Fill Out a Valid DA 5960 Form

Fill Out a Valid DA 5960 Form

The DA 5960 form, officially known as the Authorization to Start, Stop, or Adjust Basic Allowance for Housing (BAH), is a critical document used by United States Army personnel. It serves multiple purposes, including initiating, halting, or modifying an individual's housing allowance based on changes in their living situation or family status. This form plays a pivotal role in ensuring that service members receive the appropriate housing compensation they are entitled to.

Open Your Form Now

Navigating the complexities of military benefits can often seem daunting, especially when it comes to ensuring housing allowances are accurately processed and received. Among the various forms and paperwork, the DA Form 5960, Authorization to Start, Stop, or Change Basic Allowance for Quarters (BAQ), and/or Variable Housing Allowance (VHA), stands out as a crucial document for military personnel. This form serves the essential purpose of initiating, altering, or halting housing allowances, a key component of a service member's financial well-being. It is specifically designed to streamline the administration of housing benefits, ensuring that military members are properly compensated for their living arrangements, whether they are living on-base, off-base, or overseas. The process of completing and submitting the DA 5960 form requires a detailed understanding of one’s personal circumstances, including marital status, number of dependents, and current living situation, to accurately reflect any entitlements. Its completion and approval are vital for the timely and correct payment of housing allowances, making it an indispensable document for service members seeking to manage their housing benefits effectively.

Document Example

 

 

AUTHORIZATION TO START, STOP, OR CHANGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIVACY ACT STATEMENT

 

 

 

 

 

 

 

 

 

 

 

BASIC ALLOWANCE FOR QUARTERS (BAQ),

 

 

AUTHORITY:

 

 

 

 

 

 

 

 

 

 

37 USC 403; Public Law 96-343; EO 9397.

 

 

 

AND/OR VARIABLE HOUSING ALLOWANCE (VHA)

 

PRINCIPLE PURPOSE:

 

 

 

 

 

To start, adjust or terminate military member's entitlement

 

 

 

 

For use of this form, see AR 37-104-4; the proponent agency is ASA(FM)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to basic allowance for quarters

 

(BAQ) and/or variable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

housing allowance (VHA).

 

 

 

 

 

 

 

 

1.

 

 

NAME

(Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ROUTINE USE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To adjust member's military pay record, information may

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

be disclosed to Army components, such as USAFAC,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

major commands, and other Army installations; to other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOD components; other federal agencies such as IRS,

 

 

2.

 

 

SOCIAL SECURITY NUMBER

 

 

 

 

 

3.

 

 

GRADE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Administration and VA, GAO, members of

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Congress; State and local government; US and State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

courts, and various law enforcement agencies. Social

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Security Number (SSN) is used for positive identification.

 

 

4.

 

 

TYPE OF ACTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISCLOSURE IS VOLUNTARY: Nondisclosure may result in nonpayment of BAQ and/or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

START

 

 

CANCEL

 

 

 

 

CHANGE

 

 

REPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VHA. Disclosure of your SSN is voluntary. However, this

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

form will not be processed without your SSN because

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the Army identifies you for pay purposes by your SSN.

 

 

 

 

 

 

 

CORRECT

 

 

STOP

 

 

 

 

RECERTIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

DUTY LOCATION (Include Station, Name, City, State, and Zip Code)

 

 

6. DATE/ACTION

7.

 

 

 

 

 

 

 

 

 

 

 

BAQ TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITH DEPENDENTS

 

 

 

 

 

 

PARTIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITHOUT DEPENDENTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

 

 

 

 

 

 

 

 

 

 

MARITAL/DEPENDENCY STATUS

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

 

 

QUARTERS ASSIGNMENT/AVAILABILITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

SINGLE

 

 

 

 

 

 

 

 

b. MARRIED

 

 

 

 

 

c. DIVORCED (see

 

 

 

 

 

 

a.

ADEQUATE

 

 

 

 

 

 

b.

 

INADEQUATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(see blocks (1), (2) & (3))

 

 

 

 

 

 

 

blocks (1), (2) & (3))

 

 

 

 

 

 

 

 

 

 

(see block (1))

 

 

 

 

 

 

(see blocks (1), (2) & (4))

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.

LEGALLY SEPARATED

 

 

 

 

 

 

 

 

 

 

 

e.

DEPENDENT CHILD

 

 

 

 

 

 

 

 

 

 

 

 

c.

TRANSIENT

 

 

 

 

 

 

d.

 

NOT AVAILABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(see blocks (1), (2) & (3))

 

 

 

 

 

 

 

(see blocks (4), (5) & (6))

 

 

 

 

 

 

 

 

 

 

 

 

 

(see block (3))

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

Spouse/Former

 

 

(2)

 

 

 

Spouse/Former

 

 

(3)

 

 

Date of Marriage,

 

 

 

(1)

 

 

QUARTERS

 

 

(2) FAIR RENTAL

 

 

 

 

 

 

Spouse SSN

 

 

 

 

 

 

 

 

Spouse Duty Station

 

 

 

 

 

 

Divorce/Separation

 

 

 

 

 

NO.

 

 

 

 

 

 

 

 

VALUE $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

Child in

 

 

 

Member

 

 

 

 

Spouse

 

 

 

 

 

 

Former Spouse

 

 

 

 

 

Other

(3)

 

 

FROM:

 

 

TO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Custody of:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(5)

 

 

If you check "OTHER" above, prepare DD Form 137 to establish dependency.

 

 

 

 

 

 

 

 

 

 

 

MEMBER ELECTION

 

 

 

 

 

 

 

COMMANDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Member

in

grade E7 and

 

 

 

 

 

 

 

 

 

DETERMINATION

 

 

(6)

 

 

If child support received from another military member, complete (1), (2) & (3).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

above)

 

 

 

 

 

 

 

 

 

 

 

 

(Attached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPENDENTS/SHARERS (Continue on back if required)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF DEPENDENT/SHARER

 

 

COMPLETE CURRENT ADDRESS

(Include ZIP Code)

 

RELATIONSHIP

 

DOB OF CHILDREN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFICATION OF DEPENDENT SUPPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify that I can provide, or willing to provide, adequate support for the above named dependents. I am aware that failure to support the above named

 

 

 

 

 

 

 

 

 

 

 

 

 

dependents may result in stopping BAQ and recouping BAQ for any prior periods/nonsupport.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IAW service regulations. I certify that the dependency status of my primary dependents, on whose behalf I am receiving BAQ, has not changed so as to affect

 

 

 

 

 

 

 

 

 

 

 

 

 

my entitlement thereto for the period.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXPENSES, IF AUTHORIZED, I AM REQUESTING VHA BASED ON

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My permanent duty station:

 

 

 

 

 

 

 

My dependent's location:

 

 

 

 

 

 

 

 

Both my permanent duty station and dependent's location.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

 

 

Monthly Expenses:

 

 

 

Member

 

 

 

 

 

 

Dependent

 

 

 

b.

 

 

Sharer/Lease Information

 

 

 

c.

Address Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

Mortgage (PITI)

or Rent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

 

Rental/Residential Address:

(1)

 

Landlord's Name and Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

Insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

Effective Date:

(3)

 

 

Expiration Date:

(2)

 

Landlord's Phone No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTALS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

 

Number of Sharers

 

(show name(s) and address in block 10.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify ALL information regarding this authorization is correct. I will immediately notify the FAO/HRO of any changes in the information above, due to divorce,

 

 

marriage, death, living in government quarters etc, which could affect by BAQ or VHA entitlement.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT: Making a false statement or claim against the US Government is punishable by courts-martial. The penalty for willfully making a false claim or a false

 

 

statement in connection with claims is a maximum fine of $10,000 or imprisonment for 5 years, or both.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

 

 

MEMBER'S SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. DATE

 

15.

CERTIFYING OFFICER'S SIGNATURE

 

 

 

 

 

 

 

 

 

16. DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DA FORM 5960, SEP 1990

REPLACES DA FORM 3298, JUL 80 AND DA FORM 5545, JUL 86 WHICH ARE OBSOLETE

APD AEM v2.06ES

 

 

AUTHORIZATION TO START, STOP, OR CHANGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIVACY ACT STATEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BASIC ALLOWANCE FOR QUARTERS

(BAQ),

 

 

AUTHORITY:

 

 

 

 

 

 

 

 

 

 

37 USC 403; Public Law 96-343; EO 9397.

 

 

AND/OR VARIABLE HOUSING ALLOWANCE (VHA)

 

PRINCIPLE PURPOSE:

 

 

To start, adjust or terminate military member's entitlement

 

 

 

 

For use of this form, see AR 37-104-4; the proponent agency is ASA (FM)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to basic allowance for quarters (BAQ) and/or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

variable housing allowance

(VHA).

 

 

 

 

 

 

 

1.

 

 

NAME

(Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ROUTINE USE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To adjust member's military pay record, information may

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

be disclosed to Army components, such as USAFAC,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

major commands, and other Army installations; to other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOD components; other federal agencies such as IRS,

 

 

2.

 

 

SOCIAL SECURITY NUMBER

 

 

 

 

 

3.

 

 

GRADE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Administration and VA, GAO, members

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of Congress; State and local government; US and State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

courts, and various law enforcement agencies. Social

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Security Number (SSN) is used for positive identification.

 

 

4.

 

 

TYPE OF ACTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISCLOSURE IS VOLUNTARY: Nondisclosure may result in nonpayment of BAQ and/or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

START

 

 

CANCEL

 

 

 

 

CHANGE

 

 

REPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VHA. Disclosure of your SSN is voluntary. However, this

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

form will not be processed without your SSN because

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the Army identifies you for pay purposes by your SSN.

 

 

 

 

 

 

 

CORRECT

 

 

STOP

 

 

 

 

RECERTIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

DUTY LOCATION (Include Station, Name, City, State, and Zip Code)

 

 

6. DATE/ACTION

7.

 

 

 

 

 

 

 

 

 

 

 

BAQ TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITH DEPENDENTS

 

 

 

 

 

 

 

PARTIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITHOUT DEPENDENTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

 

 

 

 

 

 

 

 

 

 

MARITAL/DEPENDENCY STATUS

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

 

 

QUARTERS ASSIGNMENT/AVAILABILITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

SINGLE

 

 

 

 

 

 

 

 

b. MARRIED

 

 

 

 

 

c. DIVORCED (see

 

 

 

 

 

 

a.

ADEQUATE

 

 

 

 

 

 

 

b.

INADEQUATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(see blocks (1), (2) & (3))

 

 

 

 

 

 

 

blocks (1), (2) & (3))

 

 

 

 

 

 

 

 

 

 

(see block (1))

 

 

 

 

 

 

 

(see blocks (1), (2) & (4))

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.

LEGALLY SEPARATED

 

 

 

 

 

 

 

 

 

 

 

e.

DEPENDENT CHILD

 

 

 

 

 

 

 

 

 

 

 

 

c.

TRANSIENT

 

 

 

 

 

 

 

d.

NOT AVAILABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(see blocks (1), (2) & (3))

 

 

 

 

 

 

 

(see blocks (4), (5) & (6))

 

 

 

 

 

 

 

 

 

 

 

 

 

(see block (3))

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

Spouse/Former

 

 

(2)

 

 

 

Spouse/Former

 

 

(3)

 

 

Date of Marriage,

 

 

 

(1)

 

 

QUARTERS

 

 

(2)

 

FAIR RENTAL

 

 

 

 

 

 

Spouse SSN

 

 

 

 

 

 

 

 

Spouse Duty Station

 

 

 

 

 

 

Divorce/Separation

 

 

 

 

 

NO.

 

 

 

 

 

 

 

 

 

VALUE $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

Child in

 

 

 

Member

 

 

 

 

Spouse

 

 

 

 

 

 

Former Spouse

 

 

 

 

 

Other

(3)

 

 

FROM:

 

 

 

 

 

TO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Custody of:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(5)

 

 

If you check "OTHER" above, prepare DD Form 137 to establish dependency.

 

 

 

 

 

 

 

 

 

 

 

MEMBER ELECTION

 

 

 

 

 

 

 

 

 

COMMANDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Member

in

grade E7 and

 

 

 

 

 

 

 

 

 

 

 

DETERMINATION

 

 

(6)

 

 

If child support received from another military member, complete (1), (2) & (3).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

above)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Attached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPENDENTS/SHARERS (Continue on back if required)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF DEPENDENT/SHARER

 

 

COMPLETE CURRENT ADDRESS

(Include ZIP Code)

 

RELATIONSHIP

 

DOB OF CHILDREN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFICATION OF DEPENDENT SUPPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify that I provide, or am will to provide adequate support for the above named dependents. I am aware that failure to support the above named

 

 

 

 

 

 

 

 

 

 

 

 

 

dependents may result in stopping BAQ and recouping BAQ for any prior periods/nonsupport.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IAW service regulations, I certify that the dependency status of my primary dependents, on whose behalf I am receiving BAQ, has not changed so as to affect

 

 

 

 

 

 

 

 

 

 

 

 

 

my entitlement thereto for the period

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXPENSES, IF AUTHORIZED, I AM REQUESTING VHA BASED ON

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My permanent duty station:

 

 

 

 

 

 

 

My dependent's location:

 

 

 

 

 

 

 

 

Both my permanent duty station and dependent's location.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

 

 

Monthly Expenses:

 

 

 

Member

 

 

 

 

 

 

Dependent

 

 

 

b.

 

 

Sharer/Lease Information

 

 

 

c.

Address Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

Mortgage (PITI)

or Rent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

 

Rental/Residential Address:

(1)

 

Landlord's Name and Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

Insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

Effective Date:

(3)

 

 

Expiration Date:

(2)

 

Landlord's Phone No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTALS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

 

Number of Sharers

 

(show name(s) and address in block 10.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify ALL information regarding this authorization is correct. I will immediately notify the FAO/HRO of any changes in the information above, due to divorce,

 

 

marriage, death, living in government quarters etc, which could affect by BAQ or VHA entitlement.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT: Making a false statement or claim against the US Government is punishable by courts-martial. The penalty for willfully making a false claim or a false

 

 

statement in connection with claims is a maximum fine of $10,000 or imprisonment for 5 years, or both.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

 

 

MEMBER'S SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. DATE

 

15.

CERTIFYING OFFICER'S SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

16. DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DA FORM 5960, SEP 1990

REPLACES DA FORM 3298, JUL 80 AND DA FORM 5545, JUL 86 WHICH ARE OBSOLETE

APD AEM v2.06ES

 

 

AUTHORIZATION TO START, STOP, OR CHANGE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIVACY ACT STATEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BASIC ALLOWANCE FOR QUARTERS

(BAQ),

 

 

AUTHORITY:

 

 

 

 

 

 

 

 

 

 

37 USC 403; Public Law 96-343; EO 9397.

 

 

AND/OR VARIABLE HOUSING ALLOWANCE (VHA)

 

PRINCIPLE PURPOSE:

 

 

To start, adjust or terminate military member's entitlement

 

 

 

 

For use of this form, see AR 37-104-4; the proponent agency is ASA (FM)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

to basic allowance for quarters (BAQ) and/or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

variable housing allowance

(VHA).

 

 

 

 

 

 

 

1.

 

 

NAME

(Last, First, MI)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ROUTINE USE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

To adjust member's military pay record, information may

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

be disclosed to Army components, such as USAFAC,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

major commands, and other Army installations; to other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOD components; other federal agencies such as IRS,

 

 

2.

 

 

SOCIAL SECURITY NUMBER

 

 

 

 

 

3.

 

 

GRADE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security Administration and VA, GAO, members

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

of Congress; State and local government; US and State

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

courts, and various law enforcement agencies. Social

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Security Number (SSN) is used for positive identification.

 

 

4.

 

 

TYPE OF ACTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISCLOSURE IS VOLUNTARY: Nondisclosure may result in nonpayment of BAQ and/or

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

START

 

 

CANCEL

 

 

 

 

CHANGE

 

 

REPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

VHA. Disclosure of your SSN is voluntary. However, this

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

form will not be processed without your SSN because

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

the Army identifies you for pay purposes by your SSN.

 

 

 

 

 

 

 

CORRECT

 

 

STOP

 

 

 

 

RECERTIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5.

 

 

DUTY LOCATION (Include Station, Name, City, State, and Zip Code)

 

 

6. DATE/ACTION

7.

 

 

 

 

 

 

 

 

 

 

 

BAQ TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITH DEPENDENTS

 

 

 

 

 

 

 

PARTIAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WITHOUT DEPENDENTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

 

 

 

 

 

 

 

 

 

 

 

MARITAL/DEPENDENCY STATUS

 

 

 

 

 

 

 

 

 

 

 

 

 

9.

 

 

 

 

 

 

 

 

QUARTERS ASSIGNMENT/AVAILABILITY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

SINGLE

 

 

 

 

 

 

 

 

b. MARRIED

 

 

 

 

 

c. DIVORCED (see

 

 

 

 

 

 

a.

ADEQUATE

 

 

 

 

 

 

 

b.

INADEQUATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(see blocks (1), (2) & (3))

 

 

 

 

 

 

 

blocks (1), (2) & (3))

 

 

 

 

 

 

 

 

 

 

(see block (1))

 

 

 

 

 

 

 

(see blocks (1), (2) & (4))

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d.

LEGALLY SEPARATED

 

 

 

 

 

 

 

 

 

 

 

e.

DEPENDENT CHILD

 

 

 

 

 

 

 

 

 

 

 

 

c.

TRANSIENT

 

 

 

 

 

 

 

d.

NOT AVAILABLE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(see blocks (1), (2) & (3))

 

 

 

 

 

 

 

(see blocks (4), (5) & (6))

 

 

 

 

 

 

 

 

 

 

 

 

 

(see block (3))

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

Spouse/Former

 

 

(2)

 

 

 

Spouse/Former

 

 

(3)

 

 

Date of Marriage,

 

 

 

(1)

 

 

QUARTERS

 

 

(2)

 

FAIR RENTAL

 

 

 

 

 

 

Spouse SSN

 

 

 

 

 

 

 

 

Spouse Duty Station

 

 

 

 

 

 

Divorce/Separation

 

 

 

 

 

NO.

 

 

 

 

 

 

 

 

 

VALUE $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

Child in

 

 

 

Member

 

 

 

 

Spouse

 

 

 

 

 

 

Former Spouse

 

 

 

 

 

Other

(3)

 

 

FROM:

 

 

 

 

 

TO:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Custody of:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(5)

 

 

If you check "OTHER" above, prepare DD Form 137 to establish dependency.

 

 

 

 

 

 

 

 

 

 

 

MEMBER ELECTION

 

 

 

 

 

 

 

 

 

COMMANDER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Member

in

grade E7 and

 

 

 

 

 

 

 

 

 

 

 

DETERMINATION

 

 

(6)

 

 

If child support received from another military member, complete (1), (2) & (3).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

above)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Attached)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPENDENTS/SHARERS (Continue on back if required)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NAME OF DEPENDENT/SHARER

 

 

COMPLETE CURRENT ADDRESS

(Include ZIP Code)

 

RELATIONSHIP

 

DOB OF CHILDREN

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CERTIFICATION OF DEPENDENT SUPPORT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify that I provide, or am will to provide adequate support for the above named dependents. I am aware that failure to support the above named

 

 

 

 

 

 

 

 

 

 

 

 

 

dependents may result in stopping BAQ and recouping BAQ for any prior periods/nonsupport.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IAW service regulations, I certify that the dependency status of my primary dependents, on whose behalf I am receiving BAQ, has not changed so as to affect

 

 

 

 

 

 

 

 

 

 

 

 

 

my entitlement thereto for the period

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EXPENSES, IF AUTHORIZED, I AM REQUESTING VHA BASED ON

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

My permanent duty station:

 

 

 

 

 

 

 

My dependent's location:

 

 

 

 

 

 

 

 

Both my permanent duty station and dependent's location.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a.

 

 

Monthly Expenses:

 

 

 

Member

 

 

 

 

 

 

Dependent

 

 

 

b.

 

 

Sharer/Lease Information

 

 

 

c.

Address Information

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

Mortgage (PITI)

or Rent

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

 

 

 

Rental/Residential Address:

(1)

 

Landlord's Name and Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

Insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(3)

 

 

Other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2)

 

 

Effective Date:

(3)

 

 

Expiration Date:

(2)

 

Landlord's Phone No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TOTALS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4)

 

 

 

Number of Sharers

 

(show name(s) and address in block 10.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify ALL information regarding this authorization is correct. I will immediately notify the FAO/HRO of any changes in the information above, due to divorce,

 

 

marriage, death, living in government quarters etc, which could affect by BAQ or VHA entitlement.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

IMPORTANT: Making a false statement or claim against the US Government is punishable by courts-martial. The penalty for willfully making a false claim or a false

 

 

statement in connection with claims is a maximum fine of $10,000 or imprisonment for 5 years, or both.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13.

 

 

MEMBER'S SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. DATE

 

15.

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DA FORM 5960, SEP 1990

REPLACES DA FORM 3298, JUL 80 AND DA FORM 5545, JUL 86 WHICH ARE OBSOLETE

APD AEM v2.06ES

Form Breakdown

Fact Name Description
Purpose of DA Form 5960 Used by the military to authorize Basic Allowance for Housing (BAH), as well as to start, stop, or change the amount of BAH for personnel.
Who Uses It The form is mainly utilized by service members in the United States Army to apply for housing allowances or to update their housing status.
Governing Law Federal military regulations and policies govern the use and processing of DA Form 5960, rather than state-specific laws.
Access to the Form The form is accessible through the United States Army Publishing Directorate website or through the respective service member's human resources department.

DA 5960 - Usage Guide

When embarking on the process of filling out the DA 5960 form, individuals are engaging in a crucial step that facilitates the necessary adjustments regarding their monetary entitlements and allowances. This document serves as a formal request, meticulously reviewed and processed, to ensure the financial aspects of one’s service are accurately aligned with their current circumstances. Navigating through this form requires attention to detail and a thorough understanding of one’s own status and needs. The following steps have been designed to aid in this process, reducing the potential for errors and oversights, thereby smoothing the path to a successful submission.

  1. Begin by gathering all pertinent personal information and documentation related to your finances and dependent status. This includes identification details, marriage, birth certificates, or any other documents that will support your request.
  2. Enter your full legal name, rank, and social security number in the designated sections at the top of the form. This information establishes your identity and military status for the record.
  3. Specify your branch of service and station. Accurately stating these details is crucial for routing your form to the correct department for approval.
  4. Complete the sections related to your current living situation and any dependents. This is where you'll detail whether you're living on-base, off-base, or if special circumstances apply. Ensure that all information about dependents is current and thoroughly documented.
  5. In the section designated for financial adjustments, carefully outline the types of allowances you are claiming. This could include Basic Allowance for Housing (BAH), Cost of Living Allowance (COLA), or others. Precise figures and justifications will streamline the approval process.
  6. If there are any additional comments or explanations required, use the space provided towards the end of the form. Clarity and conciseness in this portion can significantly impact the understanding of your circumstances by the reviewing authority.
  7. Review all sections of the form for accuracy and completeness. An oversight or error can delay the processing of your request and affect your financial entitlements.
  8. Sign and date the form in the designated area. Your signature certifies that all information provided is accurate to the best of your knowledge and belief. Forging or misrepresenting information on this form can lead to severe repercussions.
  9. Submit the completed form to your commanding officer or the appropriate department as directed by your branch’s protocol. Follow up to ensure it has been received and to inquire about any further steps or additional documentation that may be required.

The careful completion and submission of the DA 5960 form is not merely a procedural task; it is a decisive action towards securing the entitlements and allowances that align with one’s life circumstances within the service. By adhering to the outlined steps, individuals can navigate this process with confidence, ensuring a thorough and accurate presentation of their situation for review. As situations evolve, remember that this form may need to be updated; thus, maintaining current knowledge on the form’s requirements and procedures is beneficial for continued financial administration.

More About DA 5960

What is a DA 5960 form?

A DA 5960 form, also known as an Authorization to Start, Stop, or Change Basic Allowance for Quarters (BAQ), and/or Variable Housing Allowance (VHA), is a document used by the U.S. Army. It is designed to formally request changes to a service member's housing and variable housing allowances. This form plays a crucial role in ensuring that personnel receive the appropriate financial compensation based on their housing situation.

Who needs to fill out a DA 5960 form?

Any active duty service member who wishes to initiate, alter, or halt their housing or variable housing allowances must fill out a DA 5960 form. This includes soldiers undergoing changes in their living circumstances, such as marriage, divorce, relocation, or a change in dependent status, which would affect their housing benefits.

When should a service member submit a DA 5960 form?

Service members should submit a DA 5960 form promptly when experiencing any life event that impacts their housing status. Timely submission is critical, ideally before or immediately following events like getting married, having a child, moving to a new residential location, or any other circumstance altering their need for housing allowance.

What information is required on a DA 5960 form?

Completing a DA 5960 form requires various pieces of personal and family information. This includes identification details, rank, social security number, and information about dependents. It also requires detailed information about the housing situation, including any changes that are being requested to the housing or variable housing allowances.

How does a service member submit a DA 5960 form?

Submission processes may vary by unit or military installation. Generally, a service member must fill out the form accurately, sign it, and then submit it through their chain of command. The form may also require endorsement by the service member's commanding officer before submission to the appropriate finance office for processing.

What happens after a DA 5960 form is submitted?

After submission, the form is reviewed by the personnel or finance office to ensure it is correctly filled out and that the request is valid based on the service member's circumstances. If approved, the allowance adjustments are processed, and the service member will receive a notification regarding the status of their request and when they can expect the changes to their allowances to take effect.

Can a DA 5960 form be rejected?

Yes, a DA 5960 form can be rejected if it is incomplete, contains incorrect information, or if the requested allowance adjustments are not justified based on the provided evidence or circumstances. In such cases, service members are usually given the opportunity to provide additional information or correct any errors and resubmit the form.

Is it possible to appeal a decision made on a DA 5960 form?

Yes, service members can appeal decisions regarding their DA 5960 form. If an initial request is denied or adjusted in a manner the service member disagrees with, they can typically file an appeal through their chain of command, providing further evidence or clarification to support their case.

Where can service members find help with their DA 5960 form?

Service members seeking assistance with their DA 5960 form can find support through their unit's personnel or finance office. Additionally, legal assistance offices on base can provide guidance, ensuring that the form is filled out correctly and that the service member's rights and benefits are fully protected.

Common mistakes

One common mistake individuals often make when filling out the DA 5960 form is inaccurately reporting their dependency status. This error can occur if someone mistakenly includes a non-dependent as a dependent or fails to include an actual dependent. Such inaccuracies can lead to incorrect Basic Allowance for Housing (BAH) rates, impacting financial planning and budgeting. Ensuring that all dependents are accurately listed, with careful consideration given to who meets the criteria as a dependent, is crucial for the accurate computation of entitlements.

Another frequent error is the failure to update personal information promptly. Life events such as marriages, divorces, or the birth of a child can significantly affect entitlements. Yet, individuals often overlook or delay updating these changes on the DA 5960 form. This oversight can result in receiving either too much or too little allowance, each scenario having its own set of complications. Regular reviews and updates of one's personal information can prevent such discrepancies.

Incorrectly calculating entitlements is also a notable error. The DA 5960 form requires specific calculations to determine the correct allowance amounts. Without a clear understanding of how to accurately calculate these entitlements, individuals can either underreport or overreport their allowances. This mistake can not only impact financial stability but also lead to potential issues with the Department of Defense (DoD). Utilizing resources and seeking clarification when needed can help avoid these calculation errors.

Lastly, a significant number of errors stem from not thoroughly reading the instructions or overlooking the necessity to include required documentation. The DA 5960 form comes with detailed instructions that many individuals skim over or completely ignore. Skipping this critical step can lead to incomplete forms or the omission of crucial supporting documents. Careful attention to the instructions and ensuring all required documentation is attached can significantly reduce errors and processing delays.

Documents used along the form

When managing allowances and financial benefits in the military, the DA 5960 form, also known as the Authorization to Start, Stop, or Adjust Basic Allowance for Quarters (BAQ), and/or Variable Housing Allowance (VHA), is a critical document. However, to ensure accurate and comprehensive processing, several other forms and documents are often required in conjunction. These documents support the DA 5960 by providing additional information, verifying eligibility, or providing the necessary authorization for action. Below is a list of documents frequently used alongside the DA 5960 form.

  • DD Form 1172 - Application for Identification Card/DEERS Enrollment: Essential for verifying military family member data and ensuring they are registered in the Defense Enrollment Eligibility Reporting System (DEERS), which is necessary for housing allowance adjustments.
  • DD Form 93 - Record of Emergency Data: Provides emergency contact information and is vital in determining the authorized dependents for housing adjustments.
  • DD Form 1351-2 - Travel Voucher or Subvoucher: Required for claiming travel expenses, this form can impact the initiation or adjustment of housing allowances based on reassignment or relocation.
  • Marriage Certificate - Used to verify marital status and spouse dependency for BAQ adjustments.
  • Birth Certificates for Dependents: Necessary for proving the number of dependents, which can alter the housing allowance.
  • Divorce Decree: Needed to document the end of a marriage and adjust housing allowances accordingly.
  • Lease Agreement or Mortgage Documents: Provide proof of residence and are often required to verify living arrangements for VHA purposes.

In order to facilitate the precise and efficient processing of housing and allowances benefits, each of these documents plays a pivotal role. They confirm personal circumstances and ensure that military members receive the entitlements appropriate to their situation. Handling these documents with care and attention to detail safeguards the rights and benefits of service members and their families, ensuring that their needs are met according to regulatory guidelines.

Similar forms

The DA 5960 form, often associated with the authorization for basic allowance for housing (BAH), shares similarities with several other government and military forms designed to manage personnel affairs and financial allowances. One such document is the DD Form 2558, which is the Authorization to Start, Stop, or Change an Allotment. Similar to the DA 5960, this form is used by military personnel to manage the distribution of their pay for specific expenses, providing a mechanism for automatic financial management and allocation.

Another document closely related to the DA 5960 is the DD Form 2058, which is used for State of Legal Residence Certificate. This form influences a service member's tax obligations and voting registration, much like the DA 5960 affects housing allowances based on geographical locations. Both forms require accurate personal and locational information to ensure proper entitlements and legal compliances.

The SF-1190 (Foreign Allowances Application, Grant, and Report) is also akin to the DA 5960, targeting personnel stationed overseas. It outlines allowances and benefits for employees in foreign areas, adjusting for cost-of-living differences, similar to how BAH rates are adjusted for various geographical locations in the DA 5960.

Another document, the DD Form 137-3, Dependency Statement - Parent, shares its purpose with the DA 5960 in verifying dependency for financial allowance purposes. While the DA 5960 focuses on housing allowances, the DD Form 137-3 establishes eligibility for certain entitlements by verifying a parent's dependency status, both pivotal in ensuring service members receive appropriate benefits.

The DA Form 31, Request and Authority for Leave, while primarily for leave requests, intertwines with the DA 5960 in that it may affect BAH entitlements. Extended leaves or changes in duty stations can impact housing allowances, highlighting the interconnected nature of personnel documentation and the need for accurate, up-to-date information across forms.

Lastly, the BAH Rate Inquiry Form, while not an official military form like the DA 5960, serves a complementary purpose by allowing service members to inquire about or contest their current BAH rates. This document’s utility underscores the importance of accurate allowances and the need for mechanisms to address discrepancies, similar to adjustments facilitated by the DA 5960.

Dos and Don'ts

Understanding the DA 5960 form, essential for Basic Allowance for Housing (BAH) documentation, requires precise attention to detail. To ensure accuracy and streamline the approval process, here are the dos and don'ts when completing the form:

  • Do double-check your personal information for accuracy. Incorrect details can delay processing.
  • Do carefully read the instructions for each section to ensure you understand what is required.
  • Do use a black or blue ink pen if filling out the form by hand to ensure legibility.
  • Do provide supporting documentation, such as marriage certificates or birth certificates, when required.
  • Don't leave mandatory fields blank. If a section does not apply to you, write "N/A" to indicate this.
  • Don't guess on dates or figures. Verify all information to ensure its correctness.
  • Don't use correction fluid or tape. If you make a mistake, start over with a new form to keep the document clean and legible.
  • Don't hesitate to ask for help from a superior or a legal advisor if you're unsure about any part of the form. Clarification can prevent errors and delays.

Following these guidelines will help facilitate a smoother process in filing the DA 5960 form, ensuring timely and accurate processing of your BAH entitlements.

Misconceptions

The DA 5960 form, often associated with the United States Army, is a document used for authorizing basic allowance for housing (BAH). Surrounding this form, several misconceptions have emerged over time. It's important to clarify these misunderstandings to ensure accurate completion and submission of the form.

  • Misconception 1: Only soldiers with dependents are eligible for BAH. It's commonly misunderstood that the DA 5960 form and thus the BAH are exclusively available to those with dependents. In reality, BAH is also available to single soldiers at a different rate. The key determinant is the soldier's pay grade and duty location, not just marital or dependent status.
  • Misconception 2: The form is complicated and requires a legal or financial expert to fill out. While the DA 5960 form involves financial implications, it is designed to be filled out by the service member with clear instructions provided. Assistance from a legal or financial expert isn't a necessity, though one might seek help from a superior or a personnel officer if there are questions.
  • Misconception 3: Once submitted, the information on the form cannot be changed. The belief that information on the DA 5960 form is set in stone after submission isn't correct. Life circumstances and military situations can change, necessitating updates to the form. Service members can submit revised forms to reflect changes such as marriage, divorce, or the birth of a child.
  • Misconception 4: Completing the DA 5960 form is the only step needed to receive BAH. While filling out and submitting the DA 5960 is a critical step in the BAH process, it is not the only requirement. The form must be approved by the designated approving authority. Additionally, service members must ensure that all supporting documentation, such as marriage certificates or birth certificates for dependents, is submitted to validate their BAH claims.

Key takeaways

The DA 5960 form, officially known as the Authorization to Start, Stop, or Change Basic Allowance for Housing (BAH), is a critical document for military personnel. Its effectiveness in facilitating housing allowances makes understanding its intricacies paramount. Here are ten key takeaways about filling out and using this form:

  1. Ensure accuracy and completeness when providing personal information to prevent delays or errors in processing your BAH entitlements.
  2. Familiarize yourself with the different types of BAH to accurately apply for the allowance that fits your situation, such as BAH With Dependents or BAH Without Dependents.
  3. Provide supporting documents as required, such as marriage certificates or orders for geographic location changes, to substantiate your claim for BAH adjustments.
  4. Clearly state the reason for the request on the form, whether it's to start, stop, or change your BAH, for efficient handling.
  5. Review the specific instructions and guidelines provided by your branch of the military or your base's housing office as procedures and requirements can slightly vary.
  6. Consult with a financial counselor or a superior officer if you encounter uncertainty or difficulties while filling out the form; they can offer valuable guidance.
  7. Submit the completed form through the proper channels as defined by your unit or base to ensure it reaches the appropriate office for processing.
  8. Keep a copy of the submitted form and any correspondence or confirmations for your records; this documentation can be crucial for resolving any potential issues.
  9. Anticipate a processing period and inquire about the expected timeframe so that you can plan your finances accordingly.
  10. Maintain open communication with the housing office or your finance department, especially if your housing situation changes, to update your BAH entitlements swiftly.

In the context of managing military benefits, the DA 5960 form serves as a vital tool for service members. A thorough understanding and meticulous handling of this form empower personnel to accurately navigate changes in housing allowances, ensuring financial stability for themselves and their families.

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