This version of the form is not currently in use and is provided for reference only. Download this version of DA Form 7574 for the current year.
DA Form 7574, Incapacitation Pay Monthly Claim Form , is a document used for claiming incapacitation pay and providing the information necessary to determine the service member's eligibility to receive it. The Incapacitation Pay Monthly Claim Form has no security classification and is approved for public release with unlimited distribution.
The latest version of the form - sometimes incorrectly referred to as DD Form 7574 - was released by the U.S. Department of the Army (DA) on March 1, 2008 . An up-to-date DA Form 7574 fillable version is available for digital filing and download below or can be found through the APD website.
Upon being notified of a soldier's injury or disease, unit commanders must immediately ensure that appropriate medical care is provided to the soldier depending upon the type of affliction or illness. The soldier must then be assisted in preparing the necessary claim form and be given travel orders to go to a Military Treatment Facility.
An overview of the form and filing guidelines can be found in the Department of the Army Pamphlet 135-381, Incapacitation of Reserve Component Soldiers Processing Procedures. DA Form 7574 instructions are as follows:
The completed DA 7574 and all paperwork related to the claim should be submitted through the chain of command.
The soldier is strongly encouraged to file an incapacitation pay claim in case of a service-related injury, disease, or illness that prevents them from performing military duties or has resulted in a loss in non-military income. In order to receive incapacitation pay, a correctly filled-in DA 7574 should be completed and submitted for each calendar month claimed.
Publications related to DA Form 7574: