes. Test one field and one save before committing. What opens an xfdl file? Only the IBM Lotus Forms Viewer. The format is IBM Lotus Forms, carried by several Army systems, and no pdf reader or word processor will touch it.
Is it free? Yes, entirely. No registration stands between you and the file, and what arrives is exactly what the publisher released.
Where do you start? At the top of the page, with the identifying entries: name as your official records spell it, identification number, unit or organisation, date of preparation. Why first? Because those entries are what the form is filed and searched under later, and a record indexed on a misspelled name is a record nobody retrieves.
What is the fastest way to fill the body? Tab from field to field. The order was set at build time and normally matches how the page reads, which is why tabbing catches boxes that clicking past would leave empty. And the boxes and buttons? Those take a click. Where only one option in a set can apply, choosing one deselects the other.
What happens if your answer is too long for the field? It prints cut off. A single-line field does not wrap, so text running past the edge stays readable on screen and then disappears at the margin on paper. What do you do instead? Move it to the remarks area or onto a continuation sheet. And a field that does not apply to you? Mark it as not applicable rather than leaving it blank — an empty box tells the reviewer nothing about whether you read the question.
Is a signature really the last step? Yes, and without it you have a draft, not a form. Who else signs? Whoever the form calls for — reviewer, approver, witness — in printed block order, each dated as of the day they sign. Which errors cause the most returns? Blank mandatory fields lead, followed by identification numbers with two digits swapped, dates written day-for-month, and leftover data in a reused file that goes forward as though it were meant.
What is the Privacy Act statement on the page? A notice appearing wherever personal information is collected, setting out the authority for the collection, the purpose, the routine uses, and whether your disclosure is mandatory or voluntary. When should you read it? At the point you reach it, before entering the details it covers. And afterwards? Your completed copy holds personal data and is stored and transmitted under the rules that apply to such records.
What happens after signing? The form is routed as the prescribing directive requires: to a named office, through the unit administrative channel, or into the personal file. Do you get the original back? No, so make a copy first. Who sets the retention period? The applicable records schedule, not the office holding the document.
Which other forms travel with this one? Those found by series and number: DA series documents sharing a proponent or a governing directive are frequently needed in combination, and a form referenced on the face of another generally accompanies it. Do you assemble them before or after sending? Before. Continuation sheets, cover sheets and transmittals are part of the same package.
Why do editions change? Because the proponent revises the content, and the edition date printed on the page marks the result. How do you tell whether a stored copy is still current? Compare its printed date against the edition in force before you use it again. Does a new edition invalidate what you already filed? No. Records executed under a superseded edition stand as they are.
Is this an official Department of the Army site? No. It is an independent site distributing reproductions of published Department of the Army documents for download, with no authority to issue forms. Does it guarantee acceptance of anything you submit? It does not, and nothing on the page is legal advice. Who should you ask instead? PMG or your servicing administrative office, whenever an entry, a requirement or your eligibility is in doubt.
Questions and answers
- What is DA Form 2675-R?
- CERTIFICATION OF WORK INCURRED INJURY OR DISABILITY (LRA)
- Which edition is current?
- 05/01/1982
- Who is responsible for this form?
- PMG
- In which formats can it be downloaded?
- PDF, XFDL, PDF
Publisher notes
- 41-ITEM ALSO PRODUCED IN ELECTRONIC MEDIA,