Every entry in the Defense records system exists because some decision needed a documented basis, and DD Form 2164 is one of those instruments: DD Form 2164, X-Ray Verification/Certification Worksheet, November 1978, created to X-Ray Verification/Certification Worksheet. The reason it carries a DD number rather than a service designation is structural — the Department maintains a single body of forms for matters that arise identically in every service, so that a record created in one component remains intelligible in another.
This is why the arrangement matters to you rather than only to the archivists. not stated governs the form throughout the Department, with not stated as the responsible office, so the record you create is legible outside your own component. Joint assignments, agency details and cross-service transactions all depend on that: the paperwork does not have to be reconstructed each time it crosses a boundary.
The edition in force is not stated, carried by the publisher as not stated, and edition discipline is stricter on a Department form than most people expect, precisely because supersession happens everywhere at once. There is no interval during which one service still works from the previous layout while another has moved on.
Work down the page in the printed order, and understand why the order exists. The identifying block establishes whose record this is and under what circumstances it arises. The body of the form then answers questions that are only meaningful once that context is fixed. The signature block comes last because a certification signed before the entries are complete certifies nothing.
Verify the printed edition against not stated first. Field structure shifts between editions, and the office that receives your record is reading the current one. That office may sit outside your service, which removes even the informal accommodation you might expect from a colleague who used the old version last month.
Leave nothing empty. Where an item genuinely does not apply, N/A is the correct entry, because the record must distinguish between a question that was answered in the negative and a question that was never reached. An empty box carries no information about which happened. Date fields deserve particular care on a Department form, since the reviewer may write dates by a convention different from yours; use the format the form itself specifies.
The Privacy Act Statement is not boilerplate appended for legal cover; it is the mechanism by which a statutory obligation is discharged at the moment of collection. When the government asks an individual for personal information, it must state the authority under which it asks, the principal purpose, the routine uses to which the data may be put, and whether answering is voluntary or mandatory. Those four disclosures are placed ahead of the data fields deliberately, because the point of telling you is to inform a choice you have not yet made.
The signature converts entries into an attestation, and that is why its form is prescribed. Ink, or a digital signature carrying a credential that identifies the signer — commonly issued on a Common Access Card. Typed characters in the box satisfy neither standard, because the whole value of a signature lies in being difficult to produce on someone else's behalf. Date it as you sign; an undated attestation cannot be placed in the sequence of events.
Every item on the standing defect list undermines the record in the same way — it leaves a question the file cannot answer later. Obsolete edition, empty mandatory boxes, illegible scanned handwriting, non-conforming dates, missing signature or date. Unclear entries are resolved from the printed instructions first and from not stated where the two texts diverge.
Download the form
Formats available: PDF, across 2 pages and about 200 fields. That several formats coexist is a consequence of scale — the Department cannot standardize the software on every desk that needs this form, so it standardizes the document instead.
Fillable and printable are not two presentations of one file but two different objects. One holds your entries as structured data within the document; the other is a static picture meant to meet a pen. Since a DD form frequently moves outside the organization that created it, the durability of the entry matters more here than on a record that stays in one drawer. Typed text reproduces indefinitely; handwriting degrades at every copy.
Xfdl appears in the set for reasons of institutional inertia rather than preference. It is the IBM Lotus Forms format, once the Department's electronic forms standard and deployed widely enough that it outlived the decision to move on. IBM Lotus Forms Viewer or an equivalent client opens it; a pdf application will not.
All of it downloads without charge. Where care is needed is in the reader you choose. A fillable pdf depends on field properties that desktop applications honour and browser previews frequently ignore, so work locally rather than inside a browser window.
What the form asks for
- Action. Press space bar to mark X in first box if required, second box if not required, or third box if taken.
- Location (include building and room number).
- Date and time of service.
- Date next service due.
- 1. Control no. 1 (master control). Manufacturer.
- Model (include type, style, size, focal spots, etc.).
- Serial number (housing).
- 2. Control no. 2 (room control). Manufacturer.
- Model.
- 3. Radiographic tube. Manufacturer.
- Model.
- Serial number.
- Serial number.
- 4. Radiographic tube (auxiliary tube). Manufacturer.
- Model.
- Serial number.
- 5. Fluoroscopic tube. Manufacturer.
- Model.
- Serial number.
- Part 2 - Visual inspection of equipment. 6. Certification labels are affixed and visible. X if no action required.
- Type of action required.
- X if action taken.
- Initial and date.
- 7. Steel counterweight cables. X if no action required.
Route the executed form as not stated or local guidance directs, and retain a duplicate first. Cross-component routing is ordinary for DD forms, which is precisely why a personal copy earns its keep: the receiving office may belong to an organization you have no standing to query about a missing document.
Cross-referenced documents are found by series and number, with nothing further required. That the DD sequence is unified across the Department means a cited number identifies one form and no other, which is the practical payoff of centralizing the numbering in the first place.
It helps to see the DA and DD sequences as what they are: separate registries with separate custodians. One serves a single service under a service proponent, the other serves the Department under not stated or an equivalent office, and neither was ever indexed against the other. A number that appears in both systems points to two unrelated documents, which is why reading the prefix comes before reading the digits.
A form is downstream of the policy that requires it, and revision usually starts there: a directive is reissued, a collection requirement is altered, notice language is updated by statute. The form is republished as a consequence. Since none of that reaches individual users, an archived copy quietly becomes wrong, and verifying not stated each time you download is the whole remedy.
A word on what this page is. It distributes a published Department of Defense document and describes what the document contains and how it is completed. It is not the issuing authority, does not speak for one, and offers no legal advice; nothing written here determines whether a particular submission will be accepted, because that determination belongs entirely to the office receiving it. Questions of applicability, eligibility or procedure go to not stated, to your servicing personnel office, or to the office identified in not stated.
Questions and answers
- What is DD Form 2164?
- DD Form 2164, X-Ray Verification/Certification Worksheet, November 1978
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?