DA 5960 PDF Form Customize Form Here

DA 5960 PDF Form

The DA 5960 form, commonly known as the Basic Allowance for Housing (BAH) form, is a document used by the United States Department of Defense. It is designed for service members to apply for housing allowance or to update their current housing status. This form plays a crucial role in ensuring military personnel receive the financial support they're entitled to for their living accommodations.

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Overview

Among the myriad of documentation the United States Army requires, the DA 5960 form, commonly referred to as the Basic Allowance for Housing (BAH) form, holds significant importance for service members. This form is a vital component for those who are entitled to receive housing allowances, enabling them to secure appropriate living conditions for themselves and, if applicable, their dependants. The process of completing and submitting the DA 5960 is essential for the calculation and distribution of housing benefits, which vary based on geographical location, pay grade, and dependent status. Its purpose extends beyond simply requesting an allowance; it is an official document that must accurately reflect the service member's current living situation, any dependants, and any change in marital status, among other circumstances that could affect housing entitlements. Filling out the form correctly ensures that the personnel are provided with the benefits they are entitled to, in a manner that reflects their service and sacrifices for the country.

Preview - DA 5960 Form

 

 

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 Specs

Fact Name Description
Purpose of DA Form 5960 Used by military personnel to authorize, start, stop, or change Basic Allowance for Quarters (BAQ) and Variable Housing Allowances (VHA).
Who Uses DA Form 5960 It is primarily used by members of the Army, though it can be relevant for all branches of the military where applicable.
When to Use DA Form 5960 It is used when a service member needs to update their housing and living situation, including marriage, divorce, or changes in dependent status.
Governing Law for DA Form 5960 While not governed by a specific state law, it abides by federal regulations concerning military allowances.
Filing Process The completed form must be submitted through the service member's chain of command or designated personnel office.

Detailed Instructions for Filling Out DA 5960

When it comes time to fill out the DA 5960 form, it's important to approach the task with care and attention to detail. This document is vital for personnel seeking to establish or change their basic allowance for housing (BAH) status. Ensuring all information is correct and up to date can make the process smoother and faster. Below, you'll find a guide designed to help you through each step, making sure nothing is overlooked.

  1. Begin by gathering all necessary documents and information. This may include military orders, marriage certificates, lease agreements, or custody documents.
  2. Locate the most recent version of the DA 5960 form. It’s essential to use the current form to avoid processing delays.
  3. Section I requires personal information. Fill in your full name, grade, social security number, and branch of service.
  4. In Section II, specify your current housing status and the type of quarters you are applying for. Be clear and accurate.
  5. For Section III, if you are claiming dependents, provide their information. Include names, relationship to you, and dates of birth.
  6. Section IV asks for authorization type. Here, you will indicate the reason for the housing allowance request, such as a change in dependents or marital status.
  7. In Section V, carefully read the certification statement. Once you understand and agree, sign and date the form.
  8. When the form is completed, review it for accuracy. Double-check all entered information to ensure it's correct and there are no omissions.
  9. Submit the completed form to your personnel or finance office for processing. Make sure to keep a copy for your records.

After you have submitted the DA 5960 form, your application will be reviewed for approval. This process can take some time, depending on your service branch and the complexity of your housing situation. During this period, stay in contact with your personnel or finance office to monitor your application's status. Being proactive can help address any issues quickly and keep the process moving forward efficiently.

More About DA 5960

  1. What is the DA 5960 form?

    The DA 5960 form, commonly referred to as the Authorization to Start, Stop, or Change Basic Allowance for Quarters (BAQ), or Variable Housing Allowance (VHA), is a document used by the United States Department of Army. It serves the primary function of managing housing allowances for soldiers who wish to start, stop, or modify their current living arrangements. This form is crucial for accurate financial compensation related to housing needs based on various circumstances like changes in marital status, dependents, or living situations.

  2. Who needs to fill out the DA 5960 form?

    Soldiers who undergo changes in their living circumstances that affect their basic allowance for housing (BAH) must complete the DA 5960 form. This includes events such as marriage, divorce, having children, or moving out of or into military quarters. The form must be filled out to reflect current living situations accurately, ensuring the soldier receives the correct housing allowance entitlements. Commanding officers and authorized personnel within the soldier's chain of command are also involved in the approval process.

  3. How can one obtain a DA 5960 form?

    To obtain a DA 5960 form, individuals should visit the official website of the United States Army or consult their unit's administrative office. Additionally, human resources support teams are available to provide the necessary forms and guidance on how to complete them properly. Digital platforms and military software systems also often have downloadable versions of the form for easier access and submission.

  4. What information is required on the DA 5960 form?

    Completing the DA 5960 form requires specific information related to the soldier's housing and living situation. Key details include the soldier's personal identification information, current and proposed housing status, information about dependents, and authorization signatures from the commanding officer. Accuracy is vital when filling out this form, as any discrepancies can affect the housing allowance and potentially result in financial discrepancies or penalties.

  5. How does one submit a completed DA 5960 form?

    Once filled, the DA 5960 form should be submitted through the soldier's chain of command for approval. This process typically involves review and signature by a commanding officer or a designated representative. After approval, the form is submitted to the appropriate finance office or human resources department for processing. In some cases, electronic submission through military personnel systems is available, streamlining the process and ensuring faster updates to the soldier's entitlements.

  6. What are the consequences of not submitting a DA 5960 form when required?

    Failure to submit a DA 5960 form under necessary circumstances can result in improper payment of the housing allowance. This might lead to overpayments or underpayments. In the case of overpayments, the soldier may be required to repay the excess funds, which can impose a significant financial burden. Additionally, continuous failure to comply with housing allowance policies can result in administrative actions or disciplinary measures. Thus, timely and accurate submission of the DA 5960 form is crucial for maintaining financial solvency and avoiding legal complications.

Common mistakes

Filling out the DA 5960 form, also known as the Authorization to Start, Stop, or Change Basic Allowance for Housing (BAH), can often be a challenging task for individuals due to its complexity. One common mistake is overlooking the necessity to provide accurate personal information. This includes errors in basic details such as spelling of names, social security numbers, or service numbers. Providing accurate personal information is crucial as it ensures the form is correctly processed and associated with the right individual.

Another area where errors frequently occur is in the section requesting details about dependents. Individuals sometimes fail to list all eligible dependents or mistakenly include those who are not eligible for consideration under the BAH policy guidelines. Ensuring that all dependent information is both accurate and complete is essential for the proper calculation of the housing allowance.

A significant mistake often made relates to the failure to properly document changes in dependency status. This could involve not updating the form when a dependent is no longer eligible, such as following a child reaching the age of majority or due to a change in marital status. Timely updates are critical to maintain compliance and ensure the housing allowance is correctly calculated.

Incorrectly selecting the type of action needed is another common error. The form requires the applicant to specify whether they are seeking to start, stop, or change their BAH. Inaccuracies or indecision in this section can result in delays or the wrong action being processed.

Errors in the section related to duty station or housing information can also occur. Individuals might input an incorrect address for their duty station or their actual housing location, which can affect the BAH rate to which they are entitled. Accuracy in this section ensures the allowance reflects the cost of living specific to the correct geographic area.

An oversight often seen is not providing or incorrectly completing the certification section. This part of the form needs the signature of the individual and sometimes a verifying officer. Missing or invalid signatures can deem the form incomplete, halting the processing of the BAH change request.

Failure to attach required documentation is another prevalent mistake. The DA 5960 form often requires accompanying documents, such as marriage certificates or birth certificates for dependents, to substantiate the information provided. Neglecting to include these documents can result in the rejection of the application.

Lastly, people sometimes do not review the form for completeness and accuracy before submission. This lack of review can lead to oversights, including the omission of required information or the inclusion of contradictory details. Taking time to thoroughly review the form can prevent processing delays and the need for resubmission.

Documents used along the form

The DA 5960 form, commonly known as the Authorization to Start, Stop, or Change Basic Allowance for Housing (BAH), is a vital document used by service members to manage housing allowances. Accompanying this form, several other forms and documents are frequently utilized to ensure that all aspects of a service member's housing and related allowances are correctly addressed. These documents encompass a range of purposes, from verifying dependency status to requesting specific types of housing or financial adjustments.

  • DD Form 1172-2: This form is used to apply for and update the Defense Enrollment Eligibility Reporting System (DEERS). It is essential for verifying a service member's dependents, which is crucial for BAH eligibility and calculation.
  • DD Form 1746: The Application for Assignment to Housing form is required when a service member applies for government housing. It complements the DA 5960 by determining the need for housing allowances based on government housing availability.
  • DD Form 1351-2: The Travel Voucher or Subvoucher is used by service members to claim reimbursement for official travel expenses. This includes relocation costs associated with changes in duty stations that may affect housing allowances.
  • DA Form 31: Request and Authority for Leave. This document is necessary when a service member is planning to take leave, especially if the leave period impacts the housing situation or allowance needs.
  • LES (Leave and Earnings Statement): Although not a form, the LES is a critical document for service members. It provides a comprehensive overview of their pay, allowances, including BAH, and deductions, which helps in tracking changes or updates.
  • DA Form 4187: Personnel Action. This form is used for a variety of personnel actions, including change of duty status that could influence BAH eligibility or amounts.
  • DD Form 2558: Authorization to Start, Stop or Change an Allotment. While the DA 5960 specifically deals with BAH, the DD 2558 is used for managing allotments, which may include specific arrangements for housing costs or savings.
  • Marriage Certificate/Birth Certificates: These documents are often required for initial BAH requests or changes, as they establish dependency status, which is a key factor in BAH determination.

In conclusion, when handling the DA 5960 form, service members and personnel specialists should be aware of and ready to work with these additional documents. Each plays a specific role in ensuring allowances are properly requested, calculated, and adjusted, reflecting the current status and needs of the service member. By understanding and utilizing these documents appropriately, service members can effectively manage their housing allowances and related financial aspects of their military service.

Similar forms

  • DD Form 1750 - Also used by the Department of Defense, this form serves a packing list purpose for military shipments. Similar to the DA 5960, the DD 1750 is detailed, requiring specific information about items being transported to ensure accountability and proper handling, mirroring the meticulous detail needed in the DA 5960 for housing allowances.
  • DA Form 31 - A request and authority for leave form used by Army personnel. Like the DA 5960, which involves administrative processes for housing allowances, the DA 31 navigates through administrative channels to grant leave, highlighting the procedural nature of both documents within military operations.
  • VA Form 26-1880 - This document is used to apply for a Certificate of Eligibility for a home loan from the Department of Veterans Affairs. Similar to the DA 5960, it plays a crucial role in the acquisition of housing but focuses on veterans seeking home ownership rather than allowances.
  • IRS Form W-4 - A form used by employees to determine the amount of taxes to be withheld from their paycheck. Like the DA 5960, it provides financial information that affects the individual’s take-home pay, albeit in a civilian context and with a focus on tax rather than housing allowance.
  • HUD-1 Settlement Statement - A document used in real estate transactions that itemizes services and fees charged to the borrower by the lender. Similar to the DA 5960, the HUD-1 ensures transparency and accountability in transactions, in this case, the closing costs associated with purchasing a home.
  • Bah Form - Specifically related to the Basic Allowance for Housing, which the DA 5960 form helps to determine eligibility for. It directly correlates as both deal with the intricacies of military housing allowances and personal living situations.
  • DA Form 638 - A form for Recommendation for Award, used in the military to recommend individuals for various awards. Similar to the DA 5960 in its function as a formal military document that goes through a chain of command, although for recognitions rather than financial assistance.
  • I-9 Employment Eligibility Verification Form - A document used to verify the identity and employment authorization of individuals hired for employment in the United States. Like the DA 5960, it collects personal data for official purposes, albeit for employment rather than housing allowances.
  • SSA-1099 - A form sent to individuals who receive Social Security benefits, detailing the amount received. Similar to the DA 5960 in that it provides essential financial information affecting an individual’s income, in this instance, from social security.
  • FHA Loan Application Form - Used to apply for a Federal Housing Administration (FHA) loan, this form collects detailed personal and financial information to assess eligibility for loan programs. Like the DA 5960, it addresses housing concerns but from a loan application perspective rather than a military housing allowance.

Dos and Don'ts

When completing the DA 5960 form, which is vital for documenting Basic Allowance for Housing (BAH) entitlements, certain practices should be followed to ensure accuracy and compliance with regulations. This guidance outlines best practices to adhere to and common pitfalls to avoid.

Things You Should Do

  1. Ensure all personal information is accurate and up-to-date. This includes checking spellings, social security numbers, and contact information to prevent delays or issues with benefits.

  2. Complete the form in a clear, legible manner. If the form is filled out by hand, use black ink and ensure that handwriting is easy to read to avoid misunderstandings or processing errors.

  3. Review the form for completeness. Make sure every required field is filled out. Overlooking sections can lead to processing delays or the need to resubmit the form.

  4. Seek guidance if unsure about any section. It's important to consult with a superior officer or human resources representative when confusion arises. Misinterpretation of instructions can lead to errors in the application.

Things You Shouldn't Do

  • Do not leave sections blank unless instructed. If a section does not apply, write "N/A" (Not Applicable) to indicate that it has been reviewed but is not relevant to your situation.

  • Avoid guesswork. If you are uncertain about what information is required for a particular section, it's better to seek clarification than to submit incorrect or incomplete information.

  • Resist the urge to submit the form without a final review. Taking a moment to double-check the form can catch mistakes or omitted information that could affect your entitlements.

  • Do not submit outdated forms. Always check that you are using the most current version of the DA 5960 form, as requirements and formats can change over time.

Misconceptions

The DA 5960 form, also known as the Authorization to Start, Stop, or Adjust Basic Allowance for Housing (BAH), is crucial for military members in managing their housing allowances. However, several misconceptions surround its usage and requirements. Let's debunk some of these common myths.

  • Only service members with dependents need to fill it out. A prevalent misconception is that the DA 5960 form is exclusively for service members who have dependents. In truth, this form is necessary for all service members who are eligible for Basic Allowance for Housing, regardless of their dependent status. This means single service members, as well as those married or with children, must complete the form to receive their entitlements.

  • It's a one-time requirement. Another myth is that you only need to submit a DA 5960 form once during your military career. The reality is quite different. Service members must submit a new form whenever there is a change in their marital status, number of dependents, or geographical location. Regular updates ensure that the BAH rates are accurate and reflect your current situation.

  • It automatically updates your Basic Allowance for Housing. A common misunderstanding is that once the DA 5960 form is submitted, the Basic Allowance for Housing (BAH) rates are automatically updated. However, submitting the form is just the first step. The form must be processed and approved by the appropriate personnel or department. This process can take some time, so service members should not assume their BAH rates will immediately reflect changes.

  • Submitting electronically speeds up the process significantly. While electronic submission can be faster than paper submission in some contexts, this does not mean it will always lead to a quicker approval process for your BAH adjustments. The processing time can vary greatly depending on the workload of the approving authority and whether the submitted documentation is complete and accurate.

  • Corrections to the form require starting over. Many service members believe that if they make a mistake on their DA 5960 form, they must complete a new form from scratch. In many cases, corrections can be made directly on the form or through a simple amendment process, without the need to start the entire process over. It's important to communicate with your administrative department for guidance on making corrections efficiently.

Understanding the DA 5960 form and its requirements is essential for service members to ensure they receive the correct housing allowances. Dispelling these misconceptions can help streamline the process and reduce unnecessary stress.

Key takeaways

The Department of the Army (DA) Form 5960, also known as the Authorization to Start, Stop, or Change Basic Allowance for Quarters (BAQ), and Variable Housing Allowance (VHA), is a crucial document for military members managing their housing benefits. Understanding how to accurately complete and utilize the DA 5960 form is essential for ensuring that entitlements are correctly processed and disbursed. Here are key takeaways to consider:

  • Ensure you have the latest version of the DA 5960 form, as it is periodically updated to reflect changes in policy or procedure.
  • Thoroughly read the instructions provided with the form to avoid common mistakes that could delay processing.
  • Provide accurate personal information, including your full legal name, social security number, and contact information, to ensure your records are correctly updated.
  • Detail your current housing situation accurately, specifying whether you are residing in government quarters, renting, or owning a home, as this directly impacts your entitlements.
  • If you are making changes to your dependency status, such as marriage, divorce, or the birth of a child, ensure you provide the necessary documentation to support these changes.
  • Be aware of the deadlines for submission, especially if you are undergoing a Permanent Change of Station (PCS), as timely submission can affect your eligibility for certain benefits.
  • Before submission, review your form for errors or omissions. Inaccurate entries can lead to delays or incorrect housing allowance payments.
  • Retain a copy of the completed DA 5960 form for your personal records. It may be required for future reference or as part of a audit trail.
  • Understand that the DA 5960 form is just one part of managing your housing allowances. Stay informed about changes to military housing policy that might affect your benefits.

Proper completion and submission of the DA 5960 form are vital steps in securing and managing your housing entitlements effectively. Taking the time to ensure accuracy and completeness can prevent issues that may impact your financial well-being.

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