important information concerning your retired pay application

IMPORTANT INFORMATION CONCERNING YOUR RETIRED PAY APPLICATION

Congratulations! The day you have worked for has finally arrived!

To ensure your application is received and certified without problem,

read and comply with all of the enclosed instruction sheets BEFORE completing the forms.

The enclosed retired pay application forms MUST BE COMPLETED, SIGNED, DATED, WITNESSED, AND RETURNED TO THIS COMMAND. We must receive your application at least 9 months and no less than 90 days prior to your 60th birthday. Failure to submit in a timely manner may result in a delay to the start of your retired pay. Minimum documents REQUIRED to start the process are:

Completed DD Form 108 (Application for Retired Pay Benefits), enclosed Completed DD Form 2656 (Data for Payment of Retired Personnel), enclosed Completed SF 1199A (Direct Deposit Sign-Up Form), [Must obtain from your financial institution]

If you are a Soldier who qualifies for the Early Age Drop due to the NDAA of January 2008, please annotate across the top of the DD Form 108 “EARLY AGE DROP” and include in your packet a copy of your mobilization orders, your DD Form 214 and orders transferring you to the Retired Reserves. If you have had any changes in your life (death, divorce, remarriage, adoptions, births), you must provide copies of the appropriate documents as part of your retirement application. If your social security number does not match your statement(s) of service you must attach a photocopy of your social security card. If the retirement packet sent to you contained an AHRC Form 249-2-E (Chronological Statement of Retirement Points) and you feel that it is correct, attach a copy to your application. You do not have to complete blocks 9 through 17 of the DD Form 108. If you feel it is incorrect, attach copies of Leave and Earning Statements (LES) which prove the additional points earned. If the packet sent to you does not include a retirement point’s statement and you were a member of the National Guard, attach a copy of the last NGB Form 23B to your application. If you do not have the form, contact the state headquarters or your last Guard unit for a copy. **** DO NOT HOLD OR DELAY YOUR APPLICATION WHILE WAITING FOR CORRECTION OF RETIREMENT POINTS. THEY WILL BE CORRECTED AS PART OF THE APPLICATION OR AFTER YOU HAVE STARTED RECEIVING RETIRED PAY. Should you die after age 60 and have not submitted your retirement application, your Survivor Benefit Plan (SBP) will be void, and your spouse will not be entitled to SBP Benefits. It is critical to the retired pay process that all blocks on the enclosed DD Form 108 and DD Form 2656 are completed where applicable. All signature blocks must be signed and dated, to include those of your spouse and witnesses. Proper completion and submission 9 months prior to your 60th birth date will ensure timely disbursement of your retired pay. If you have been retained beyond age 60, a copy of the orders must be included with your application. Soldiers extended beyond age 60 should apply for retired pay at least 6 months prior to the expiration of their extension/mobilization period. Along with the application, you must include a copy of the extension order and memorandum of extension authorization from your MACOM or higher authority. For Soldiers mobilized past age 60, a copy of the mobilization orders must be attached. If you were given an administrative grade reduction, please provide a copy of the reduction order and the order promoting you to a higher grade. VETERANS GROUP LIFE INSURANCE (VGLI) is available to retired Soldiers who previously held Servicemen’s Group Life Insurance (SGLI). Soldiers interested in converting their SGLI to VGLI should write to: SGLI, 213 Washington Street, Newark, New Jersey 07102-2904. Questions pertaining to completion of the enclosed forms may be directed to the Human Resource Contact Center (HRCC) of this Command by dialing 1-888-276-9472. YOU WILL NOT RECEIVE NOTICE OF RECEIPT OF YOUR APPLICATION. If you desire a receipt, it is recommended that you enclose a self-addressed stamped return post card, with your return address, with your application. Upon receipt of your application, the post card will be date stamped and returned to you. Do not return the completed application by certified or registered mail. The postage is unauthorized on business reply mail. ALL FORMS AND INFORMATION MAY BE OBTAINED FROM OUR WEBSITE:

https://www.hrc.army.mil/site/reserve/

AHRC Form 4001, January 2011 (Prior editions are obsolete.)

RETIRED PAY APPLICATION CHECKLIST

(All signatures must be originals on DD 108, DD 2656 and 1199A)

Documents Required:

o DD Form 108 Application for Retired Pay Benefits (Ensure it is signed and dated)

o DD Form 108 (Complete blocks 1-8 and 18-19)

o DD Form 2656 Data for Payment of Retired Personnel (Ensure it is signed and dated)

o DD Form 2656 (Section XI) ensure you sign/date and also have witness sign/date)

o DD Form 2656 (XII) Spouse must concur if you elect child(ren) only coverage (26c),

does not elect full spouse coverage (27a) or declines coverage (26g) when married.

o Retirement Points History Statement (NGB 23B, NGB 22) need documents for periods

of service not covered on NGB 23B, NGB 22

o 20 Year Letter or 15 Year Letter (Eligibility for Retired Pay at AGE 60)

o SF 1199A Direct Deposit form (see your bank) or complete (Section II) DD Form 2656)

o Promotion or Reduction Order (for soldiers applying at higher rank held)

o Separation Order (Transfer orders to Retired Reserves or Discharged)

o Age 60 Extension Waiver (if applicable)

o DD Form 2656-5 (if applicable)

o DD Form 2656-6 (RCSBP Election Change Certificate) with supporting documents

(marriage, death, birth certificates and Divorce Decree) (if applicable)

o Reduced Age/90 Day Drop (Write on top of DD Form 108 & 2656) with Mobilization

Orders, Retired Reserve Orders, and DD 214. Eligibility must be after 29 JAN 2008 to

qualify for Early Age Drop (if applicable)

Please complete checklist and return it with the application signed and dated to:

ATTN TAGD (AHRC-PDP-TR)

U.S. ARMY HUMAN RESOURCES COMMAND

1600 SPEARHEAD DIVISION AVENUE DEPT 482

FORT KNOX KY 40122-9986

For any questions call 1-888-276-9472 or 502-613-8950

SIGNATURE DATE SIGNED (YYYYMMDD)

APPLICATION FOR RETIRED PAY BENEFITS See back for Instructions andPrivacy Act Statement.

1. TO 2. DATE OF BIRTH (YYYYMMDD) 3. DATE RETIRED PAY TO BEGIN (YYYYMMDD)

4. HIGHEST MILITARY PAYGRADE HELD

5. APPLICANT NAME (Last, First, Middle Initial) 6a. SERVICE NUMBER (If applicable) b. SOCIAL SECURITY NUMBER

7a. PRESENT HOME ADDRESS (Street, Apt No., City, State, ZIP Code) 8. PRESENT ASSIGNMENT

SERVICE BEFORE 1 JULY 1949

9.ARMED FORCE

AND COMPONENT

10.GRADE OR

RATING

11. APPROXIMATE DATES OF SERVICE 12. ACTIVE DUTYa. FROM

DAY MONTH YEAR

b. TO

DAY MONTH YEAR

a. FROM

DAY MONTH YEAR

b. TO

DAY MONTH YEAR

13. RETIREMENT YEARa. FROM

DAY MONTH YEAR

b. TO

DAY MONTH YEAR

SERVICE AFTER 30 JUNE 1949

14.ARMED FORCE

AND COMPONENT

15.GRADE OR

RATING

16. ACTIVE DUTYa. FROM

DAY MONTH YEAR

b. TO

DAY MONTH YEAR

17.RETIREMENT

POINTS EARNED

18. SIGNATURE 19. DATE SIGNED (YYYYMMDD)

DD FORM 108, JUL 2002 PREVIOUS EDITION IS OBSOLETE.

b. HOME TELEPHONE NUMBER ( )

PRIVACY ACT STATEMENT

DD FORM 108 (BACK), JUL 2002

AUTHORITY: 10 U.S.C. 1331; EO 9397, November 1943 (SSN).

PRINCIPAL PURPOSE(S): Used by members and former members of the Reserve Components to apply for retired pay at age60. Application is reviewed to determine eligibility.

ROUTINE USE(S): Information provided by the member is used to:a. Identify the individual and his/her service record.b. Determine eligibility for retired pay under 10 U.S.C. 1331.c. Determine effective date that retired pay can and will commence.

DISCLOSURE: Voluntary; however, unless this form is completed, the individual will not receive retired pay.

INSTRUCTIONS

GENERAL. This form is to be submitted in one copy(duplicate for Naval personnel). Entries must betypewritten or hand printed. Brief instructions for makingentries are provided below in numerical order. Submissionof official statements of service is not required. If allinformation required is not readily available, prepare formto the best of your ability.NOTE: Primary purpose of Items 9 through 17 is to enablereviewing authority to verify service which may not be ofrecord.

ITEM 1. Addresses of Headquarters of Armed Forces forpurpose of forwarding application for retired pay are listedbelow. Application will be addressed to the Armed Forcein which you are presently (or were last) a member.

ARMY: Commander United States Army Reserve Personnel Center 9700 Page Boulevard, St. Louis, MO 63132-5200

NAVY: Commanding Officer Naval Reserve Personnel Center (Code N221) 4400 Dauphine St. New Orleans, LA 70149-7800

AIR FORCE: United States Air Force Military Personnel Center (AFPMPR) Building 499C Randolph Air Force Base, TX 78148-9997

MARINE CORPS: Commandant United States Marine Corps (Code MMSR-5) Washington, DC 20380-0001

COAST GUARD: Commandant United States Coast Guard (SP-4) Washington, DC 20593-0001

ITEM 2. Enter correct date of birth (proof of date of birthmay be required before final action is taken on application.)

ITEM 3. Enter date you desire retired pay to begin (cannotbe before age 60).

ITEM 4. Enter highest grade or rating held in ArmedForces.

ITEM 5. Enter your name in the order indicated.

ITEM 6a. Enter service (serial) number. If you have been amember of more than one Armed Force, enter the servicenumber of each, i.e. "2 532 430 ARMY" and "603-1-91NAVY."

ITEM 6b. Enter your Social Security Number.

ITEM 7. Enter your present home address and telephonenumber.

ITEM 8. Enter the complete designation of your presentorganization. If you are presently a member of a NationalGuard organization, give name of state. If not a member ofa reserve organization, enter "none."

NOTE: Primary purpose of Items 9 through 17 is to enablereviewing authority to verify service which may not be ofrecord.

ITEM 9. Enter the Armed Force and component for periodsof service covered in Item 11. Example: "Army, USAR","Navy, USNR." All enlisted service will include organizationto which you were assigned. For National Guard service,include name of state.

ITEM 10. Enter the highest grade or rating held during eachperiod of service shown in Item 11.

ITEM 11. Enter approximate dates of each individual periodof service. Example: 2 May 1936 to 1 May 1939; 20 Oct1942 to 15 Nov 1946.

ITEM 12. Enter inclusive dates of all periods of active dutyperformed during each individual period of service indicatedin Item 11.

ITEM 13. Enter inclusive dates of each individual year ofservice performed after 30 June 1949. Example: If youwere a member of a reserve component on 1 July 1949,your retirement year will be from 1 July 1949 to 30 June1950, your second year will be 1 July 1950 to 30 June1951, etc. If you were not a reservist on 1 July 1949 orhave had a break in service since that time, your retirementyear will begin on the date of acquiring an active status in areserve component and end one year later. Example: 15Sep 1956 to 14 Sep 1957.

ITEM 14. Enter the Armed Force and component in whichyou served during each year as shown in Item 13. Allenlisted service will also include the organization to whichyou were assigned during the year specified, and, in thecase of National Guard service, name of state.

ITEM 15. Enter highest grade or rating held during each yearof service shown in Item 13.

ITEM 16. Enter inclusive dates of all periods of active duty,including active duty for training, performed during the yearor years indicated in item 13.

ITEM 17. Enter the total retirement points earned for eachperiod shown in Item 13. This total to include points earnedthrough drills, correspondence courses, active duty,membership, etc.

ITEM 18. Place your signature in this space. Signatureappearing therein must coincide with the name shown inItem 4.

ITEM 19. Insert date application is prepared.

Standard Form 1199A (EG)(Rev. August 2012)Prescribed by Treasury DepartmentTreasury Dept. Cir. 1076

DIRECT DEPOSIT SIGN-UP FORMOMB No. 1510-0007

DIRECTIONSTo sign up for Direct Deposit, the payee is to read the back of this formand fill in the information requested in Sections 1 and 2. Then take ormail this form to the financial institution. The financial institution willverify the information in Sections 1 and 2, and will complete Section 3. The completed form will be returned to the Government agencyidentified below.

A separate form must be completed for each type of payment to besent by Direct Deposit.

The claim number and type of payment are printed on Governmentchecks. (See the sample check on the back of this form.) Thisinformation is also stated on beneficiary/annuitant award letters andother documents from the Government agency.

Payees must keep the Government agency informed of any addresschanges in order to receive important information about benefits and toremain qualified for payments.

SECTION 1 (TO BE COMPLETED BY PAYEE)NAME OF PAYEE (last, first, middle initial)A

ADDRESS (street, route, P.O. Box, APO/FPO)

CITY STATE ZIP CODE

TELEPHONE NUMBER AREA CODE NAME OF PERSON(S) ENTITLED TO PAYMENTB

CLAIM OR PAYROLL ID NUMBERC

Prefix Suffix

TYPE OF DEPOSITOR ACCOUNTD CHECKING SAVINGS

DEPOSITOR ACCOUNT NUMBERE

TYPE OF PAYMENT (Check only one)FSocial SecuritySupplemental Security IncomeRailroad RetirementCivil Service Retirement (OPM)VA Compensation or Pension

Fed. Salary/Mil. Civilian PayMil. ActiveMil. Retire.Mil. SurvivorOther

(specify)THIS BOX FOR ALLOTMENT OF PAYMENT ONLY (if applicable)G

TYPE AMOUNT

PAYEE/JOINT PAYEE CERTIFICATION

I certify that I am entitled to the payment identified above, and that I haveread and understood the back of this form. In signing this form, Iauthorize my payment to be sent to the financial institution named belowto be deposited to the designated account.

JOINT ACCOUNT HOLDERS’ CERTIFICATION (optional)

I certify that I have read and understood the back of this form,including the SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS.

SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE

SECTION 2 (TO BE COMPLETED BY PAYEE OR FINANCIAL INSTITUTION)GOVERNMENT AGENCY NAME GOVERNMENT AGENCY ADDRESS

SECTION 3 (TO BE COMPLETED BY FINANCIAL INSTITUTION)NAME AND ADDRESS OF FINANCIAL INSTITUTION ROUTING NUMBER CHECK

DIGIT

DEPOSITOR ACCOUNT TITLE

FINANCIAL INSTITUTION CERTIFICATION

I confirm the identity of the above-named payee(s) and the account number and title. As representative of the above-named financial institution, Icertify that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts 240, 209, and210.

PRINT OR TYPE REPRESENTATIVE’S NAME SIGNATURE OF REPRESENTATIVE TELEPHONE NUMBER DATE

Financial institutions should refer to the GREEN BOOK for further instructions.THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE.

NSN 7540-01-058-0224 GOVERNMENT AGENCY COPY 1199-207Designed using Perform Pro, WHS/DIOR, Mar 97









CITY STATE ZIP CODE



Prefix Suffix






TYPE AMOUNT





SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE



DIGIT






NSN 7540-01-058-0224 FINANCIAL INSTITUTION COPY 1199-207Designed using Perform Pro, WHS/DIOR, Mar 97









CITY STATE ZIP CODE



Prefix Suffix






TYPE AMOUNT





SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE



DIGIT






NSN 7540-01-058-0224 PAYEE COPY 1199-207Designed using Perform Pro, WHS/DIOR, Mar 97

Month Day Year 08 31 84

SF 1199A (Back)

BURDEN ESTIMATE STATEMENT The estimated average burden associated with this collection of information is 10 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Financial Management Service, Records Management Branch, Room 135, 3700 East-West Highway, Hyattsville, MD 20782. THIS ADDRESS SHOULD ONLY BE USED FOR COMMENTS AND/OR SUGGESTIONS CONCERNING THE AMOUNT OF TIME SPENT TO COLLECT THIS DATA. DO NOT SEND THE COMPLETED PAPERWORK TO THE ADDRESS ABOVE FOR PROCESSING.

PRIVACY ACT NOTICE

Collection of the information in this Direct Deposit Sign-Up form is authorized by 5 U.S.C. § 552a, 31 U.S.C. § 3332(g), and Executive Order 9397 (November 22, 1943). Your social security number and the other information requested will allow the federal government to process your direct deposit. Your social security number is requested to ensure the accurate identification and retention of records pertaining to you and to distinguish you from other recipients of federal payments. This information will be disclosed to the Department of the Treasury and its fiscal and financial agents, and other federal agencies, as necessary to process your direct deposit. This information may also be disclosed to a court, congressional committee or another government agency as authorized or required to verify your receipt of federal payments. Although providing the requested information is voluntary, your direct deposit cannot be processed without it.

PLEASE READ THIS CAREFULLY

All information on this form, including the individual claim number, is required under 31 USC 3322, 31 CFR 209 and/or 210. The information is confidential and is needed to prove entitlement to payments. The information will be used to process payment data from the Federal agency to the financial institution and/or its agent. Failure to provide the requested information may affect the processing of this form and may delay or prevent the receipt of payments through the Direct Deposit/Electronic Funds Transfer Program.

INFORMATION FOUND ON CHECKS

Most of the information needed to complete boxes A and F in Section 1 is printed on your government check:

United States Treasury

15-51 000

KANSAS CITY, MO

Check No. 0000 415785

A Be sure that payee’s name is written exactly as it appears on the check. Be sure current address is shown.

Pay to

28 28

VA COMP

DOLLARS CTS

$****100 00

F Type of payment is printed to the left of the amount. the order of JOHN DOE

123 BRISTOL STREET HAWKINS BRANCH TX 76543

A

F

NOT NEGOTIABLE ’:00000518’: 041571926"

SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS

Joint account holders should immediately advise both the Government agency and the financial institution of the death of a beneficiary. Funds deposited after the date of death or ineligibility, except for salary payments, are to be returned to the Government agency. The Government agency will then make a determination regarding survivor rights, calculate survivor benefit payments, if any, and begin payments.

CANCELLATION

The agreement represented by this authorization remains in effect until cancelled by the recipient by notice to the Federal agency or by the death or legal incapacity of the recipient. Upon cancellation by the recipient, the recipient should notify the receiving financial institution that he/she is doing so.

The agreement represented by this authorization may be cancelled by the financial institution by providing the recipient a written notice 30 days in advance of the cancellation date. The recipient must immediately advise the Federal agency if the authorization is cancelled by the financial institution. The financial institution cannot cancel the authorization by advice to the Government agency.

CHANGING RECEIVING FINANCIAL INSTITUTIONS

The payee’s Direct Deposit will continue to be received by the selected financial institution until the Government agency is notified by the payee that the payee wishes to change the financial institution receiving the Direct Deposit. To effect this change, the payee will complete a new SF 1199A at the newly selected financial institution. It is recommended that the payee maintain accounts at both financial institutions until the transition is complete, i.e. after the new financial institution receives the payee’s Direct Deposit payment.

FALSE STATEMENTS OR FRAUDULENT CLAIMS

Federal law provides a fine of not more than $10,000 or imprisonment for not more than five (5) years or both for presenting a false statement or making a fraudulent claim.

PAY SCALE EFFECTIVE 1 January 2014

APPROXIMATE POINT VALUE FOR RETIREMENT BENEFITS

This point value table has been prepared to assist you in determining what your

approximate gross monthly retired pay may be at age 60. The exact amount will be

computed by the Defense Finance and Accounting Service when you are certified for

retired pay. Their computation will be based on the pay scale in effect on your

60th birthday or the day you enter on the retired rolls (whichever is later). The

columns are based on your total years service for pay (longevity) and may be more

than your total years qualifying service (good years).

Highest Over 20

Years

Over 22

Years

Over 24

Years

Over 26

Years

Over 28

Years

Over 30

Years

Over 32

Years

Over 34

Years

Over 36

Years

Over 38

Years

Over 40

Years Grade Held

Satisfactorily

LTG (O9) 0.976 0.990 1.011 1.048 1.185 1.244 1.244 1.307 1.307 1.372 1.372

MG (O8) 0.924 0.948 0.948 0.948 0.948 0.972 0.972 0.995 0.995 0.995 0.995

BG (O7) 0.836 0.836 0.836 0.840 0.840 0.858 0.858 0.858 0.858 0.858 0.858

COL (O6) 0.669 0.686 0.704 0.739 0.739 0.753 0.753 0.753 0.753 0.753 0.753

LTC (O5) 0.584 0.603 0.603 0.603 0.603 0.603 0.603 0.603 0.603 0.603 0.603

MAJ (O4) 0.511 0.511 0.511 0.511 0.511 0.511 0.511 0.511 0.511 0.511 0.511

CPT (O3) 0.438 0.438 0.438 0.438 0.438 0.438 0.438 0.438 0.438 0.438 0.438

1LT (O2) 0.322 0.322 0.322 0.322 0.322 0.322 0.322 0.322 0.322 0.322 0.322

2LT (O1) 0.254 0.254 0.254 0.254 0.254 0.254 0.254 0.254 0.254 0.254 0.254

CPT (O3E) 0.467 0.467 0.467 0.467 0.467 0.467 0.467 0.467 0.467 0.467 0.467

1LT (O2E) 0.373 0.373 0.373 0.373 0.373 0.373 0.373 0.373 0.373 0.373 0.373

2LT (O1E) 0.315 0.315 0.315 0.315 0.315 0.315 0.315 0.315 0.315 0.315 0.315

CW5 (W5) 0.494 0.520 0.538 0.559 0.559 0.587 0.587 0.615 0.615 0.646 0.646

CW4 (W4) 0.449 0.470 0.488 0.507 0.507 0.518 0.518 0.518 0.518 0.518 0.518

CW3 (W3) 0.412 0.421 0.431 0.446 0.446 0.446 0.446 0.446 0.446 0.446 0.446

CW2 (W2) 0.362 0.369 0.375 0.375 0.375 0.375 0.375 0.375 0.375 0.375 0.375

WO1 (W1) 0.341 0.341 0.341 0.341 0.341 0.341 0.341 0.341 0.341 0.341 0.341

SGM (E9) 0.394 0.410 0.425 0.451 0.451 0.472 0.472 0.497 0.497 0.522 0.522

MSG (E8) 0.340 0.355 0.364 0.384 0.384 0.392 0.392 0.392 0.392 0.392 0.392

SFC (E7) 0.304 0.314 0.320 0.343 0.343 0.343 0.343 0.343 0.343 0.343 0.343

SSG (E6) 0.256 0.256 0.256 0.256 0.256 0.256 0.256 0.256 0.256 0.256 0.256

SGT (E5) 0.215 0.215 0.215 0.215 0.215 0.215 0.215 0.215 0.215 0.215 0.215

CPL (E4) 0.168 0.168 0.168 0.168 0.168 0.168 0.168 0.168 0.168 0.168 0.168

PFC (E3) 0.142 0.142 0.142 0.142 0.142 0.142 0.142 0.142 0.142 0.142 0.142

* WITH OVER FOUR (4) YEARS OF ACTIVE ENLISTED SERVICE.

To compute the approximate amount of retired pay you will receive (before taxes and

other deductions), you should multiply the total number of your retirement points by

the amount shown above in the Retirement Point Value Table for your pay grade and

years of service for longevity pay purposes. For example, if a LTC (05) has earned a

total of 4,000 retirement points and has over 22 years service for pay, his/her

approximate amount of monthly retired pay would be $2,276.00 (4,000 X .569). If a MSG

(E8) has 3,250 points and has over 24 years service for pay, his/her monthly retired

pay would be approximately $1,111.00 (3,250 X .342). Eligible members of the reserve

components, upon application, can receive retired pay from age 60 for the rest of their

lives. They may provide a portion of that benefit for their survivors by electing

coverage under the Survivor Benefit Plan (SBP). Visit the U.S. Army Human Resources

Command web site https://www.hrc.army.mil for additional retirement information.

AHRC Form 1259-1, Jan 2012 (Prior editions are obsolete.)

SEE REVERSE FOR IMPORTANT INFORMATION REGARDING

ELECTION OF RETIRED RESERVE VERSUS DISCHARGE

https://www.hrc.army.mil/

IMPORTANT INFORMATION

RETIRED RESERVE - VERSUS - DISCHARGE

Have you received your 20-Year Letter and are considering electing discharge rather than transfer to the Retired Reserve? Based upon the date you initially entered military service, you may want to reconsider your decision.

Retired Pay Computations Depending on the Date you Initially Entered Military Service (DIEMS), your monthly Army Reserve retired pay will be calculated under the "Final Basic Pay" or "High-3" formula as follows: If your DIEMS date is before 8 September 1980 1. Multiply your years of satisfactory/equivalent service (see equivalent

service formula below) by 2.5% up to a maximum of 75%. 2. Multiply the result by the basic pay in effect on the date your retired

pay begins (normally age 60). If your DIEMS date is on or after 8 September 1980 1. Multiply your years of satisfactory/equivalent service (see equivalent

service formula below) by 2.5% up to a maximum of 75%. 2. Multiply the result by the average of your highest 36 months of basic

pay. Note: The highest 36 months of basic pay for a Soldier who transfers to the Retired Reserve until age 60 will normally be the 36 months before age 60. Longevity service will continue and pay raises will continue to accrue. Soldiers, who elect discharge before age 60, will have their highest 36 months of basic pay based on the date of discharge. Longevity service stops and future pay raises will not be considered. As can be seen from these two examples, if you initially entered military service on or after 8 September 1980 you should think carefully before requesting a discharge. Taking a discharge will impact your retired pay.

Equivalent Service = Total Creditable Retirement Points / 360.

Reverse of AHRC Form 1259-1

1 AHRC Form 1459, January 2011 (Prior editions are obsolete.)

SURVIVOR BENEFIT PLAN (SBP) INFORMATION FOR RESERVISTS PREPARING

FOR NON-REGULAR RETIREMENT AND RECEIPT OF RETIRED PAY

1. The following information is provided to answer questions pertaining to SBP for Reserve Component Soldiers about to start receiving military retired pay for non-regular service under Title 10 U.S. Code, Chapter 1223. 2. Facts. a. SBP offers a means for Reserve Component Soldiers to provide a portion of their military retired pay to their eligible survivors when their death occurs after the effective date they are placed on the Army of the United States (AUS) Retired List and concurrently granted retired pay. SBP has positive features such as cost-of-living adjustments, government-subsidized premiums, and tax-free features that make it a beneficial program.

Without SBP, retired pay stops the day the retiree dies. SBP allows a portion of the Soldier’s retired pay to continue for selected eligible beneficiaries. b. The Reserve Component SBP (RC-SBP) decision at notification of eligibility (NOE) for non-regular retirement directly affects SBP coverage. (1) RC-SBP Option B or C elections will become the SBP election at non-regular retirement. Once in receipt of retired pay, the reservist with RC-SBP Option B or C will pay a premium for the RC-SBP coverage already received and a premium for current SBP coverage. Reservists with RC-SBP Option B or C will not make an SBP election on the DD Form 2656 (Data for Payment of Retired Pay). (2) If RC-SBP Option A was elected at NOE for future non-regular retirement, RC-SBP coverage was declined and there is no RC-SBP premium payable because no RC-SBP coverage was received. However, Reservists who elected Option A at NOE must make an SBP election at non-regular retirement. If SBP coverage is elected, Reservists with RC-SBP Option A pay only SBP premiums since no RC-SBP coverage was received. If SBP election is for less than the maximum spouse coverage allowable by law, the spouse’s written notarized concurrence on the DD Form 2656, section XI, SBP Spouse Concurrence is required or the retiree will receive automatic spouse SBP coverage based on gross retired pay. (3) Information on RCSBP is available on the Army G-1 Retirement Services Office (RSO) pamphlet Reserve Component Survivor Benefit Plan - The Simple Facts at http://www.armyg1.army.mil/rso/docs/SBP/RCSBP_Basic_Questions.pdf. c. The following guidance provides the information required to determine the SBP election for Reservists who did not make an RC-SBP election at NOE for future non-regular retirement. (1) Effective on or after 1 January 2001, the law required Reservists who failed to make an RC-SBP election at NOE for future non-regular retirement to receive automatic (Option C) immediate RC-SBP coverage based on full retired pay for spouse and/or

http://www.armyg1.army.mil/rso/docs/SBP/RCSBP_Basic_Questions.pdf


children. These Reservists who had an eligible spouse and/or children at the time they received the NOE for future non-regular retirement are not authorized to make an SBP election. Their SBP election will be Option C for the dependent categories they had at the time they received the NOE for future non-regular retirement and any authorized changes to RC-SBP dependent categories prior to non-regular retirement. (2) All Reservists without eligible dependents when they received the NOE for future non-regular retirement are actually Option A, No Eligible Beneficiary. They have the option to elect RC-SBP within one year of first acquiring a spouse or eligible dependent child. However if no action is taken to change their RC-SBP election within one year of first obtaining a spouse or eligible dependent child, their RC-SBP election remains Option A until non-regular retirement and they must make an SBP election. (3) In order for the Human Resources Command (HRC) to ensure the retired pay accounts and SBP elections are established correctly without delay, Reservists who did not make an RC-SBP election at NOE of future non-regular retirement must provide HRC information on their dependents at the time of their NOE and any intervening dependent changes. d. Reservists preparing for non-regular who are not sure of their RC-SBP coverage, need to contact Army HRC Reserve Retirements Branch at 502-613-8950 or 1-888-ARMY-HRC (276-9472) for assistance. 3. SBP the Simple Facts. a. SBP is the only way your survivors can receive a portion of your military retired pay.

Without SBP, retired pay stops the day the retiree dies! b. A major advantage of SBP is its annual Cost-Of-Living adjustment (COLA). This feature helps keep SBP's purchasing power in step with tomorrow's dollar value. All features of SBP – cost to retiree and payment to annuitant – are increased by the same percentage as the retiree COLA. The ratio of cost to benefit is constant. c. SBP elections are made by category, so the SBP beneficiary category choice made is critical. If SBP coverage was declined, coverage for an eligible SBP category such as an eligible child, that child and any future child is excluded from SBP. SBP’s six election categories are as follows: (1) Spouse. A spouse is the spouse you’re married to when you die. If you marry after retirement, the marriage must last at least one year or you must have had children born of that spouse. Benefits are paid until the spouse dies, but stop if the surviving spouse remarries before age 55 (and can be resumed if the remarriage ends). Additional information on spouse SBP is available on the Army G-1 RSO SBP Fact Sheet Spouse Coverage at http://www.armyg1.army.mil/rso/docs/sbp/fact/spousecoverage.pdf. Spouse SBP is offset dollar for dollar by Dependency and Indemnity Compensation (DIC). Any premiums paid for SBP coverage that are offset by DIC will be refunded to the spouse. Spouses with an offset of SBP by DIC are also authorized Special Survivor Indemnity Allowance. A court case allows spouses entitled to both SBP and DIC who remarry after

http://www.armyg1.army.mil/rso/docs/sbp/fact/spousecoverage.pdf


age 57 to receive both SBP and DIC without an offset. Additional information on spouse SBP and DIC is available on the Army G-1 RSO SBP Fact Sheet VA Payments and SBP at http://www.armyg1.army.mil/rso/sbp.asp. (2) Spouse & Child(ren). The spouse is the primary beneficiary, with eligible children as the secondary beneficiaries. Children only receive the SBP annuity if the spouse dies or remarries before age 55. The annuity is divided equally among all eligible children. Eligible children are defined as adopted children, stepchildren, foster children and recognized natural children who live with the retiree in a regular parent-child relationship. Children are eligible until age 18 or 22 if full time unmarried students with the exception of incapacitated children. Child coverage offers excellent protection for incapacitated children, since the annuity is payable to them for life. The mental or physical incapacity must have been incurred while in the age eligibility range. Note, it is recommended that you research the impact SBP for a fully disabled child may have on other benefits the child is receiving or will receive. Children of all marriages are eligible beneficiaries under this election. (3) Child(ren) Only. Eligible children are the primary beneficiaries. If the retiree dies while a child is eligible, the annuity continues until the child exceeds the age of eligibility. More information on child SBP is available on the Army G-1 RSO Fact Sheet Child Coverage at http://www.armyg1.army.mil/rso/docs/SBP/fact/ChildCoverage.pdf. (4) Former Spouse. This option can be elected voluntarily or be required by a state court. Former spouse costs and benefits are identical to those for spouses. The same remarriage limitations apply. (5) Former Spouse & Child(ren). This is identical to the “spouse & children” option in costs and benefits, except that only children of the marriage to the former spouse are eligible beneficiaries. Additional information on former spouse and former spouse and children SBP is available on the Army G-1 RSO SBP Fact Sheet Child Former Spouse Coverage at http://www.armyg1.army.mil/rso/docs/SBP/fact/FormerSpouse.pdf. (6) Insurable Interest. If unmarried with no children or one dependent child at retirement, this option may be selected. The “natural person” must be someone with a financial interest in your life such as a close relative or a business partner. Retiring Soldier must provide justification of financial interest except for relatives closer than a cousin. You can elect "insurable interest" coverage or decline coverage. Insurable interest SBP is more expensive than spouse and/or child SBP. Insurable interest can be stopped at any time without the beneficiary’s concurrence. If you elect insurable interest and gain a spouse or child in the future, you may enroll them within one year. More information on insurable interest SBP is available on the Army G-1 RSO Fact Sheet Insurable Interest Coverage at http://www.armyg1.army.mil/rso/docs/SBP/fact/FormerSpouse.pdf. d. SBP annuity and Premium Calculation. (1) The SBP Base Amount is the dollar amount of retired pay selected by a retiring Soldier on which the SBP annuity and premium cost are based. It can be any amount between $300 per month and full retired pay. The base amount will increase with Cost-of-

http://www.armyg1.army.mil/rso/sbp.asp

http://www.armyg1.army.mil/rso/docs/SBP/fact/FormerSpouse.pdf



Living Adjustments (COLAs) as will retired pay, SBP premiums, and the survivor’s SBP annuity. (2) Spouse or Former Spouse. The premium cost is 6.5 percent of the base amount. For example, with a base amount of $1,000 per month, the cost for spouse coverage is $65. In this example the spouse’s SBP annuity at the retiree’s death is 55 percent of $1,000 or $550. Reservists retiring for non-regular service will receive the more advantageous of the 6.5 percent of chosen base amount or 2.5 percent of the threshold amount, plus 10 percent of the remaining base amount. The threshold amount will increase at the same time and by the same percentage as future active duty basic pay. For examples of the threshold calculation refer to the SBP Fact Sheet Spouse coverage, Table One, on the Army G-1 RSO Homepage at http://www.armyg1.army.mil/rso/docs/sbp/fact/spousecoverage.pdf. (3) Spouse (or Former Spouse) and Child. The spouse portion of this election costs 6.5% of the base amount. The child cost portion is based on the ages of the Soldier, the spouse and the youngest child. The child cost is very low, given typical ages because the children are secondary beneficiaries. (4) Child Only. The cost is based on the ages of the retiree and youngest child. Using a $1,000 base amount as an example, if you are 42 and the youngest child is 10, the child cost is $3.80 monthly. Children are primary beneficiaries in this option and the child cost is higher than the child cost in spouse or former spouse and child elections. Eligible children equally divide the 55% benefit. (5) Insurable Interest. The base amount must be full retired pay in this option. Costs are 10% of retired pay, plus 5% for each full five years the beneficiary is younger than the retiree, and cannot exceed 40% of retired pay. The annuity is 55% of retired pay minus the SBP premium, and continues for life. This option may be cancelled at any time. Should you gain a spouse or child in the future, the insurable interest coverage may be changed to spouse or child or both, within one year of marriage or acquisition of a child.

(6) Retired pay, SBP calculators, and other benefits information are available on the My Army Benefits website at http://myarmybenefits.us.army.mil/. Soldiers and Families are validated through the Defense Enrollment Eligibility Reporting System (DEERS) for program access to benefits information including Retirement, Survivorship, Deployment, and Disability planning; 150 benefit fact sheets; resource locators; and State/Federal benefits. Soldier access to the calculators is granted by using their Common Access Card (CAC); Retirees and Family Members registered on Army Knowledge Online (AKO) will continue accessing the website through AKO username and password.

(7) The SBP Fact Sheet Premium Calculations provides information on SBP premium calculation with examples and is available on the Army G-1 RSO Homepage at http://www.armyg1.army.mil/rso/docs/SBP/fact/PremWorksheet.pdf.

e. Termination or withdrawal from SBP. SBP elections are generally permanent and irrevocable. However, retirees can withdraw from SBP for one of the following reasons:

http://www.armyg1.army.mil/rso/docs/sbp/fact/spousecoverage.pdf

http://myarmybenefits.us.army.mil/


(1) Retirees, by law, have the option of terminating SBP between the 25th and 36th month following start of retired pay. Spouse concurrence is required; no SBP premiums are refunded for coverage already received; and no future enrollment is allowed even if an open enrollment period is declared. Termination of SBP premium costs does not terminate RC-SBP premium costs because RC-SBP premiums are for coverage already received. (2) Retirees in receipt of retired pay may withdraw from SBP if they have a service-connected disability that has been rated by the VA as totally disabling for not less than five continuous years from the last date of active duty or if awarded after retirement for ten or more continuous years. Withdrawal is allowed because surviving spouse will qualify for DIC benefits because death will be presumed to be from service-connected reasons. When the retiree dies, the surviving spouse will be entitled to a refund of all the SBP costs that were paid.

3 The Army G-1 RSO, SBP Fact Sheet Withdrawal from SBP, provides information on SBP withdrawal or termination and is available on the Army G-1 RSO Homepage at http://www.armyg1.army.mil/rso/docs/SBP/fact/Withdrawal.pdf. f. Premiums continue as long as there is an eligible beneficiary; costs are suspended if a spouse is lost to death or divorce. Then, if the retiree remarries, coverage resumes automatically at the first anniversary unless the retiree makes a written request to decline resumption of SBP before that date. Child costs stop when there are no longer eligible children with the exception of RC-SBP premiums for children. Child RC-SBP costs continue even when there is no eligible child. g. Former Spouse. (1) Reservists who elected RC-SBP Option B or C spouse coverage had one year from the date of divorce to make a written request to change their RC-SBP election from spouse to former spouse, voluntarily or in compliance with a court order or written agreement. The former spouse had the same one-year period to notify HRC requesting a deemed former spouse election. If no action was taken within one year, the RC-SBP election defaulted by law to spouse suspended. If the Reservist remarried with suspended spouse RC-SBP, the new spouse became the RC-SBP beneficiary at the date of the first anniversary of the remarriage. (2) Reservists who elected Option A can elect SBP for a former spouse at non-regular retirement either voluntarily, written agreement, or by court order. The former spouse of a Reservist with Option A RC-SBP who has court ordered SBP had one year from the date of the first court order awarding SBP to notify the Defense Finance and Accounting Service they are requesting deemed SBP. (3) A former spouse must submit a deemed election on a DD Form 2656-10, SBP/RC-SBP Request for Deemed Election, with appropriate copies of the divorce and subsequent court orders concerning the divorce.


(4) Additional information on former spouse SBP and deemed former spouse elections are available on the Army G-1 RSO SBP Fact Sheet Former Spouse Coverage at http://www.armyg1.army.mil/rso/docs/SBP/fact/FormerSpouse.pdf. 4. To assist Reservists with their SBP decisions, we recommend use of the following SBP related Resources: a. Contact the Army HRC Reserve Retirements Branch for assistance at 502-613-8950 or 1-888-ARMY-HRC (276-9472). b. Army Reserve Non-Regular Retirement Information Guide at http://www.armyg1.army.mil/rso/docs/ARReserveRetirementGuide.pdf. c. Army National Guard Information Guide on Non-Regular Retirement at http://www.armyg1.army.mil/rso/docs/ARNG_Information_Guide.pdf. d. The Army G-1 Retirement Services Office Homepage SBP section at http://www.armyg1.army.mil/rso/sbp.asp e. Army Installation Retirement Services Officers (RSO) can provide information on the SBP program. The Installation RSO Contact information is available at http://www.armyg1.army.mil/rso/rso.asp. f. Retired pay, SBP calculators, and other benefits information are available on the My Army Benefits website at http://myarmybenefits.army.mil/. g. Retired Reserves can view their own file at HRC’s My Portal to determine their RC-SBP election at NOE for non-regular retirement under the retirement tab at: https://www.hrcapps.army.mil/portal/?page_id=5740. h. The Defense Finance and Accounting Service provides basic information on SBP on its homepage at http://www.dfas.mil/retiredmilitary/provide/sbp.html.


http://www.armyg1.army.mil/rso/docs/ARReserveRetirementGuide.pdf

http://www.armyg1.army.mil/rso/docs/ARNG_Information_Guide.pdf

http://www.armyg1.army.mil/rso/sbp.asp

http://myarmybenefits.army.mil/

https://www.hrcapps.army.mil/portal/?page_id=5740

RETIREMENT POINTS ACCOUNTING SYSTEM (RPAS) INFORMATION

1. The RPAS provides an annual listing of creditable military service through the previous retirement

anniversary year. The ARPC Form 249-E (Chronological Statement of Retirement Points) for current

anniversary year is generated within 30 days after the retirement year end (RYE) date (Located on page 1,

column 2 of the ARPC 249-E) and necessitates prompt submission of retirement points as they are earned

throughout the retirement year to facilitate accuracy. The Detail Point Listing for the Previous Retirement

Year (Located on page 2 of the ARPC 249-E) reflects retirement points earned in the previous completed

anniversary year to assist the unit and Soldier in verifying retirement points earned during the annual

review. Soldiers may access the My Record Portal at www.hrc.army.mil for personalized retirement point

information such as the ARPC Form 249-E, Points Corrections, Points Detail, and the Retired Pay

Calculator. The Points Corrections reflects Regional Level Accounting System (RLAS) retirement point

actions submitted to the Human Resource Command (HRC) reference the member from Troop Program

Units. The Points Detail reflects retirement points earned from 1994 to present reference the member.

2. The ARPC Form 249-E should be reviewed annually. It should reflect all military service and breaks-in-

service by retirement anniversary year in each of the appropriate categories of IDT Duty, Correspondence,

Membership and Active Duty. Discrepancies may be due to late or no submission from outside sources and

lack of supporting documentation for verification via HRC for input.

A. Troop Program Units should verify the Soldier’s ARPC Form 249-E when a Soldier in-processes into

the unit and annually. If a Soldier or the unit finds an error, the following procedures are available to update

the record:

(1.) Per AR 140-185, Chapter 3, TPU members must provide their supporting documents to their Unit.

(2.) The Unit will submit the action via Regional Level Application Software (RLAS) for anniversary lines

already established on the ARPC 249-E and forward supporting documents reference the request to the

appropriate HRC Personnel Action Branch for validation. Per AR 600-8-104, Table B-1, units will iPERM

supporting documentation if listed as an authorized document.

(3). The unit will manually submit via email, a request adding new anniversary lines with supporting

documentation to the HRC Personnel Action Branch responsible for the Soldier’s AOC/MOS to validate

request. Per AR 600-8-104, Table B-1, units will iPERM supporting documentation if listed as an authorized

document.

B. Individual Management Augmentee (IMA) and Individual Ready Reserve (IRR) Soldiers will submit

action directly to the HRC Personnel Action Branch responsible for their AOC/MOS.

C. All prior service data will be manually updated at HRC.

3. Copies of supporting documents to substantiate uncredited retirement points and a copy of both sides of the

ARPC Form 249-E should be provided for retirement actions. Acceptable documents are:

A. For non-paid Inactive Duty Training (IDT), provide copies of DA Form 1380. This form must be

iPERM’d per AR 600-8-104. Per page 2 of the DA Form 1380 and AR 140-185, paragraph 3-3, the form is

prepared and submitted monthly.

B. For paid IDT, provide copies of LES or MMPA.

http://www.hrc.army.mil/

C. RTU and IMA Detachment Commanders will submit DA Form 1379’s (U.S. Army Reserve

Components Unit Record of Reserve Training) and/or DA Form 1380’s (Record of Individual Performance of

Reserve Duty Training) directly to HRC, G-3, who will verify the unit’s status for the period of non-paid duty

and, upon verification, forward to the Soldier’s appropriate HRC Personnel Action Branch for action.

D. For Active Duty (90 or more consecutive days), provide copies of DD Form 214 (Certificate of Release

or Discharge from Active Duty). For shorter tour lengths less than 90 days, provide copies of LES/MMPA or

DD Form 220. DD Form 214’s and DD Form 220’s must be iPERM’d per AR 600-8-104.

E. For Membership, provide copies of Appointment (DA Form 71) or Enlistment documents (DD Form 4).

F. For Correspondence Course non-resident distance learning instruction, provide copies of course

completion notices for each course or sub-course. Army War College, Command and General Staff College,

Sergeants Major Academy, Academy of Health Sciences, and some other services’ schools do not submit

correspondence hours electronically to RPAS. Only The Army Institute for Professional Development (AIPD)

transmits completed correspondence hours electronically to RPAS weekly. All Course completions prior to

16 May 1997 require documentation to validate and award retirement points. Source documentation to

verify non-resident correspondence completions are the ATTRS Unofficial Transcript, DA Form 2328 or

certificate/memorandum from the nonresident service school listing name of Soldier, course, sub-course,

date of completion, and number of hours. Course completions must be iPERM’d per AR 600-8-104.

G. For periods of omitted prior reserve service, provide copies of the DA Form 1383, AGUZ Form

115, DARP Form 249, DARP Form 249-2-E, ARPC Form 249-E, AHRC Form 249-2-E,NGB Form 23, AF

Form 526, NAVPERS Form 1070-611, NAVMC Form 798, or CG HQ Form 4973. HRC will require the

reserve component’s retirement point statement for input into RPAS.

4. When a correction to the Soldier’s account is completed, RPAS will generate a revised ARPC Form

249-E. The revised statement will be submitted to the Soldier’s Reserve Record at www.hrc.army.mil

within 3 to 4 days. The document should be reviewed for accuracy.

5. The requirement to actively participate or earn retirement points toward qualifying service did not exist

before 1 July 1949. After 1 July 1949, reserve Soldiers were required to earn a minimum of 50 retirement

points each full retirement year to credit it as qualifying service. For periods less than a full retirement year,

a proportionate number of points must be earned to have that partial year credited as qualifying service.

6. The sixty-point rule provides that no more than a combined total of sixty points may be credited for IDT,

extension courses, and membership, in addition to any active duty points earned. Effective 23 September

1996, the sixty-point rule was replaced by the seventy-five point rule for Soldiers whose RYE fall on or after

this date. O n 31 October 2000, the seventy-five point rule was replaced by the ninety-point rule. Reserve

Soldiers whose RYE falls on or after this date are entitled to a combined total of 90 retirement points for IDT,

extension courses, and membership. Effective 30 October 2007, maximum points allowed increased to 130.

7. Only members in an active reserve status (Ready Reserve) or in active federal service are authorized to

earn and be credited with retirement points. After an individual reaches mandatory removal date (MRD),

unless given an exception to policy to remain past MRD, the law prohibits the crediting of any retirement

points even if the member remained in an active status beyond MRD through administrative oversight.

Transfer to the Individual Ready Reserve (IRR) Control Groups (Reinforcement and Annual Training) is

considered active reserve.


8. The retirement year is established by the date the member entered into active service or into active

status in a Reserve Component. The start date (month and day) for each successive anniversary year will

not be adjusted unless the member has a break-in-service. A break-in-service occurs only when a member

transfers to an inactive status list, the inactive National Guard, a temporary disability retired list, the Retired

Reserve or is discharged to civilian life for longer than 24 hours.

9. To qualify for non-regular retired pay, at or after the specified in Title 10, Section 12731, a member must

have completed 20 years of qualifying service unless otherwise provided by law. For members who

completed the years of qualifying service before October 5, 1994, the last 8 years of qualifying service must

have been in the Reserve component. For members who completed the years of qualifying service on or

after October 5, 1994 but before April 25, 2005, the last 6 years of qualifying service must have been in a

Reserve component. For members who completed the qualifying service on or after April 25, 2005, there is

no minimum Reserve component requirement.

10. A member of the Ready Reserve who serves on active duty orders as specified in DoDI 1215.07,

subparagraph 6.5.2.2 or performs active service as specified in subparagraph 6.5.2.3 after January 28, 2008

shall have the eligibility age of receipt of retired pay under USC 10, Section 12731 of reference (c) reduced

below 60 years of age by 3 months for each aggregate of 90 days the member serves on active duty per

fiscal year.

Understanding the ARPC Form 249-E:

Item 1 – The Beginning Date of the Anniversary Year is established by the date the Soldier entered into

active service or into active status (Ready Reserve) in a Reserve component. The start date for each

successive anniversary year will not be adjusted unless the member has a break-in-service (Inactive

Status, Inactive National Guard, TDRL, Retired Reserve or is discharged to civilian life for longer than 24

hours.).

Item 2 – The Ending Date is normally the ending date of the anniversary year. When a change in military

personnel class, status or component occurs, an anniversary year may be listed on two lines. RPAS will

allow the anniversary line to continue to the next line to add new status, adding both lines in Item 9

(Qualifying for Retirement) to equal 12 months to establish credit for the period.

Item 3 – The Military Personnel Class will be either enlisted, officer, or warrant officer during the

anniversary year. If the MPC changes during the anniversary year, RPAS will allow the anniversary line

to continue to the next line to add new status, adding both lines in Item 9 (Qualifying for Retirement) to

equal 12 months to establish credit for the period.

Item 4 – The Status or Component will be the Soldier’s status during the anniversary year. If the status or

component changes during the anniversary year, RPAS will allow the anniversary line to continue to the

next line to add new status, adding both lines in Item 9 (Qualifying for Retirement) to equal 12 months to

establish credit for the period.

Item 5 – IDT points are paid and non-paid IDT duties. Per AR 600-8-104, DA Form 1380s are required to

be iPERM’d. One retirement point may be earned for each IDT attendance with a maximum of two

retirement points per calendar day. Duty will be either 4 or 8 hours with the exception of the two hour

funeral honors duty. If funeral duty is performed, only one retirement point per day is allowed per 10 USC

12503.

Item 6 – Extension Course Points are military distance learning non-resident instruction correspondence

points earned in the anniversary year. Non-resident correspondence credit is submitted in RPAS via

hours. Upon completion of the anniversary year, the system will divide the total correspondence hours by

three to establish the amount of retirement points earned. Non-automated correspondence courses

should be forwarded immediately upon completion to HRC for processing.

Item 7 – Membership points shall be awarded at the rate of 15 points per anniversary year or a

proportionate amount thereof based on the member of a Reserve component being in an active status.

Item 8 – Active Duty Points shall be credited at the rate of one point per day of active service. Per DoDI

1215.07, paragraph 6.5.2.11, a member in active service may not receive retirement points for other

activities performed concurrently; however, no membership point’s deduction is required for active service

other than duty as a member of a Regular component during an anniversary year. If a member is on

active duty the entire anniversary year, membership points will not be counted in column 10 of the ARPC

249-E due to paragraph 6.4.2.12 of DoDI 1215.07, which states a maximum of 365 points (366 points in a

leap year) may be awarded in any anniversary year.

Item 9 – Qualification for Retirement will track the number of years, months, and days utilized to achieve a

qualifying good year of 50 retirement points in column 10 of the ARPC 249-E for a non-regular retirement.

Item 10 – Total Points Creditable utilizes 10 USC to establish what is creditable in retirement points in the

anniversary year. IDT, Extension Courses, and Membership Points with the exception of funeral honors

cannot exceed the 60, 75, 90, and 130 point rule per DoDI 1215.07, paragraph 6.4.2.9. The maximum

amount of retirement points earned in an anniversary year cannot exceed 365 points (366 points in a leap

year) per DoDI 1215.07, paragraph 6.4.2.12.

CURRENT ARMY RESERVE MEMBER’S POINTS OF CONTACT:

Enlisted:

FSD Personnel Action Branch: MOS 27, 36, 42, 44, 45, 51, 52, 56, 62, 65, 68, 71, 76, 79, 88, 89, 90, 91, 92, and 94

Email: [email protected] / Phone: (502) 613-5964 MFD Personnel Action Branch: MOS 09B, 11, 13, 14, 15, 18, 19, 29E, 37, 38, and 46

Email: [email protected] / Phone: (502) 613-5977 OSD Personnel Action Branch: MOS 09L, 12, 21, 25, 31, 33, 35, 74, 96, 97, 98, and All E9’s

Email: [email protected] / Phone: (502) 613-5896 Officer:

Officer Personnel Action Branch:

Email: [email protected] / Phone: (502) 613-6727 Officer Health Services Personnel Action Branch (Previously AMEDD):

Email: [email protected] / Phone: (502) 613-6846

PRIOR ARMY RESERVE MEMBER’S POINTS OF CONTACT:

Veterans Inquiry Branch: Phone (888) 276-9472

For further U.S. Army Human Resources Command information, you may visit the

website at https://www.hrc.army.mil or call (888) 276-9472 (ARMYHRC)

mailto:[email protected]






Reverse of AHRC Form 2363-1

APPLICATION FOR RETIRED PAY BENEFITS See back for Instructions andPrivacy Act Statement.

1. TO 2. DATE OF BIRTH (YYYYMMDD) 3. DATE RETIRED PAY TO BEGIN (YYYYMMDD)

4. HIGHEST MILITARY PAYGRADE HELD

5. APPLICANT NAME (Last, First, Middle Initial) 6a. SERVICE NUMBER (If applicable) b. SOCIAL SECURITY NUMBER

7a. PRESENT HOME ADDRESS (Street, Apt No., City, State, ZIP Code) 8. PRESENT ASSIGNMENT

SERVICE BEFORE 1 JULY 1949

9.ARMED FORCE

AND COMPONENT

10.GRADE OR

RATING

11. APPROXIMATE DATES OF SERVICE 12. ACTIVE DUTYa. FROM

DAY MONTH YEAR

b. TO

DAY MONTH YEAR

a. FROM

DAY MONTH YEAR

b. TO

DAY MONTH YEAR

13. RETIREMENT YEARa. FROM

DAY MONTH YEAR

b. TO

DAY MONTH YEAR

SERVICE AFTER 30 JUNE 1949

14.ARMED FORCE

AND COMPONENT

15.GRADE OR

RATING

16. ACTIVE DUTYa. FROM

DAY MONTH YEAR

b. TO

DAY MONTH YEAR

17.RETIREMENT

POINTS EARNED

18. SIGNATURE 19. DATE SIGNED (YYYYMMDD)

DD FORM 108, JUL 2002 PREVIOUS EDITION IS OBSOLETE.

b. HOME TELEPHONE NUMBER ( )

PRIVACY ACT STATEMENT

DD FORM 108 (BACK), JUL 2002

AUTHORITY: 10 U.S.C. 1331; EO 9397, November 1943 (SSN).

PRINCIPAL PURPOSE(S): Used by members and former members of the Reserve Components to apply for retired pay at age60. Application is reviewed to determine eligibility.

ROUTINE USE(S): Information provided by the member is used to:a. Identify the individual and his/her service record.b. Determine eligibility for retired pay under 10 U.S.C. 1331.c. Determine effective date that retired pay can and will commence.

DISCLOSURE: Voluntary; however, unless this form is completed, the individual will not receive retired pay.

INSTRUCTIONS

GENERAL. This form is to be submitted in one copy(duplicate for Naval personnel). Entries must betypewritten or hand printed. Brief instructions for makingentries are provided below in numerical order. Submissionof official statements of service is not required. If allinformation required is not readily available, prepare formto the best of your ability.NOTE: Primary purpose of Items 9 through 17 is to enablereviewing authority to verify service which may not be ofrecord.

ITEM 1. Addresses of Headquarters of Armed Forces forpurpose of forwarding application for retired pay are listedbelow. Application will be addressed to the Armed Forcein which you are presently (or were last) a member.

ARMY: Commander United States Army Reserve Personnel Center 9700 Page Boulevard, St. Louis, MO 63132-5200

NAVY: Commanding Officer Naval Reserve Personnel Center (Code N221) 4400 Dauphine St. New Orleans, LA 70149-7800

AIR FORCE: United States Air Force Military Personnel Center (AFPMPR) Building 499C Randolph Air Force Base, TX 78148-9997

MARINE CORPS: Commandant United States Marine Corps (Code MMSR-5) Washington, DC 20380-0001

COAST GUARD: Commandant United States Coast Guard (SP-4) Washington, DC 20593-0001

ITEM 2. Enter correct date of birth (proof of date of birthmay be required before final action is taken on application.)

ITEM 3. Enter date you desire retired pay to begin (cannotbe before age 60).

ITEM 4. Enter highest grade or rating held in ArmedForces.

ITEM 5. Enter your name in the order indicated.

ITEM 6a. Enter service (serial) number. If you have been amember of more than one Armed Force, enter the servicenumber of each, i.e. "2 532 430 ARMY" and "603-1-91NAVY."

ITEM 6b. Enter your Social Security Number.

ITEM 7. Enter your present home address and telephonenumber.

ITEM 8. Enter the complete designation of your presentorganization. If you are presently a member of a NationalGuard organization, give name of state. If not a member ofa reserve organization, enter "none."

NOTE: Primary purpose of Items 9 through 17 is to enablereviewing authority to verify service which may not be ofrecord.

ITEM 9. Enter the Armed Force and component for periodsof service covered in Item 11. Example: "Army, USAR","Navy, USNR." All enlisted service will include organizationto which you were assigned. For National Guard service,include name of state.

ITEM 10. Enter the highest grade or rating held during eachperiod of service shown in Item 11.

ITEM 11. Enter approximate dates of each individual periodof service. Example: 2 May 1936 to 1 May 1939; 20 Oct1942 to 15 Nov 1946.

ITEM 12. Enter inclusive dates of all periods of active dutyperformed during each individual period of service indicatedin Item 11.

ITEM 13. Enter inclusive dates of each individual year ofservice performed after 30 June 1949. Example: If youwere a member of a reserve component on 1 July 1949,your retirement year will be from 1 July 1949 to 30 June1950, your second year will be 1 July 1950 to 30 June1951, etc. If you were not a reservist on 1 July 1949 orhave had a break in service since that time, your retirementyear will begin on the date of acquiring an active status in areserve component and end one year later. Example: 15Sep 1956 to 14 Sep 1957.

ITEM 14. Enter the Armed Force and component in whichyou served during each year as shown in Item 13. Allenlisted service will also include the organization to whichyou were assigned during the year specified, and, in thecase of National Guard service, name of state.

ITEM 15. Enter highest grade or rating held during each yearof service shown in Item 13.

ITEM 16. Enter inclusive dates of all periods of active duty,including active duty for training, performed during the yearor years indicated in item 13.

ITEM 17. Enter the total retirement points earned for eachperiod shown in Item 13. This total to include points earnedthrough drills, correspondence courses, active duty,membership, etc.

ITEM 18. Place your signature in this space. Signatureappearing therein must coincide with the name shown inItem 4.

ITEM 19. Insert date application is prepared.

DATA FOR PAYMENT OF RETIRED PERSONNEL

PRIVACY ACT STATEMENTAUTHORITY: 10 U.S.C. Chapter 73, subchapters II and III; DoD Instruction 1332.42, Survivor Annuity Program Administration, DoD FinancialManagement Regulation, Volume 7B, Chapter 42; and E.O. 9397 (SSN).PRINCIPAL PURPOSE(S): To collect information needed to establish a retired/retainer pay account, including designation of beneficiaries forunpaid retired pay, state tax withholding election, information on dependents, and to establish a Survivor Benefit Plan election.ROUTINE USE(S): Disclosures are made to the Department of Veterans Affairs (DVA) regarding establishments, changes and discontinuing of DVAcompensation to retirees and annuitants.To former spouses for purposes of providing information, consistent with the requirements of 10 U.S.C. Section 1450(f)(3), regarding SurvivorBenefit Plan coverage.To spouses for purposes of providing information, consistent with the requirements of 10 U.S.C. Section 1448(a), regarding Survivor Benefit Plancoverage.DISCLOSURE: Voluntary; however, failure to provide requested information will result in delays in initiating retired/retainer pay.

INSTRUCTIONSGENERAL.

1. Read these instructions and Privacy Act Statement carefully beforecompleting the data form.

2. The Defense Finance and Accounting Service (DFAS) - Cleveland willestablish your retired/retainer pay account based on the data provided onthe form and your retirement/transfer orders. Your personnel office,disbursing/finance office, and SBP Counselor will assist you in the

proper completion and submission of this form. You should maintainthese instructions along with a copy of the form as a permanentrecord of pay data. Please complete the form by typing or printingin ink.

3. Ensure that you promptly advise DFAS - Cleveland of changes toyour marital/family status and any changes to your correspondenceaddress and direct deposit information (or your Reserve Component if agray area retiree).

SECTION I - PAY IDENTIFICATION.

ITEMS 1 and 2. Self-explanatory.

ITEM 3. If you are retiring from active duty, enter the date you transfer tothe Fleet Reserve or date of retirement. If you are a Reserve memberqualified to retire under 10 U.S. Code, Chapter 1223, enter either the dateof your 60th birthday or, a later date on which you desire to beginreceiving retired pay.

ITEMS 4 and 5. Self-explanatory.

ITEM 6. Enter the address and telephone number (include area code)where you can be contacted.

SECTION II - DIRECT DEPOSIT/ELECTRONIC FUND TRANSFERINFORMATION.

This section must be completed. Your net retired/retainer pay must besent to your financial institution by direct deposit/electronic fund transfer(DD/EFT).

ITEMS 7 through 10. If you are directing your retired pay to the sameaccount number and financial institution to which you directed your activeduty pay, annotate Items 7 through 10 "SAME AS ACTIVE DUTY". If youhave a copy of the Direct Deposit Authorization form used to establishyour DD/EFT for your active duty pay, attach a copy to this form.

If you are not currently on DD/EFT or are a Reservist, you mustcomplete Items 7 through 10. Provide the nine digit Routing TransitNumber (RTN) of your financial institution in Item 7. The RTN is the ninedigit number located in the lower left-hand corner of either your checks orcheck deposit tickets. If you still are unable to obtain the RTN, you willhave to contact your financial institution to which you want yourretired/retainer pay directed and request the RTN. Also, indicate whetheryour account is (S) for Savings or (C) for Checking account in Item 8,your account number in Item 9, and your financial institution name andaddress in Item 10.

SECTION III - SEPARATION PAYMENT INFORMATION.

ITEM 11. Complete if you are retiring from active duty or amember/former member of the Reserve Component not on active dutyretiring at age 60.

11.a. through 11.c. Complete if you received any type of separationbonus. In Item11.a, enter an X in the YES block. In Item 11.b., enter"SE" for Severance Pay, "SP" for Separation Pay, "VSI" for VoluntarySeparation Incentive, and "SSB" for Special Separation Bonus. In Item11.c., enter the lump-sum gross amount for Severance, Separation andSpecial Separation Bonus payments and the annual installment grossamount for Voluntary Separation Incentive payments. Be sure to attach acopy of the orders that authorized the payment and a copy of your DDForm 214.

SECTION IV - MEMBER OF THE RESERVE COMPONENT.

ITEM 12. Complete if you are a member/former member of a ReserveComponent, not on active duty, retiring at age 60.

SECTION V - DESIGNATION OF BENEFICIARIES FOR UNPAIDRETIRED PAY.

ITEM 13. Upon your death, 10 U.S. Code Section 2771 provides thatany pay due and unpaid will be paid to the surviving person highest onthe following list: (1) beneficiary(ies) designated in writing; (2) yourspouse; (3) your children and their descendants, by representation; (4)your parents in equal parts, or if either is dead, the survivor; (5) the legalrepresentative of your estate, and (6) person(s) entitled under the law ofyour domicile. Therefore, if you choose to designate a beneficiary orbeneficiaries, you must complete Items 13.a. through 13.e. If youdesignate multiple beneficiaries, you can either provide a SHAREpercentage to be paid to each person or leave the SHARE percentageblank. If you leave the SHARE percentage blank, any retired pay you areowed when you die will be divided equally among your designatedbeneficiaries. If you list more than one person with a 100% SHARE, thebeneficiaries will be paid in the order as you list them on the form. If, forexample, you designate two beneficiaries, then the SHARE percentagemust either be 100% for each beneficiary, or the SHARE percentageswhen added together must equal 100%. If you designate more than oneperson, and the total percentage designated is greater than 100%, theperson listed first is considered the primary beneficiary. Use theRemarks section for additional beneficiary information. If you do not designate a beneficiary or beneficiaries in Item 13, or alldesignated beneficiaries have died before the date of your death, anyunpaid retired pay will be paid to the living person or persons in thehighest category of beneficiary listed above, as required by law.

SECTION VI - FEDERAL INCOME TAX WITHHOLDINGINFORMATION.

Complete this section after determining your allowed exemptions withthe aid of your disbursing/finance office, or from the instruc- tionsavailable on IRS Form W-4, or other available IRS publications. LeaveItems 14 through 16 blank if completing Item 17.

ITEM 14. Mark the status you desire to claim.

ITEM 15. Enter the number of exemptions claimed.

ITEM 16. Enter the dollar amount of additional Federal income tax youdesire withheld from each month's pay. Leave blank if you do not desireadditional withholding.

ITEM 17. Enter the word "EXEMPT" in this item only if you meet all thefollowing criteria: (1) you had no Federal income tax liability in the prioryear; (2) you anticipate no Federal income tax liability this year; and (3)you therefore desire no Federal income tax to be withheld from yourretired/retainer pay.

NOTE: You must file a new exemption claim form with DFAS - Clevelandby February 15th of each year for which you claim exemption fromwithholding.

DD FORM 2656 INSTRUCTIONS, APR 2009 PREVIOUS EDITION IS OBSOLETE Adobe Professional 8.0

SECTION VI (Continued)

ITEM 18. If you are not a U.S. citizen, provide, on an additionalsheet, a list of all periods of ACTIVE DUTY served in the continentalU.S., Alaska, and Hawaii. Indicate periods of service by year andmonth only. List only service at shore activities; do not reportservice aboard a ship.For example:FROM (Year/Month) DUTY STATION TO (Year/Month)1994/02 NAVSTA, Norfolk, VA 1995/01

NOTE: This information may affect the determination as to thatportion of retired/retainer pay which is taxable in accordance with theInternal Revenue Code, if you will maintain your permanentresidence outside the U.S., Alaska, or Hawaii.

SECTION VII - VOLUNTARY STATE TAX WITHHOLDING.

NOTE: Complete this section only if you want monthly state taxwithholding. If you choose not to have a monthly deduction, youremain liable for state taxes, if applicable.

ITEM 19. Enter the name of the state for which you desire state taxwithheld.

ITEM 20. Enter the dollar amount you want deducted from yourmonthly retired/retainer pay. This amount must not be less than$10.00 and must be in whole dollars (Example: $50.00, not $50.25).

ITEM 21. Enter only if different from the address in Item 6.

SECTION VIII - DEPENDENCY INFORMATION.

This information is needed by DFAS to determine SBP costs,annuities and options, and to maintain your account in specialcircumstances at the time of death.

ITEM 22.a. Provide your spouse's name. If none, enter "N/A" andproceed to Item 25.

ITEMS 22.b. through 24. Provide the requested information aboutyour spouse. In Item 24, if marriage occurred outside the UnitedStates, include city, province, and name of country.

ITEM 25. If you do not have dependent children, enter "N/A" in thisitem. If you do have dependent children, provide the requestedinformation. Designate which children resulted from marriage toformer spouse, if any, by indicating (FS) after the relationship incolumn d.

25.e. A disabled child is an unmarried child who meets one of thefollowing conditions: a child who has become incapable of selfsupport before the age of 18, or, a child who has become incapableof self support after the age of 18 but before age 22 while a full timestudent. Attach documentation. Enter Yes or No as appropriate.

SECTION IX - SURVIVOR BENEFIT PLAN (SBP) ELECTION.

It is very important that you are counseled and are fully aware ofyour options under SBP. You may discontinue your SBPparticipation within one year after the second anniversary of thecommencement of retired/retainer pay. Termination of SBP iseffective the first of the month after DFAS-Cleveland receives theSBP disenrollment request. There will be no refund of SBP costspaid for the period before the SBP disenrollment. If you make noelection, maximum coverage will be established for all eligible familymembers (spouse and/or children). It is highly advisable to completethis part in the presence of your SBP counselor. Members qualified to retire under 10 U.S. Code 1223 after 20qualifying years of service, who either elected Reserve ComponentSurvivor Benefit Plan (RCSBP) or who received automatic coverageunder RCSBP must attach a copy of the RCSBP election or thenotification of coverage to this form. Do not complete Items 26through 28 as that election is permanent. However, Reservemembers who declined SBP until age 60 must complete Items 26through 28 (and Items 32 and 33 if applicable). If you elected eitherImmediate (Option C) or Deferred (Option B) RCSBP coverage andthe elected beneficiary is no longer eligible, annotate this in theRemarks section and provide supporting documentation with thisform.

ITEM 26. Complete if you are retiring from active duty or if you are areservist (retiring under 10 U.S. Code, Chapter 1223) who declinedRCSBP. You may only select one item.

INSTRUCTIONS (Continued)

SECTION IX (Continued)

26.a. through 26.c. Mark the applicable item that indicates thebeneficiaries you desire to cover under SBP. In Items a. and c., you MUSTindicate whether you do or do not have eligible dependents.

ITEM 26.d. Mark if you are not married and desire coverage for a personwith an insurable interest in you, and provide the requested informationabout that person in Item 28. An election of this type must be based onyour full gross retired/retainer pay. If the person is a non-relative or asdistantly related as a cousin, attach evidence that the person has afinancial interest in the continuance of your life. Under provisions of PublicLaw 103-337, you are permitted to withdraw from insurable interestcoverage at any time. Such a withdrawal will be effective on the first day ofthe month following the month the request is received by DFAS -Cleveland. Therefore, no refund of SBP costs collected before the effectivedate of the withdrawal will be paid.

26.e. and 26.f. Mark Item 26.e. if you desire coverage for a formerspouse. Mark Item 26.f. if you desire coverage for a former spouse anddependent child(ren) of that marriage, and provide the requestedinformation about these children in Item 25 as appropriate. Provide acertified photocopy of final decree that includes separation agreement orproperty settlement which discusses SBP for former spouse coverage. TheDD Form 2656-1, "Survivor Benefit Plan (SBP) Election Statement forFormer Spouse Coverage," must also be completed and accompany thecompleted DD Form 2656 to DFAS - Cleveland.

26.g. Mark if you do not desire coverage under SBP. If married anddeclining coverage, Items 32 and 33 of Section XII must be completed.

ITEM 27.a. Mark if you desire the coverage to be based on your full grossretired/retainer pay.

27.b. Mark if you desire the coverage to be based on a reduced portionof your retired/retainer pay. This reduced amount may not be less than$300.00. If your gross retired/retainer pay is less than $300.00, the fullgross pay is automatically used as the base amount. Enter the desiredamount in the space provided to the right of this item. Proceed to SectionXII, if married.

27.c. Used by a REDUX member who wants coverage based on actualretired pay received under REDUX. If this option is selected, proceed toSection XII, if married.

27.d. Mark if you desire the higher threshold amount in effect on the dateof your retirement.

ITEM 28. Enter the information for insurable interest beneficiary.

SECTION X - REMARKS.

ITEM 29. Reference each entry by item number. Continue on separatesheets of paper if more space is needed.

SECTION XI - CERTIFICATION.

Read the statement carefully, then sign your name and indicate the dateof signature. For your SBP election to be valid, you must sign and date theform prior to the effective date of your retirement/transfer. A witness cannotbe named as beneficiary in Sections V, VIII, or IX.

SECTION XII - SURVIVOR BENEFIT PLAN SPOUSE CONCURRENCE.

Title 10 U.S. Code, Section 1448 requires that an otherwise eligiblespouse concur if the member declines to elect SBP coverage, elects lessthan maximum coverage, or elects child only coverage. Therefore, amember with an eligible spouse upon retirement, who elects anycombination other than items 26.a. or 26.b. and 27.a., must obtain thespouse's concurrence in Section XII. A Notary Public must be the witness.In addition, the witness cannot be named beneficiary in Section V, VIII, orIX. Spouse's concurrence must be obtained and dated on or after the dateof the member's election, but before the retirement/transfer date. Ifconcurrence is not obtained when required, maximum coverage will beestablished for your spouse and child(ren) if appropriate.

DD FORM 2656 INSTRUCTIONS (BACK), APR 2009

DATA FOR PAYMENT OF RETIRED PERSONNEL(Please read Instructions and Privacy Act Statement before completing form.)

DD FORM 2656, APR 2009

SECTION I - PAY IDENTIFICATION 1. NAME (LAST, First, Middle Initial) 2. SSN 3. RETIREMENT/

TRANSFER DATE (YYYYMMDD)

5. DATE OF BIRTH (YYYYMMDD)

4. RANK/PAY GRADE/ BRANCH OF SERVICE

7. ROUTING NUMBER (See Instructions) 8. TYPE OF ACCOUNT (Savings (S) or Checking (C))

9. ACCOUNT NUMBER (See Instructions)

10. FINANCIAL INSTITUTION a. NAME b. STREET ADDRESS c. CITY d. STATE e. ZIP CODE

6. CORRESPONDENCE ADDRESS (Ensure DFAS - Cleveland Center is advised whenever your correspondence address changes.) a. STREET (Include apartment number) b. CITY c. STATE d. ZIP CODE e. TELEPHONE (Incl. area code)

SECTION III - SEPARATION PAYMENT INFORMATION11. Complete if you have received any one of the payment types listed in 11.a.

a. DID YOU RECEIVE SEVERANCE PAY (SE), READJUSTMENT PAY (RP), SEPARATION PAY (SP), VOLUNTARY SEPARATION INCENTIVE (VSI), OR SPECIAL SEPARATION BONUS (SSB)? (X one. If "Yes," attach a copy of the orders which authorized the payment, and a copy of the DD Form 214.)

b. TYPE OF PAYMENT c. GROSS AMOUNT

YES NOSECTION IV - MEMBER OF THE RESERVE COMPONENT12. Complete only if a member or former member of the reserve component not on active duty retiring at age 60. a. DO YOU RECEIVE OR WERE YOU RECEIVING ON THE DATE OF RETIREMENT ANY VA COMPENSATION FOR DISABILITY? (X one)

b. EFFECTIVE DATE OF PAYMENT (YYYYMMDD)

c. MONTHLY AMOUNT OF PAYMENT

YES NOSECTION V - DESIGNATION OF BENEFICIARIES FOR UNPAID RETIRED PAY (See INSTRUCTIONS)

13. Complete this section if you wish to designate a beneficiary or beneficiaries to receive any unpaid retired pay you are due at death. (Continue in Section X, "Remarks," if necessary.)

a. NAME (Last, First, Middle Initial) c. ADDRESS (Street, City, State, ZIP Code) d. RELATIONSHIP e. SHARE%%%%%

SECTION VI - FEDERAL INCOME TAX WITHHOLDING INFORMATION (Submit information in Items 14 - 17 in lieu of IRS Form W-4 for tax purposes.)

14. MARITAL STATUS (X one)

SINGLE MARRIED

MARRIED BUT WITHHOLD ATHIGHER SINGLE RATE

15. TOTAL NUMBER OF EXEMPTIONS CLAIMED

16. ADDITIONAL WITHHOLDING (Optional)

17. I CLAIM EXEMPTION FROM WITHHOLDING (Enter "EXEMPT")

18. ARE YOU A UNITED STATES CITIZEN? (X one)

YESNO (See Instructions)

SECTION VII - VOLUNTARY STATE TAX WITHHOLDING INFORMATION (Complete only if monthly withholding is desired.)19. STATE DESIGNATED TO RECEIVE TAX

20. MONTHLY AMOUNT (Whole dollar amount not less than $10.00)

21. RESIDENCE ADDRESS (If different from address listed in Item 6) a. STREET (Include apartment number) b. CITY c. STATE d. ZIP CODE

SECTION VIII - DEPENDENCY INFORMATION (This section must be completed regardless of SBP Election.)22. SPOUSE a. NAME (Last, First, Middle Initial) b. SSN c. DATE OF BIRTH

(YYYYMMDD)

23. DATE OF MARRIAGE (YYYYMMDD)

24. PLACE OF MARRIAGE (See Instructions)

25. DEPENDENT CHILDREN (Indicate which child(ren) resulted from marriage to former spouse by entering (FS) after relationship in column d. Continue in Section X, "Remarks," if necessary.)

a. NAME (Last, First, Middle Initial) b. DATE OF BIRTH (YYYYMMDD) c. SSN d. RELATIONSHIP (Son, daughter,stepson, etc.) e. DISABLED?

(Yes/No)

SECTION II - DIRECT DEPOSIT/ELECTRONIC FUND TRANSFER (DD/EFT) INFORMATION (See Instructions)

b. SSN

DD FORM 2656 (BACK), APR 2009

SECTION IX - SURVIVOR BENEFIT PLAN (SBP) ELECTION (It is recommended that you see your Survivor Benefit Plan counselor before making an election.)

26. BENEFICIARY CATEGORY(IES) (X only one item) (See Instructions and Section XI.)

e. I ELECT COVERAGE FOR MY FORMER SPOUSE (See Instructions and complete DD 2656-1, "Survivor Benefit Plan (SBP) Election Statement for Former Spouse Coverage").f. I ELECT COVERAGE FOR MY FORMER SPOUSE AND DEPENDENT CHILD(REN) OF THAT MARRIAGE (See Instructions and complete DD 2656-1, "Survivor Benefit Plan (SBP) Election Statement for Former Spouse Coverage").

27. LEVEL OF COVERAGE (X one. Complete UNLESS 26.d. or 26.g. was selected above. See Instructions.)a. I ELECT COVERAGE BASED ON FULL GROSS PAY. (If I elected the Career Status Bonus and REDUX, full gross pay is the amount of retired pay I would have received had I NOT elected the Career Status Bonus.)b. I ELECT COVERAGE WITH A REDUCED BASE AMOUNT OF $ (See Instructions).

28. INSURABLE INTEREST BENEFICIARY a. NAME (Last, First, Middle Initial) b. SSN c. RELATIONSHIP d. DATE OF BIRTH (YYYYMMDD)

e. STREET ADDRESS (Include apartment number) f. CITY g. STATE h. ZIP CODE

SECTION X - REMARKS

32. SPOUSE. I hereby concur with the Survivor Benefit Plan election made by my spouse. I have received information that explains the options available and the effects of those options. I know that retired pay stops on the day the retiree dies. I have signed this statement of my free will. a. SIGNATURE b. DATE SIGNED (YYYYMMDD)

SECTION XII - SBP SPOUSE CONCURRENCE (Required when member is married and elects child(ren) only coverage, does not elect full spousecoverage, or declines coverage. The date of the spouse's signature in item 32.b MUST NOT be before the date of the member's signature in item30.b, above.) The spouse's signature MUST be notarized.

a. I ELECT COVERAGE FOR SPOUSE ONLY. I (X) DO DO NOT HAVE DEPENDENT CHILD(REN).b. I ELECT COVERAGE FOR SPOUSE AND CHILD(REN).c. I ELECT COVERAGE FOR CHILD(REN) ONLY. I (X) DO DO NOT HAVE A SPOUSE.d. I ELECT COVERAGE FOR THE PERSON NAMED IN ITEM 28 WHO HAS AN INSURABLE INTEREST IN ME (See Instructions).

g. I ELECT NOT TO PARTICIPATE IN SBP. I (X) DO DO NOT HAVE ELIGIBLE DEPENDENTS UNDER THE PLAN.

29. Use this section to continue an item or make additional comments. Attach separate sheets if more space is needed.

d. I ELECT COVERAGE BASED ON THE THRESHOLD AMOUNT IN EFFECT ON THE DATE OF RETIREMENT.

c. REDUX MEMBERS ONLY: I ELECT COVERAGE BASED ON MY FULL GROSS PAY UNDER REDUX. I UNDERSTAND THAT THIS REPRESENTS A REDUCED BASE AMOUNT AND REQUIRES SPOUSE CONCURRENCE. (See Instructions).

30. MEMBER. Under penalties of perjury, I certify that the number of withholding exemptions claimed does not exceed the number to which I am entitled, and thatall statements on this form are made with full knowledge of the penalties for making false statements (18 U.S. Code 287 and 1001 provide for a penaltyof not more than $10,000 fine, or 5 years in prison, or both). Also, I have been counseled that I can terminate SBP participation, with my spouse's written concurrence, within one year after the secondanniversary of commencement of retired pay. However, if I exercise my option to terminate the SBP, future participation is barred. a. SIGNATURE b. DATE SIGNED (YYYYMMDD)

31.a. WITNESS NAME (Last, First, Middle Initial) c. DATE SIGNED (YYYYMMDD)

d. UNIT OR ORGANIZATION ADDRESS (Include room number) e. CITY/BASE OR POST f. STATE g. ZIP CODE

SECTION XI - CERTIFICATION

b. SIGNATURE

33. NOTARY WITNESS. On this day of , 20 , before me, the undersigned notary public,

, provided to me through

satisfactory evidence of identification, which were

the person whose name is signed in block 32.a. of this document in my presence.

(Signature of Notary)

personally appeared (Name of spouse (block 32.a.)

, to be

My commission expires: NOTARY SEAL

MEMBER NAME (LAST, First, Middle Initial) SSN









CITY STATE ZIP CODE



Prefix Suffix






TYPE AMOUNT





SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE



DIGIT






NSN 7540-01-058-0224 GOVERNMENT AGENCY COPY 1199-207Designed using Perform Pro, WHS/DIOR, Mar 97









CITY STATE ZIP CODE



Prefix Suffix






TYPE AMOUNT





SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE



DIGIT






NSN 7540-01-058-0224 FINANCIAL INSTITUTION COPY 1199-207Designed using Perform Pro, WHS/DIOR, Mar 97









CITY STATE ZIP CODE



Prefix Suffix






TYPE AMOUNT





SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE

SIGNATURE DATE



DIGIT






NSN 7540-01-058-0224 PAYEE COPY 1199-207Designed using Perform Pro, WHS/DIOR, Mar 97

Month Day Year 08 31 84

SF 1199A (Back)

BURDEN ESTIMATE STATEMENT The estimated average burden associated with this collection of information is 10 minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be directed to the Financial Management Service, Records Management Branch, Room 135, 3700 East-West Highway, Hyattsville, MD 20782. THIS ADDRESS SHOULD ONLY BE USED FOR COMMENTS AND/OR SUGGESTIONS CONCERNING THE AMOUNT OF TIME SPENT TO COLLECT THIS DATA. DO NOT SEND THE COMPLETED PAPERWORK TO THE ADDRESS ABOVE FOR PROCESSING.

PRIVACY ACT NOTICE

Collection of the information in this Direct Deposit Sign-Up form is authorized by 5 U.S.C. § 552a, 31 U.S.C. § 3332(g), and Executive Order 9397 (November 22, 1943). Your social security number and the other information requested will allow the federal government to process your direct deposit. Your social security number is requested to ensure the accurate identification and retention of records pertaining to you and to distinguish you from other recipients of federal payments. This information will be disclosed to the Department of the Treasury and its fiscal and financial agents, and other federal agencies, as necessary to process your direct deposit. This information may also be disclosed to a court, congressional committee or another government agency as authorized or required to verify your receipt of federal payments. Although providing the requested information is voluntary, your direct deposit cannot be processed without it.

PLEASE READ THIS CAREFULLY

All information on this form, including the individual claim number, is required under 31 USC 3322, 31 CFR 209 and/or 210. The information is confidential and is needed to prove entitlement to payments. The information will be used to process payment data from the Federal agency to the financial institution and/or its agent. Failure to provide the requested information may affect the processing of this form and may delay or prevent the receipt of payments through the Direct Deposit/Electronic Funds Transfer Program.

INFORMATION FOUND ON CHECKS

Most of the information needed to complete boxes A and F in Section 1 is printed on your government check:

United States Treasury

15-51 000

KANSAS CITY, MO

Check No. 0000 415785

A Be sure that payee’s name is written exactly as it appears on the check. Be sure current address is shown.

Pay to

28 28

VA COMP

DOLLARS CTS

$****100 00

F Type of payment is printed to the left of the amount. the order of JOHN DOE

123 BRISTOL STREET HAWKINS BRANCH TX 76543

A

F

NOT NEGOTIABLE ’:00000518’: 041571926"

SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS

Joint account holders should immediately advise both the Government agency and the financial institution of the death of a beneficiary. Funds deposited after the date of death or ineligibility, except for salary payments, are to be returned to the Government agency. The Government agency will then make a determination regarding survivor rights, calculate survivor benefit payments, if any, and begin payments.

CANCELLATION

The agreement represented by this authorization remains in effect until cancelled by the recipient by notice to the Federal agency or by the death or legal incapacity of the recipient. Upon cancellation by the recipient, the recipient should notify the receiving financial institution that he/she is doing so.

The agreement represented by this authorization may be cancelled by the financial institution by providing the recipient a written notice 30 days in advance of the cancellation date. The recipient must immediately advise the Federal agency if the authorization is cancelled by the financial institution. The financial institution cannot cancel the authorization by advice to the Government agency.

CHANGING RECEIVING FINANCIAL INSTITUTIONS

The payee’s Direct Deposit will continue to be received by the selected financial institution until the Government agency is notified by the payee that the payee wishes to change the financial institution receiving the Direct Deposit. To effect this change, the payee will complete a new SF 1199A at the newly selected financial institution. It is recommended that the payee maintain accounts at both financial institutions until the transition is complete, i.e. after the new financial institution receives the payee’s Direct Deposit payment.

FALSE STATEMENTS OR FRAUDULENT CLAIMS

Federal law provides a fine of not more than $10,000 or imprisonment for not more than five (5) years or both for presenting a false statement or making a fraudulent claim.