Forms at the PEB & for administrative/apellate review

DA Form 199

Physical Evaluation Board Proceedings (Prescribed in paras 3–5d, 4–15h, 4–19, 4–20, 6–10b, 6–12c, 7–20, 8–8, C–7c(1), C–8b(1), and C–8e.)

DA Form 199–1

Formal Physical Evaluation Board Proceedings (Prescribed in paras 4–19l(1), 4–19o, 4–19p(1), 4–21r, 4–21t, and 4–21u.)

DA Form 199–2

Revised Findings of United States Army Physical Disability Agency, in paras 4–22d(4), 4–22f, and 4–25b(6).

DA Form 5889

PEB Referral Transmittal Document (Prescribed in para 4–15a.)

DA Form 5890

Acknowledgment of Notification of Formal Physical Evaluation Board Hearing (Prescribed in para 4–21d(5)(a).)

DA Form 5891

Acknowledgment of Counseling on Legal/Procedural Rights (Prescribed in para 4–21e(2).)

DA Form 5892

PEBLO Estimated Disability Compensation Worksheet (Prescribed in paras 4–20d(1) and C–12.)

DA Form 5893

Soldier’s Medical Evaluation Board/Physical Evaluation Board Counseling Checklist (Prescribed in para C–16.)