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The DA Form 5960, often essential in the lives of military personnel, serves a pivotal role in managing Basic Allowance for Housing (BAH) entitlements. This document is designed to ensure that service members receive the housing support they are entitled to, whether for residing off-base or for specific changes in their living situations, such as marriage or having children. It requires detailed information about dependents, current living arrangements, and other factors that influence housing allowances. The process of completing and updating the DA 5960 can directly impact the financial well-being of military families, making it crucial for service members to understand its nuances and requirements. Through its structured framework, the form also aids in maintaining accurate and up-to-date records for military administrations, facilitating efficient management of housing benefits and ensuring compliance with military housing policies.

Form Preview

 

 

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

File Attributes

Fact Number Fact Description
1 The DA 5960 form is used by the U.S. Army for authorization to start, stop, or change Basic Allowance for Housing (BAH).
2 It is required when a service member experiences a change in marital status, dependents, or living situation.
3 Service members must submit the form to their Personnel Service Battalion or the finance office.
4 Accuracy in filling out the DA 5960 form is crucial as it affects the service member's pay and allowances.
5 The form requires details about the service member's dependents, if applicable.
6 Information about the member’s current housing and reason for the BAH request is also necessary.
7 Errors or inaccuracies on the form can lead to delays or incorrect BAH rates.
8 Upon approval, adjustments to BAH are reflected in the service member’s Leave and Earnings Statement (LES).
9 This form is governed by federal military regulations, rather than state law, as it is a federal military form.

How to Fill Out DA 5960

Once you've been tasked with completing the DA 5960 form, it's crucial to approach the process with attention to detail to ensure that every section is filled out correctly. This document is essential for documenting necessary personal information for administrative purposes. By following these step-by-step instructions, you can confidently navigate through the form, reducing the likelihood of errors and ensuring the accuracy of the information provided.

  1. Start by entering your full name (last, first, middle initial) in the designated area at the top of the form.
  2. Fill in your Social Security Number (SSN) in the next section, ensuring accuracy to avoid any identity errors.
  3. Proceed to specify your rank within the organization, accurately reflecting your position.
  4. In the section labeled 'date', input the current date to document when the form is being filled out.
  5. Identify the type of action requested by checking the appropriate box that correlates with your needs on the form.
  6. For those required to provide information about dependents, accurately list each dependent's name, relationship to you, and date of birth, ensuring no one is overlooked.
  7. Detail your current housing situation, including the type of residence and address, to provide context on your living arrangements.
  8. If applicable, specify the changes in your housing or dependency status that prompted the completion of the DA 5960 form, giving a brief explanation in the space provided.
  9. Carefully review all entered information for accuracy, then sign and date the form in the designated areas to verify the information.
  10. Lastly, submit the completed form to the appropriate office as directed, ensuring it reaches the correct hands for processing.

With these steps, you've taken the necessary precautions to accurately complete the DA 5960 form. It's important to keep a copy of the submitted document for your records. Additionally, staying informed about the processing progress and any further actions required on your part contributes to a smooth administrative experience.

Frequently Asked Questions

What is a DA 5960 form?

The DA 5960 form, known as the Authorization to Start, Stop, or Change Basic Allowance for Housing (BAH), is a document used by the United States Army. It serves to request adjustments to a soldier's housing allowance. Such adjustments may include initiating an allowance for those who are newly eligible, changing the amount due to family status changes (like marriage or the birth of a child), or stopping the allowance when it's no longer applicable.

Who needs to fill out a DA 5960 form?

Members of the Army who experience a change in their housing or family status requiring an update to their Basic Allowance for Housing benefits are required to fill out the form. This includes changes such as marriage, divorce, having a child, or moving off-base. The updated form ensures the allowance accurately reflects their current situation.

When should I submit a DA 5960 form?

You should submit a DA 5960 form promptly after any change affecting your eligibility or need for housing allowance. Timely submission helps prevent any discrepancies in pay that could arise from delayed adjustments. The military finance office can provide specific deadlines for submission based on your situation.

What information do I need to provide on the DA 5960 form?

  • Personal information such as name, rank, and service number
  • Current housing status and desired changes
  • Information about dependents, if applicable
  • Marital status and any changes affecting allowance eligibility
  • Signature of the service member and, in some cases, the verifying officer

How do I submit the DA 5960 form?

After completing the DA 5960 form, you should submit it to your unit's finance office or the designated personnel within your chain of command responsible for handling pay and allowances. Some units may allow electronic submission, while others require a physical form. It's important to verify the preferred method of submission within your specific command.

Can I fill out the DA 5960 form online?

While you cannot officialy submit the DA 5960 form online through military channels, you may be able to download, fill, and print the form from online sources. After filling it out electronically, you must print and sign it before submitting it through your unit’s finance office or the appropriate military pay personnel.

What should I do if my housing situation changes after submitting the DA 5960 form?

If your housing situation changes after you've submitted a DA 5960 form, you need to fill out and submit a new form reflecting the change. This ensures your housing allowance remains accurate and prevents overpayments or underpayments. Always notify your unit's administration and follow the specific procedures in place for updating your information.

Common mistakes

One common mistake people make when filling out the DA 5960 form is not thoroughly checking their personal information for accuracy. This includes errors in basic details such as name, rank, social security number, and service component. These inaccuracies can lead to delays in processing and may even result in denial of the requested allowances.

Another error involves the misunderstanding of entitlements. Applicants often fail to correctly identify the type of Basic Allowance for Housing (BAH) they are eligible for, whether it is with dependents or without. This misunderstanding can significantly affect the financial benefits they are entitled to receive.

Many also overlook the importance of providing accurate details about their dependents. This includes failing to update changes in dependent status, such as a marriage, birth, or divorce. Such oversights can result in incorrect BAH rates and potential overpayments that the service member will be obligated to repay.

Failure to include necessary documentation is a frequent oversight. Supporting documents, such as marriage certificates or birth certificates for dependents, are often required to process the DA 5960 form. Without these, the application cannot be properly evaluated, leading to processing delays or outright denial.

Incorrect assignment information is another common mistake. Applicants sometimes provide outdated or incorrect duty station information, affecting the calculation of their BAH since rates vary by geographic location.

Some individuals mistakenly believe they do not need to update their DA 5960 form unless they are relocating. However, any change in family status or financial situation necessitates a review and potential update of the form to ensure allowances are accurately calculated and disbursed.

Entering inaccurate contact information is yet another mistake that can lead to complications. If the contact information is incorrect, it becomes challenging for the processing office to reach out for any clarifications or to request additional documents, thus delaying the entire process.

Lastly, rushing through the form without double-checking each section for completeness and accuracy tends to result in errors. This is particularly true for sections that require detailed information about housing, leases, or mortgage arrangements. Such haste can lead to omissions that may necessitate re-submission of the form, further delaying receipt of allowances.

Documents used along the form

When handling official matters related to the DA 5960 form, which is primarily used by military personnel to request, start, stop, or adjust basic allowance for housing (BAH), several other forms and documents might also need to be filled out or provided. These forms are often necessary for processing the request accurately and efficiently, ensuring the service member’s housing needs and allowances are adequately taken into account. Understanding each form’s purpose can help streamline the process.

  • DD Form 1172-2: This form is used to apply for and renew military identification cards for dependents. It's commonly required alongside the DA 5960 when updating BAH due to changes in dependent status.
  • LES (Leave and Earnings Statement): This document provides a detailed breakdown of a service member's pay, allowances, deductions, and benefits. It's crucial for verifying income and entitlements when adjusting BAH.
  • Marriage Certificate: For service members who are married and seeking to adjust their BAH to reflect their marital status, an official marriage certificate must be presented.
  • Birth Certificates for Dependents: Similar to the marriage certificate, birth certificates for any children or dependents are required to verify family size for BAH adjustments.
  • PCS Orders: Permanent Change of Station (PCS) orders are necessary when a service member is relocating. These orders are used to validate the move and the entitlement to BAH at a new location.

Gathering the correct documentation is a key step in the process of applying for or adjusting BAH. Each document plays a specific role in confirming the details of a service member's situation, ensuring that their allowances accurately reflect their current living arrangement and familial obligations. Being prepared with the right forms and documents can help facilitate a smoother transaction and avoid any unnecessary delays.

Similar forms

The DA Form 5960, used by the U.S. Army for Basic Allowance for Housing (BAH) adjustments, shares similarities with the DD Form 137-3, which is used across all military branches to verify dependency status. Both forms are critical for service members to show evidence of dependents, affecting their housing and financial benefits. The significant similarity lies in their purpose to ensure military personnel receive appropriate allowances based on their current family status.

Similar to the DA Form 5960 is the I-864, Affidavit of Support, used in immigration proceedings. Though serving different sectors, both forms play a pivotal role in verifying the financial responsibility for dependents. The I-864 ensures a sponsor can support an immigrant, akin to how the DA 5960 showcases a service member’s entitlement to increased housing allowance due to dependents.

The DA Form 5960 also parallels the IRS Form 1040, the primary U.S. individual income tax return form. Both documents require detailed financial information that influences financial benefits or liabilities. Service members use the DA 5960 to adjust housing benefits, while taxpayers use Form 1040 to calculate their tax due or refund, including deductions for dependents similar to considerations on the DA 5960.

Another form with similarities is the W-4, Employee’s Withholding Certificate. Like the DA Form 5960, individuals use the W-4 to make adjustments that affect their take-home pay—dependent on their financial and dependent status. Both are proactive forms allowing for adjustments to personal and financial circumstances to influence financial outcomes.

The HUD-1 Settlement Statement, used in real estate transactions, also shares commonalities. While it’s used in a different context, it, like the DA 5960, deals with housing allowances and costs. Both forms detail housing expenses and adjustments necessary for proper financial management and entitlements related to housing.

Similar to DA Form 5960, the SSA-1099, Social Security Benefit Statement, is crucial for reporting specific types of income for tax purposes and determining entitlements. Both necessitate accurate reporting of financial information that directly affects the benefits one may receive, with the SSA-1099 focusing on social security benefits.

Also akin to the DA Form 5960, the FAFSA (Free Application for Federal Student Aid) is essential for identifying financial assistance eligibility. Each form evaluates financial information to determine benefits, be it for education funding through FAFSA or housing allowances through DA Form 5960.

The VA Form 26-1880, Request for Certificate of Eligibility for VA Home Loan, is yet another form related in functionality to the DA Form 5960. Both forms are vital for securing housing benefits—DA Form 5960 for military housing allowances, and VA Form 26-1880 for veteran home loans, reflecting their roles in assisting with housing finances.

Similarly, the Application for Federal Housing Administration (FHA) Loan exhibits parallels with DA Form 5960. While the FHA application is used to secure a government-insured mortgage, both it and the DA Form 5960 facilitate access to housing assistance, spotlighting the individual’s financial state and housing needs.

Lastly, the Change of Program or Place of Training (VA Form 22-1995), used by veterans or service members to update their education program or location, has operational similarities. Like the DA Form 5960, it helps in adjusting benefits based on life changes, focusing on education for VA Form 22-1995 and housing for DA Form 5960.

Dos and Don'ts

Filling out the DA 5960 form, also known as the Authorization to Start, Stop, or Change Basic Allowance for Housing (BAH), is an important process for service members. Whether you're completing this form for the first time or updating your information due to life changes, accuracy and attention to detail are crucial. Here are eight essential dos and don'ts to help guide you through the process.

  • Do:
    1. Read instructions carefully before filling out the form to ensure you understand all requirements and provide accurate information.
    2. Verify your personal information, including your full name, social security number, and service details, to prevent any processing delays.
    3. Use black ink or type your responses if possible to enhance legibility and minimize the risk of errors during processing.
    4. Include all necessary supporting documents, such as marriage certificates or birth certificates, to validate your BAH entitlement.
    5. Consult a superior or a human resources officer if you are unsure about any part of the form to avoid mistakes.
    6. Review your completed form thoroughly for any errors or omissions before submission.
    7. Keep a copy of the form and any accompanying documents for your records.
    8. Submit the form in a timely manner, especially if you're applying due to a life event that changes your BAH entitlement, such as marriage or the birth of a child.
  • Don't:
    1. Rush through filling out the form, as this can lead to mistakes that may delay processing or impact your entitlement.
    2. Leave any required fields blank. If a section does not apply to you, mark it as "N/A" (not applicable)
    3. Use pencil or colors of ink other than black, as they may not be accepted or legible when photocopied or scanned.
    4. Laminate or use correction fluid (white-out) on the form, as altered documents may not be accepted and can require you to start over.
    5. Guess on dates or financial amounts. Ensure all provided information is accurate and verifiable.
    6. Ignore requests for additional information or clarification from your human resources department, as delays can affect your entitlement.
    7. Forget to sign and date the form. An unsigned form is considered incomplete and will not be processed.
    8. Submit outdated information. If your circumstances change after submission, update your form as soon as possible.

Following these guidelines will help streamline the DA 5960 form filling process, ensuring you receive the correct Basic Allowance for Housing entitlement in a timely manner. Always remember, when in doubt, seek guidance from a superior or human resources officer familiar with military housing allowances.

Misconceptions

When dealing with the DA 5960 form, commonly known as the Basic Allowance for Housing (BAH) form, several misconceptions tend to circulate. These can lead to confusion and errors during completion. It's important to address and clarify these misunderstandings to ensure the form is filled out accurately and efficiently.

  • Only military members can fill out the DA 5960 form. This misunderstanding can cause delays. While the form is designed for service members to apply for housing allowances, the responsibility of completing it can also fall on authorized representatives, such as a spouse or a designated official, under certain circumstances.

  • Completion of the DA 5960 form guarantees immediate housing allowance. The process involves verification and approval by the appropriate authority. After submission, there might be a waiting period during which the form is reviewed and the eligibility for the housing allowance is determined.

  • The DA 5960 form is only for those living off-base. This form actually caters to various housing situations, including on-base, off-base, and government quarters. The form helps determine the appropriate housing allowance based on the individual's specific living arrangements.

  • The information provided on the DA 5960 form is final and cannot be changed. Life circumstances change, and the military understands this. The DA 5960 form can be updated as needed to reflect new living arrangements or changes in dependency status, ensuring that allowances are accurate and fair.

  • There is only one type of BAH that applies once the DA 5960 form is approved. In reality, BAH rates vary based on rank, geographic duty location, and dependency status. This ensures that allowances are tailored to the specific needs and circumstances of each service member.

  • Filling out the DA 5960 form is a long and complicated process. While it’s crucial to provide accurate information, the form itself is designed to be straightforward. Proper preparation and having the necessary documentation on hand can simplify the process significantly.

Understanding these misconceptions about the DA 5960 form is the first step toward demystifying the process of applying for housing allowances. Clearing up these misunderstandings helps ensure that service members and their families are better equipped to navigate the allowances that support their housing needs.

Key takeaways

The DA 5960 form, also known as the Authorization to Start, Stop, or Change Basic Allowance for Quarters (BAQ), Variable Housing Allowance (VHA), and/or Overseas Housing Allowance (OHA), is a crucial document for service members. Understanding how to properly fill out and use this form can significantly impact one’s living situation and financial health. Here are five key takeaways that everyone dealing with the DA 5960 should know:

  • Accuracy is paramount. Every detail you provide on the DA 5960 form must be accurate. Inaccuracies can delay the processing of your request and affect your entitlements. From personal information to data on dependents and housing status, double-checking all entries for accuracy ensures that the process runs smoothly.
  • Understanding entitlements. Before filling out the form, it’s essential to have a clear understanding of your entitlements. This comprehension will guide you in requesting the appropriate allowances for your situation, whether you’re single, married, or have dependents. Familiarize yourself with the regulations surrounding BAQ, VHA, and OHA to make informed decisions.
  • Changes in personal circumstances. The DA 5960 must be updated and resubmitted whenever there is a change in your personal circumstances that could affect your allowance eligibility. This includes marriage, divorce, the birth of a child, or a change in your spouse's employment status. Staying on top of these changes ensures you receive the correct allowances without interruption.
  • Seek guidance when needed. If you encounter uncertainties while filling out the form or have specific questions about your allowance eligibility, do not hesitate to seek guidance. Your base’s personnel or financial office can provide assistance and ensure that your submissions are correctly completed and processed.
  • Timely submission. Submitting the DA 5960 form promptly is crucial, especially when reporting a change in your housing or dependent status. Delays in submission can result in delayed adjustments to your allowances, impacting your financial situation. Make sure to adhere to any deadlines provided by your command or housing office.

Properly completing and utilizing the DA 5960 form is fundamental for service members to manage their housing allowances effectively. By paying close attention to these key takeaways, individuals can navigate the process more smoothly and ensure that their financial and living arrangements are accurately reflected and adequately supported.

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