Dd Form 137-6, Dependency Statement - Full Time Student 21 - 22 Years Of Age

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CONTROL NUMBER

DEPENDENCY STATEMENT -

OMB No. 0730-0014

FULL TIME STUDENT

OMB approval expires

21 - 22 YEARS OF AGE

Jul 31, 2017

The public reporting burden for this collection of information is estimated to average 50 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 this burden estimate or any other aspect of this collection of information,

including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive,

Alexandria, VA 22350-3100 (0730-0014). 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.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO YOUR LOCAL SERVING PERSONNEL/PAYROLL OFFICE.

PRIVACY ACT STATEMENT

AUTHORITY: 5 U.S.C. Section 301; Departmental Regulations; 37 U.S.C. Section 404, Travel and Transportation Allowances general; DoD Directive 5154.29, DoD Pay

and Allowances Policy and Procedures; Joint Travel Regulation, Chapter 10; and E.O. 9397 (SSN), as amended.

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

to authorized benefits.

ROUTINE USE(S): In addition to those generally permitted under 5 U.S.C. 552(b), as amended, of the Privacy Act, these records or information contained therein may

specifically be disclosed outside of DoD as a routine use pursuant to 5. U.S.C. 552a(b)(3) as follows: The DoD Blanket Routine Uses published at:

apply.

Applicable SORNs: DJMS-AC/RC, DRAS:

USMC MCTFS:

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: This form is used to determine Basic Allowance for Housing (BAH) eligibility for students 21 - 22 years of age. Member completes

items 1 and 15. Member, student, or student's custodian completes Items 2 through 14, and has the form notarized. Answer every question. If any

question does not apply, write "NOT APPLICABLE" or "N/A" in that block. Report and verify any income in GROSS amounts. A verification of

enrollment at an institution of higher learning is required. Verification must be on official school letterhead, and include the school's name and

address, the student's status (full-time or part-time), the projected graduation date, and the school's official stamp. Proof of member's contribution

(dependent support allotments, cancelled checks, copies of money order receipts, etc., is required.

1. ENTITLEMENTS REQUESTED

(X and complete as applicable)

a. TYPE

b. FIRST APPLICATION?

c. LAST APPLICATION WAS

BAH

USIP CARD

YES

APPROVED

(If No, give date of last application)

TRAVEL ALLOWANCE