Dd Form 1607, 2010, Application For Homeowners Assistance Page 2

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OMB No. 0704-0463
APPLICATION FOR HOMEOWNERS ASSISTANCE
REPORT CONTROL SYMBOL
OMB approval expires
DD-A&T(AR)1154
(Read Privacy Act Statement and Instructions before completing form.)
Nov 30, 2013
The public reporting burden for this collection of information is estimated to average 1 hour 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, Information Management Division, 1155 Defense Pentagon,
Washington, DC 20301-1155 (0704-0463). 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 THE APPROPRIATE ARMY CORPS OF ENGINEERS
OFFICE.
PRIVACY ACT STATEMENT
AUTHORITY: Public Law 89-754, Section 1013 and Executive Order 9397.
PRINCIPAL PURPOSE(S): To determine eligibility for benefit and process requests for the Homeowners Assistance Program.
ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained therein may
specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) including the Department of Housing and Urban Development when assuming
custody of acquired homes, to manage and dispose of such properties on behalf of the Secretary of Defense; Department of Veterans Affairs in accepting subsequent
purchaser in private sales when property is encumbered by a mortgage loan guaranteed or insured by them; Department of Justice to review final title and deeds of
conveyance to the Government for properties acquired under the program, pursuant to their responsibilities under Public Law 91-393; and the Internal Revenue Service
to determine tax liability for sale of property to the Government.
DISCLOSURE: Voluntary; however, failure to provide requested information will hinder verification of employment and homeowner information and may result in delay or
denial of benefits provided under this law.
Please type or print, limiting each entry to the space provided. If there is not enough space for an answer, use the "Remarks" section on Page 4 of
this form. Repeat the item number and give the additional information. If a date is required, enter year, month and day (for example, June 1, 2008
would be 20080601). Complete all sections of the form as indicated.
SECTION I - QUALIFICATION (To be completed by Applicant)
1. NAME
2. SOCIAL SECURITY NUMBER
3. GRADE/RANK
(Last, First, Middle Initial)
4. PRESENT MAILING ADDRESS
a. STREET (Include apartment number)
b. CITY
c. STATE
d. ZIP CODE
5. EMAIL ADDRESS
7. WORK TELEPHONE NUMBER
6. HOME TELEPHONE NUMBER
(Include area code)
(Include area code)
a. HOME
b. CELL
a. COMMERCIAL
b. DSN
8. INSTALLATION/ACTIVITY ANNOUNCED FOR CLOSURE OR REDUCTION IN SCOPE
(BRAC applicants only)
9. DATE OF CLOSURE OR
REDUCTION ANNOUNCE-
a. NAME OF INSTALLATION/ACTIVITY
b. CITY
c. STATE
MENT (BRAC)
(YYYYMMDD)
10. EMPLOYMENT OR SERVICE AT INSTALLATION
(Military and Federal Employee Applicants only)
a. ELIGIBILITY CATEGORY
b.
c. BRANCH OF SERVICE.
(X)
(X one)
(X one)
WOUNDED
CSRS
ARMY
MARINE CORPS
BRAC
FERS
NAVY
COAST GUARD
PCS
NAFI
AIR FORCE
OTHER (Specify)
d. STARTING DATE (YYYYMMDD)
e. TYPE OF APPOINTMENT
f. ENDING DATE (YYYYMMDD)
g. NATURE OF SEPARATION
11. REASON FOR DESIRING ASSISTANCE
(Complete 11.a. if Civilian Employee, 11.b. if Military Service Member)
a. CIVILIAN EMPLOYEE (X and complete as applicable)
(1) ACCEPTED FEDERAL TRANSFER
(2) WOUNDED, INJURED OR ILL (WII)
(3) SURVIVING SPOUSE
(a) FOR BRAC OR WII (Name of Installation or Hospital)
(b) DATE
(c) LOCATION OF INSTALLATION (City, State, Country)
(YYYYMMDD)
(4) ACCEPTED OTHER EMPLOYMENT (BRAC applicants only)
(a) AT (Name of Subsequent Employer)
(b) DATE
(c) LOCATION OF EMPLOYMENT (City, State, Country)
(YYYYMMDD)
(a) UNEMPLOYED FROM (YYYYMMDD)
(5) UNEMPLOYED (Furnish unemployment dates only when application is based on financial hardship due to your
inability to be employed in the area of the closed/reduced installation. Attach statement on why employment is not
available or has not been accepted; also state amount and frequency of all income, nature and amount of debts,
(b) TO (YYYYMMDD)
number and amount of installment payments (including mortgage) in arrears, and any other information providing
evidence of financial hardship.)
b. MILITARY SERVICE MEMBER (X and complete as applicable)
(1) TRANSFERRED TO: (a) NAME OF INSTALLATION
(b) DATE (YYYYMMDD)
(2) ORDERED INTO ON-POST QUARTERS ON (YYYYMMDD)
(3) PCS ORDERS (YYYYMMDD)
(4) RETIRED OR SEPARATED ON (YYYYMMDD)
DD FORM 1607, DEC 2010
Page 1 of 4 Pages

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