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The DD Form 137-5 serves as a Dependency Statement for military members claiming support for incapacitated children over the age of 21. This form gathers essential information aimed at establishing the relationship and dependency status of claimed dependents, which ultimately determines the member's entitlements to various military benefits. Whether a member is divorced, separated, or currently holds a different marital status, accurate completion of the form is crucial. The form requires details about the child’s living situation, their other parents, and any financial support provided by the military member. It also inquires about the child’s income, expenses related to living and healthcare, and educational pursuits beyond the age of 21. Accurate and complete responses are necessary, as any omissions could lead to delays in processing benefits. Understanding the complexities involved in the requirements of the DD 137-5 can help families navigate the intricacies of military benefit entitlements, ensuring that those who are eligible receive the necessary support. Furthermore, the form includes instructions regarding notarization, which adds a layer of validation to the information submitted. Maintaining an awareness of this important paperwork can greatly assist both military members and their families in securing necessary benefits.

Dd 137 5 Example

SEPARATED DIVORCED

CUI (when filled in)

DEPENDENCY STATEMENT - INCAPACITATED CHILD OVER AGE 21

OMB No. 0730-0014 OMB approval expires June 30, 2024

The public reporting burden for this collection of information, 0730-0014, is estimated to average 30-60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

RETURN COMPLETED FORM TO YOUR LOCAL SERVING PERSONNEL/PAYROLL OFFICE.

PRIVACY ACT STATEMENT

AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 37 U.S.C., Pay and Allowances of the Uniformed Services; DoD Directive 5154.29, DoD Pay and Allowances Policy and Procedures; DoD 7000.14-R, DoD Financial Management Manual, Volume 7A, Military Pay Policy and Procedures – Active Duty and Reserve Pay; and Joint Travel Regulations (JTR) current edition.

PURPOSE(S): The information will be used to determine the relationship and dependency of the claimed dependents and determine the member's entitlement of authorized benefits.

ROUTINE USE(S): To the Treasury Department to provide information on check issues and electronic funds transfers. To Federal, state, and local governmental agencies in response to an official request for information with respect to law enforcement, investigatory procedures, criminal prosecution, civil court action and regulatory order. Additional routine uses can be found within the applicable system of records notices, T7344, Defense Joint Military Pay System-Reserve Component; T7340, Defense Joint Military Pay System-Active Component; and M01040-3, Marine Corps Manpower Management Information System Records, located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/

DISCLOSURE: Voluntary: however, failure to provide this information will result in a suspension of the dependent entitlements until the member can provide the required certificate.

INSTRUCTIONS

The member must complete the form in its entirety, sign and date the form, and have it notarized. If the child resides alone or with someone other than the member, the member completes Items 1, 2, and 16, signs and dates the form, and the child or child's representative completes Items 3 through 15, signs and dates the form, and has it notarized. If the member is deceased, the child or child's representative completes the form in its entirety, signs and dates the form, and has it notarized. Information furnished must reflect the 12 months prior to member's death. Verification of income is required.

NOTES: Answer all questions. If any question does not apply, write "NOT APPLICABLE" or "N/A" in that block. Use the Remarks section when required. Incomplete answers will delay final action on the application.

1.ENTITLEMENTS REQUESTED (X and complete as applicable)

a. TYPE

 

b. FIRST APPLICATION?

BAH

USIP CARD

YES

(If No, give date of last application)

TRAVEL ALLOWANCE

NO

(YYYYMMDD)

 

 

 

 

2. MEMBER INFORMATION

c. LAST APPLICATION WAS

APPROVED DISAPPROVED

a. NAME (Last, First, Middle Initial)

b. DoD ID NUMBER

c. RANK

d. STATUS (X and complete as applicable)

 

 

 

ACTIVE DUTY

NATIONAL GUARD

ARMY

NAVY

DECEASED (Date of death) (YYYMMDD)

RETIRED

RESERVE

MARINE CORPS

AIR FORCE

OTHER (Specify)

e. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)

f. COMPLETE MILITARY ADDRESS (Include assignment: squadron and base)

g. TELEPHONE NUMBERS (Include DSN or Area Code)

(1) WORK

(2) HOME

 

 

h. E-MAIL ADDRESS

i. MARITAL STATUS (X one)

SINGLE

MARRIED

WIDOWED

3. MEMBER'S CHILD

a. NAME (Last, First, Middle Initial)

b. DOD ID NUMBER

c. DATE OF BIRTH (YYYYMMDD)

d. RELATIONSHIP TO MEMBER (X one)

 

 

 

 

LEGITIMATE CHILD

CHILD BORN OUT OF WEDLOCK

ADOPTED CHILD

STEPCHILD

 

 

 

e. COMPLETE ADDRESS (Street, Apartment Number, City, State, ZIP Code)

f. HAS CHILD EVER BEEN MARRIED? (If Yes, attach a copy of annulment decree, final

 

 

divorce decree, or death certificate of child's spouse.)

 

 

 

YES

 

 

 

 

NO

 

 

 

 

 

 

 

DD FORM 137-5, MAR 2018

CUI (when

filled in)

Category: PRVCY

Page 1 of 5

 

 

 

Controlled by: DFAS

 

PREVIOUS EDITION IS OBSOLETE.

 

 

Distribution/DISTRO: FEDCON

 

 

 

 

POC: (888) 332-7411

 

CUI (when filled in)

4. CHILD'S OTHER PARENT(S)

a.

(1) NAME (Last, First, Middle Initial)

b.

(1) NAME (Last, First, Middle Initial)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(2) RELATIONSHIP TO CHILD

(2) RELATIONSHIP TO CHILD

 

 

 

 

 

 

(3) COMPLETE ADDRESS (Street, Apartment Number, City, State, ZIP Code)

(3) COMPLETE ADDRESS (Street, Apartment Number, City, State, ZIP Code)

 

 

 

 

 

 

 

c. IS/ARE OTHER PARENT(S) IN ANY BRANCH OF SERVICE, INCLUDING RESERVE OR NATIONAL GUARD (X one)

YES

NO

 

(If Yes, show rank, name, SSN, and military address.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. DOES OTHER PARENT CLAIM CHILD FOR BASIC ALLOWANCE FOR HOUSING (BAH), TRAVEL ALLOWANCE, OR USIP CARD (X one)

YES

NO

(If Yes, explain.)

 

 

 

 

 

 

 

 

5. CHILD'S RESIDENCE

a. TYPE OF RESIDENCE (X and complete as applicable)

HOME OR APARTMENT OF OTHER PARENT

 

 

HOME OR APARTMENT OF FRIEND OR RELATIVE (State relationship)

 

HOME OR APARTMENT OF MEMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

HOME OR APARTMENT OF CHILD

 

 

HOSPITAL OR INSTITUTION

 

HOME OR APARTMENT OF FORMER SPOUSE OF MEMBER

 

 

OTHER (Explain)

 

STUDENT DORMITORY OR OTHER ON-CAMPUS FACILITY

 

 

 

 

 

 

 

 

 

 

 

 

 

b. OWNER OF RESIDENCE

 

 

 

 

 

 

 

(1) NAME (Last, First, Middle Initial)

(2) ADDRESS (Street, Apartment Number, City, State, ZIP Code)

 

 

 

 

c. IS RESIDENCE SUBSIDIZED HOUSING?

d. DATE CHILD STARTED LIVING AT CURRENT ADDRESS (YYYYMMDD)

 

YES

NO

 

 

 

 

 

 

 

 

 

 

6.IF CHILD IS IN HOSPITAL OR INSTITUTION

If child is in a hospital or institution, all of the following information must be furnished. Obtain this information from the hospital or institution.

a. DATE CHILD ENTERED HOSPITAL/INSTITUTION (YYYYMMDD)

b. ANTICIPATED DATE OF DISCHARGE (If known) (YYYYMMDD)

c. WILL CHILD RETURN TO MEMBER'S HOME AFTER DISCHARGE? (If "NO," explain where child will reside)

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. CHILD'S EXPENSES IN HOSPITAL OR INSTITUTION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1)

(2)

 

 

 

(1)

(2)

ITEM

PRESENT MONTHLY

TOTAL EXPENSE FOR

ITEM

 

PRESENT MONTHLY

TOTAL EXPENSE FOR

 

EXPENSE

PAST 12 MONTHS

 

 

 

EXPENSE

PAST 12 MONTHS

(1) ROOM

 

 

(8) EDUCATION

 

 

 

 

 

 

 

 

 

 

 

 

(2) FOOD

 

 

(9) TRANSPORTATION

 

 

 

 

 

 

 

 

 

 

 

 

(3) REHABILITATION CLASSES

 

 

(10) PERSONAL INSURANCE

 

 

 

 

 

 

(Specify)

 

 

 

 

OR SERVICES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(4) SPECIALIZED EQUIPMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(5) MEDICAL CARE

 

 

(11) OTHER (Specify)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(6) CLOTHING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(7) LAUNDRY/DRY CLEANING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DD FORM 137-5, MAR 2018

CUI (when filled in)

 

 

 

Page 2 of 5

PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

6. IF CHILD IS IN HOSPITAL OR INSTITUTION (Continued)

e. CHILD'S EXPENSES IN HOSPITAL OR INSTITUTION ARE PAID BY:

 

 

(1)

(2)

 

(1)

(2)

 

SOURCE

PRESENT MONTHLY

TOTAL EXPENSE FOR

SOURCE

PRESENT MONTHLY

TOTAL EXPENSE FOR

 

 

EXPENSE

PAST 12 MONTHS

 

EXPENSE

PAST 12 MONTHS

(1)

(a) CIVILIAN MEDICAL

 

 

(3) STATE OR LOCAL AGENCY

 

 

U

TREATMENT FACILITY

 

 

(Give name and address

 

 

S

(CHAMPUS)

 

 

in Remarks section)

 

 

I

 

 

 

 

P

 

 

 

 

 

 

(b) MILITARY MEDICAL

 

 

 

 

 

C

 

 

(4) MEMBER

 

 

A

TREATMENT FACILITY

 

 

 

 

R

 

 

 

 

 

D

 

 

 

 

 

 

(2) PRIVATE INSURANCE

 

 

(5) OTHER (Explain and give

 

 

 

(Give name and address

 

 

name and address in

 

 

 

in Remarks section)

 

 

Remarks section)

 

 

7. PERSONS LIVING IN HOUSEHOLD WITH CHILD

When child resides in a hospital or institution and Item 6 is completed, do not complete this item. List all persons who live in the household, including claimed child. If employed, show hours per week worked. Continue in Remarks if more space is needed.

a. NAME (Last, First, Middle Initial)

b.RELATIONSHIP TO CHILD

c. AGE

d. MARRIED (X)

e. EMPLOYED

 

 

 

 

 

YES

NO

HOURS PER WEEK

NO (X)

 

 

 

 

8. HOUSEHOLD EXPENSES

When child resides in a hospital or institution and Item 6 is completed, do not complete this item. List the household expenses for all persons living in the home. If expense was one-time only, such as purchase of a new chair, do not show this as a monthly expense; list it as an expense for the past 12 months. If child resides in the member's household or in a dwelling owned by the member, use Fair Rental Value (FRV) for dwelling. If child does not reside in member's household or in a dwelling owned by member, list actual mortgage, rent, or FRV if dwelling is mortgage-free. If FRV is used, give a brief explanation of how Fair Rental Value was obtained using the Remarks section.

FAIR RENTAL VALUE (FRV): FRV is a single monthly sum for the entire dwelling where the child lives. This sum is an amount the owner can reasonably expect to receive from a stranger to rent the dwelling. FRV will not include food, utilities, furniture, and home repairs, which are listed separately.

 

 

(1)

(2)

 

(1)

(2)

ITEM

 

PRESENT MONTHLY

TOTAL EXPENSE FOR

ITEM

PRESENT MONTHLY

TOTAL EXPENSE FOR

 

 

EXPENSE

PAST 12 MONTHS

 

EXPENSE

PAST 12 MONTHS

a. (X one)

 

 

 

 

 

 

RENT

FRV

 

 

d. FURNITURE AND

 

 

 

 

APPLIANCES

 

 

MORTGAGE (Specify

 

 

 

 

 

 

 

 

 

amount of tax and

 

 

 

 

 

 

 

 

 

 

insurance if applicable)

 

 

 

 

 

TAX

 

 

 

e. REPAIRS ON HOME

 

 

 

 

 

 

 

INSURANCE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. FOOD

 

 

 

 

 

 

 

 

 

 

f. OTHER (Itemize in Remarks

 

 

c. UTILITIES (Heat, power,

 

 

 

 

 

 

section)

 

 

water, and telephone)

 

 

 

 

 

 

 

 

 

 

 

 

9. CHILD'S PERSONAL EXPENSES

When child resides in a hospital or institution and Item 6 is completed, do not complete this item. List all of the child's personal expenses regardless of who is paying for

them.

 

(1)

(2)

 

(1)

(2)

ITEM

PRESENT MONTHLY

TOTAL EXPENSE FOR

ITEM

PRESENT MONTHLY

TOTAL EXPENSE FOR

 

EXPENSE

PAST 12 MONTHS

 

EXPENSE

PAST 12 MONTHS

a. CLOTHING

 

 

g. PRIVATE AUTO PAYMENTS

 

 

 

 

 

(If auto is registered in

 

 

b. LAUNDRY AND DRY

 

 

 

 

 

 

child's name)

 

 

CLEANING

 

 

 

 

 

 

 

 

h. MONTHLY TRANSPORTA-

 

 

c. MEDICAL (Do not include

 

 

 

 

 

 

TION PAYMENTS (Specify

 

 

expenses paid by insurance,

 

 

 

 

 

 

type)

 

 

welfare, or Medicare)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

d. VALUE OF USIP CARD

 

 

 

 

 

(Verification of amount is

 

 

 

 

 

 

 

 

 

 

required)

 

 

i. SCHOOL EXPENSES

 

 

 

 

 

 

 

e. PERSONAL INSURANCE

 

 

 

 

 

(Specify)

 

 

j. OTHER (Specify)

 

 

 

 

 

 

 

 

f. PERSONAL TAXES (Specify)

 

 

 

 

 

 

 

 

 

 

 

DD FORM 137-5, MAR

2018

CUI (when filled in)

 

Page 3 of 5

PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

10. CHILD'S INCOME

All gross income received by or in behalf of the child, whether taxable or nontaxable, and whether received monthly, quarterly, or yearly, must be listed. This includes any income you receive as custodian or administrator for the child. If any income received during the past 12 months was a lump-sum (one-time) payment, be sure to state this. Verification documents are required.

 

(1)

(2)

 

(1)

(2)

SOURCE

PRESENT

TOTAL INCOME

SOURCE

PRESENT

TOTAL INCOME

MONTHLY

FOR PAST 12

MONTHLY

FOR PAST 12

 

 

 

INCOME

MONTHS

 

INCOME

MONTHS

a. WAGES, SALARIES, TIPS, OR

 

 

g. SOCIAL SECURITY PAYMENTS,

 

 

 

 

DISABILITY OR REGULAR

 

 

OTHER CASH GRATUITIES

 

 

 

 

 

 

(Specify)

 

 

 

 

 

 

 

b. INTEREST ON INVESTMENTS,

 

 

 

 

 

BONDS, SAVINGS, TRUST

 

 

 

 

 

 

 

h. SUPPLEMENTAL

 

 

FUNDS, ETC.

 

 

 

 

 

 

SECURITY INCOME (SSI)

 

 

 

 

 

 

 

c. INSURANCE OR PUBLIC/

 

 

i. VETERANS ADMINISTRATION

 

 

GOVERNMENT PENSION

 

 

PAYMENTS (Specify type)

 

 

PAYMENTS,UNEMPLOYMENT

 

 

 

 

 

OR DISABILITY COMPENSATION

 

 

 

 

 

(Specify type)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

j. STATE OR LOCAL WELFARE AID,

 

 

 

 

 

 

 

d. CONTRIBUTIONS FROM

 

 

INCLUDING AID TO DEPENDENT

 

 

PERSONS OTHER THAN

 

 

CHILDREN (Include agency and

 

 

MEMBER

 

 

address in Remarks section)

 

 

 

 

 

 

 

 

e. SCHOLARSHIPS OR

 

 

k. OTHER (Specify)

 

 

EDUCATIONAL GRANTS

 

 

 

 

 

f. TAX REFUNDS (Specify)

 

 

 

 

 

 

 

 

 

 

 

11. CHILD'S EMPLOYMENT (Show additional periods of work in the Remarks section.)

HAS CHILD BEEN EMPLOYED DURING THE PAST 12 MONTHS?

YES

NO (If Yes, furnish the following:)

 

(1) NAME OF EMPLOYER

(2)

DATE EMPLOYMENT

(3)

DATE EMPLOYMENT

(4)

MONTHLY SALARY

 

 

 

STARTED (YYYYMMDD)

 

ENDED (YYYYMMDD)

 

(Gross)

a.

 

 

 

 

 

 

(5) TYPE OF WORK PERFORMED

(6) REASON EMPLOYMENT ENDED

 

 

 

 

 

 

 

 

 

 

 

 

(1) NAME OF EMPLOYER

(2)

DATE EMPLOYMENT

(3)

DATE EMPLOYMENT

(4)

MONTHLY SALARY

 

 

 

STARTED (YYYYMMDD)

 

ENDED (YYYYMMDD)

 

(Gross)

b.

 

 

 

 

 

 

(5) TYPE OF WORK PERFORMED

(6) REASON EMPLOYMENT ENDED

 

 

 

 

 

 

 

 

 

 

 

 

(1) NAME OF EMPLOYER

(2)

DATE EMPLOYMENT

(3)

DATE EMPLOYMENT

(4)

MONTHLY SALARY

 

 

 

STARTED (YYYYMMDD)

 

ENDED (YYYYMMDD)

 

(Gross)

c.

 

 

 

 

 

 

(5) TYPE OF WORK PERFORMED

(6) REASON EMPLOYMENT ENDED

 

 

 

 

 

 

 

 

 

 

 

d. IS OR WAS CHILD'S JOB CONSIDERED AS BEING A "SHELTERED WORKSHOP" - THAT IS, OPEN ONLY TO DISABLED OR HANDICAPPED PEOPLE?

YES

NO (If Yes, and child is currently working, attach a statement from the employer verifying this information.)

12. CHILD'S SCHOOL ATTENDANCE

 

HAS CHILD ATTENDED COLLEGE SINCE AGE 21?

YES

NO

(If Yes, furnish the following:)

 

 

 

 

 

 

 

 

(1) NAME AND ADDRESS OF SCHOOL

 

 

 

 

(2) (X as applicable)

 

 

 

 

 

 

VOCATIONAL

a.

 

 

 

 

 

FOR RECEIVING DEGREE

 

(3) DATES ATTENDED

 

(4) (X)

FULL-TIME

(5) CHILD'S MAJOR

 

 

 

 

PART-TIME

 

 

 

 

 

 

 

 

 

(1) NAME AND ADDRESS OF SCHOOL

 

 

 

 

(2) (X as applicable)

 

 

 

 

 

 

VOCATIONAL

b.

 

 

 

 

 

FOR RECEIVING DEGREE

 

(3) DATES ATTENDED

 

(4) (X)

FULL-TIME

(5) CHILD'S MAJOR

 

 

 

 

PART-TIME

 

 

 

 

 

 

 

 

DD FORM 137-5, MAR 2018

CUI (when filled in)

 

 

Page 4 of 5

PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

13.MEMBER'S CONTRIBUTION

a. SHOW THE TOTAL AMOUNT THE MEMBER HAS CONTRIBUTED TO THE CHILD'S SUPPORT FOR EACH OF THE PAST 12 MONTHS.

(1) MONTH AND YEAR

(2) AMOUNT

(1) MONTH AND YEAR

(2) AMOUNT

(1) MONTH AND YEAR

(2) AMOUNT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. MEMBER PROVIDES SUPPORT BY (X one)

ALLOTMENT

PERSONAL CHECK

MONEY ORDER

OTHER (Explain)

11. REMARKS (Use back if necessary)

READ THE PENALTY PROVISIONS, SIGN AND DATE THE FORM, AND HAVE IT NOTARIZED.

NOTE: Whoever, in any matter within the jurisdiction of any department or agency of the United States, knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device, a material fact, or makes any false, fictitious, or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry, shall be fined as provided in Title 18, or imprisoned not more than 5 years, or both (U.S. Code, title 18, section 1001). The information provided in this form may be referred to the appropriate Military Service investigative agency.

I make the foregoing claim with full knowledge of the penalties involved for willfully making a false claim. (U.S. Code, title 18, section 287, formerly section 80, provides a penalty as follows: Imprisonment for not more than five years and subject to a fine in the amount provided in this title.)

15.SIGNATURES a. CUSTODIAN

I/we(print name(s)) will immediately notify

the service concerned of any change in child's financial circumstances, marital status, physical custody, or change in dependency upon the service member as shown in this form.

(1)SIGNATURE OF PERSON WHO HAS PHYSICAL CUSTODY OF THE CHILD (Can be member or other than member)

(2) RELATIONSHIP TO CHILD

(3)DATE SIGNED (YYYYMMDD)

b. NOTARY PUBLIC

Subscribed and duly sworn (or affirmed) to before me according to law by the above named affiant(s).

 

 

 

 

This

 

day of

,

 

, at city (or town) of

, county of

,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

and state (or territory) of

 

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Notary)

 

 

 

(Official Seal)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Official Title)

 

 

 

 

 

 

 

 

 

 

 

 

 

c. MEMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(1) SIGNATURE

 

 

 

 

 

 

 

(2) DATE SIGNED (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

DD FORM 137-5, MAR 2018

 

 

CUI (when filled in)

 

 

Page 5 of 5

PREVIOUS EDITION IS OBSOLETE.

Form Characteristics

Fact Name Description
OMB Control Number The DD Form 137-5 has an OMB control number of 0730-0014, which is valid until June 30, 2024.
Estimated Response Time Filling out the form is estimated to take between 30 to 60 minutes. This includes reviewing instructions and collecting necessary data.
Authority The form operates under various laws, including 37 U.S.C. related to Pay and Allowances of the Uniformed Services and the Privacy Act of 1974.
Voluntary Disclosure Although completion is voluntary, not providing the required information may lead to a suspension of dependent entitlements.

Guidelines on Utilizing Dd 137 5

Filling out the DD 137-5 form correctly is essential for ensuring that all necessary information is provided for the assessment of benefits related to a dependent child who is incapacitated and over the age of 21. This process includes gathering detailed information about both the member and the child, along with relevant documentation. Below are simplified steps to guide you in completing the form.

  1. Entitlements Requested: Check all applicable boxes under the section regarding entitlements. Indicate if this is the first application and, if applicable, provide details of the last application.
  2. Member Information: Fill in personal details including full name, DoD ID number, rank, status, addresses (both residence and military), telephone numbers, email, and marital status.
  3. Member's Child: Provide the child's full name, DoD ID number, date of birth, relationship to the member, address, and marital history.
  4. Child's Other Parent(s): Input the names and relationships of the child's other parent(s), along with their service status and any claims they may have for benefits.
  5. Child's Residence: Specify the type of residence where the child lives, the owner's name, address, and whether the residence is subsidized. Include the date the child started living there.
  6. If Child is in Hospital or Institution: Complete this section with details about the child's hospital admission, anticipated discharge date, expenses, and who pays for these costs.
  7. Persons Living in Household: List all individuals living with the child, their relationships, ages, marital status, and employment status.
  8. Household Expenses: Provide details on all regular expenses for the household, including any relevant fair rental values or individual costs for food, utilities, and other essential expenses.
  9. Child's Personal Expenses: Outline all personal expenses of the child, including clothing, medical payments, and others as appropriate.
  10. Child's Income: Document all sources of gross income received by or on behalf of the child over the last 12 months, ensuring to indicate whether the income is ongoing or a one-time payment.
  11. Child's Employment: If the child has worked in the last year, include employers’ details, including start and end dates of employment and salary details.
  12. Child's School Attendance: If applicable, indicate whether the child has attended a college since turning 21 and detail the school attended.
  13. Member's Contribution: List the total financial support provided to the child for each of the past 12 months.
  14. Remarks: Use this section to clarify any answers or provide additional relevant information as necessary.
  15. Signatures: Ensure all required signatures are obtained, including the custodian of the child and notary public. The form must be dated appropriately.

It is important to ensure that all applicable sections are completed accurately to avoid delays in processing. Be sure to review the completed form carefully before submission to your local personnel or payroll office.

What You Should Know About This Form

What is the purpose of the DD Form 137-5?

The DD Form 137-5 is used to establish the dependency status of an incapacitated child over the age of 21 for military pay purposes. It helps determine the relationship between the service member and the child, as well as assess the eligibility for benefits such as Basic Allowance for Housing (BAH) and travel allowances. It contains important information that directly influences the member's entitlement to support those dependents.

Who needs to complete the DD Form 137-5?

Completion of the form is required by the service member claiming the dependent benefits. If the child resides with someone other than the member, that person can assist in filling out specific sections. In the case of the member’s death, the child or their representative can complete the form, providing necessary details as outlined in the instructions. It is crucial that all parties involved provide accurate and comprehensive information to avoid delays in processing.

What happens if I do not complete the DD Form 137-5?

Failure to submit the completed form may lead to a suspension of dependent entitlements. Without the required information, the military cannot assess the dependency status or entitlement to benefits. To avoid interruptions in support, it’s essential to provide all necessary details and documentation in a timely manner.

What kind of information is requested on the DD Form 137-5?

The form requests a range of information, including personal details about the service member, the claimed child, and financial contributions. It includes sections for documenting income, employment, household expenses, and personal expenses for the child. Additional inquiries about living arrangements, support contributions, and educational pursuits are also included. Comprehensive answers ensure that the form serves its purpose effectively.

Common mistakes

When filling out the DD Form 137-5, individuals often make several common mistakes that can result in delays or complications in processing their claims. One significant error is failing to provide complete information in the required sections. Each component of the form is essential for determining entitlements, and leaving any question unanswered can hinder the evaluation process.

Another frequent mistake involves neglecting to notarize the form as required. The instructions explicitly state that the form must be signed and notarized. Omitting this step can lead to the form being returned for corrections, which prolongs the time needed to process benefits.

Moreover, many people underestimate the importance of documenting all requested income sources. Claimants must list all gross income received on behalf of the child. Failing to provide verification documents for these income sources can complicate the determination of dependency. It is crucial to be thorough and accurate in reporting any financial contributions.

Additionally, individuals often forget to specify the correct residency type in the appropriate section. This oversight can confuse the dependency status of the child and cause unnecessary delays. Clearly identifying the living arrangement is crucial for accurate assessment.

Lastly, a common error is not utilizing the Remarks section or providing inadequate details when required. This space is intended for clarifying answers or explaining circumstances that don’t fit neatly into the provided categories. Taking the opportunity to add context can prevent misunderstandings and assist decision-makers in the review process.

Documents used along the form

The DD Form 137-5 is a crucial document for military service members claiming dependent benefits for incapacitated children over the age of 21. To effectively manage claims and provide necessary information, several other documents are often needed. Below is a list of common forms and documents that accompany the DD Form 137-5, along with brief descriptions of each.

  • DD Form 1172-2: This form is required to verify and establish entitlement for benefits for dependents. It collects information regarding dependent eligibility and must be completed for initial enrollment in military benefits programs.
  • DD Form 285: This document is a related application for military family member identification cards. It provides necessary information to obtain ID cards that grant access to military facilities and services.
  • VA Form 21-527EZ: This form is used to apply for pension benefits from the Department of Veterans Affairs. It helps determine income eligibility and can be relevant for the financial assessments needed for dependent claims.
  • Social Security Administration (SSA) Form SSA-827: This authorization form allows the release of the disabled child's medical records to the SSA. It's crucial for verifying the child's incapacity when applying for benefits.
  • State-specific Guardianship or Custody Documentation: If applicable, these documents verify legal custody or guardianship. They are vital for confirming dependency status when relevant to the member's benefits claim.

Gathering these forms and documents will help ensure a smoother claims process and support the dependents' eligibility for the necessary military benefits. It’s essential to provide complete and accurate information to avoid delays in processing these claims.

Similar forms

  • DD Form 1172-2: This document verifies eligibility for benefits for military family members. It similarly assesses dependency and relationship status and is often required for issuing military ID cards.
  • DD Form 214: The DD 214 is a Certificate of Release or Discharge from Active Duty. Like the DD 137-5, it captures essential details about a service member’s military history, including benefits eligibility. Both forms require accurate personal and service information.
  • DA Form 2-1: This is the Personnel Qualification Record for Army service members. It includes details about dependents and can be used for benefits eligibility. Like the DD 137-5, it often requires notarization.
  • SF 75: The Request for Annual Leave form tracks eligibility for military leave. It shares similarities with the DD 137-5 as it demands detailed personal information and relationships to ascertain benefits.
  • DD Form 2870: Known as the Authorization for Disclosure of Medical or Dental Information, this form is used to enable services to verify dependent health care eligibility. Both forms are linked to dependency verification for entitlement purposes.
  • VA Form 21-686c: This form registers a dependent for Veteran Affairs benefits. It also confirms relationships and support, similar to the DD 137-5, to establish eligibility for benefits.
  • DD Form 2656: The data on this form assists in determining retirement pay eligibility. Like the DD 137-5, it gathers detailed information about the service member’s family and dependents.
  • Form W-4: This form is used to determine tax withholding. While focused on taxation rather than military benefits, both require information regarding dependents and can influence financial entitlements based on familial status.

Dos and Don'ts

When filling out the DD Form 137-5, here are seven important do's and don'ts to consider:

  • Do complete the form fully.
  • Don't leave any questions unanswered; if a question doesn't apply, indicate as "N/A."
  • Do review your information for accuracy before submitting.
  • Don't forget to sign and date the form.
  • Do ensure the form is notarized if required.
  • Don't use vague terms; be specific in explanations and remarks.
  • Do return the completed form to your local personnel or payroll office promptly.

Taking these steps can help ensure that your submission is processed smoothly and efficiently.

Misconceptions

When dealing with the DD Form 137-5, there are several common misconceptions that can lead to confusion. Here are seven of those misconceptions, along with clarifications to help clear up any misunderstandings:

  1. It is only for service members' children under 21. Many believe this form is strictly for children under 21. However, it is also used for incapacitated children over that age, provided they meet certain conditions.
  2. Submitting the form is optional. Some think they can choose whether or not to submit the form. In reality, while filling it out is voluntary, failing to do so can result in a suspension of dependent entitlements.
  3. The form requires a lot of information that may not be necessary. While the form does request detailed information regarding the child and the household, this information is essential for determining eligibility for benefits.
  4. Notarization can be skipped if I know the child. It is a common belief that notarization isn’t crucial if you have a close relationship with the child. However, notarization is required to ensure authenticity and verification of the information provided.
  5. Only one parent needs to fill out the form. Some assume that only the member or the custodial parent should complete the form. In fact, both parents may need to provide information to establish support and dependency clearly.
  6. Once submitted, I don’t need to check on the status. Individuals may think that after submission, the process is complete. However, it is advisable to follow up to ensure that all information has been processed correctly and that benefits are being received.
  7. The form can be submitted at any time. There is a misconception that the timing of submitting this form doesn’t matter. However, certain benefits may require the form to be submitted within specific timeframes to avoid disruptions in support.

Understanding these misconceptions about the DD Form 137-5 can help ensure a smoother process for claiming dependent benefits and avoid potential pitfalls associated with incomplete or inaccurate submissions.

Key takeaways

The DD 137-5 form is crucial for establishing the dependency status of a child over the age of 21 who may be incapacitated. Here are some key takeaways related to filling out and utilizing this form:

  • Complete Information is Essential: Members must fill out the form thoroughly. Omitting any details or providing incomplete answers can lead to delays in processing.
  • Documentation Required: Verification of income and other supporting documents are necessary to substantiate claims made in the application. This includes proof of expenses and support provided by the member.
  • Notification of Changes: It is the responsibility of the member and the child’s custodian to inform the appropriate military service of any significant changes in the financial or custodial circumstances related to the child.
  • Notarization is Mandatory: The completed form must be signed and notarized. Failure to do so may render the application invalid and result in denial of benefits.
  • Privacy and Compliance: Respondents should understand that the information collected is subject to strict privacy regulations. Providing false information can lead to severe penalties under U.S. law.