Da Form 137-1 - Unit Clearance Record
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2UNIT CLEARANCE RECORD
For use of this form, see AR 600-8-101; the proponent agency is DCS, G1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Section 301, Title 5, USC.
AUTHORITY:
To ensure Soldier readiness before PCS. To complete clearance verification before transition from active duty, transfer to another Service or Component,separation,
PRINCIPAL PURPOSE:
discharge, or retirement.
ROUTINE USES:
To close out installation personnel and finance records. To ensure that debt to the government and its instrumentalities is identified and that action is taken to obtain
payment before the Soldier's transition from active duty, separation or retirement. Forms will not be disclosed outside the Department of Defense (DoD) and
sponsored agencies.
DISCLOSURE:
Disclosure is voluntary; however, failure to complete this form may result in only partial payment of final pay.
INSTRUCTIONS TO THE SOLDIER: This out-processing packet is designed to assist you and the installation in completing your final clearance as accurately and expeditiously as possible.
You are responsible for ensuring that this checklist is completed properly. If you are transitioning from the Active Army, failure to complete this checklist correctly and entirely will result in you
receiving only 55 percent of your final pay pending verification by DFAS of any outstanding debts. This checklist must be completed before your final military pay appointment. Separation
payments will not be released until installation clearance is completed.
TO THE UNIT COMMANDER/BN S1: This Soldier is scheduled to PCS or transition from the Active Army. We need your assistance to ensure proper installation clearance and computation of
the Soldier's final leave and pay entitlements. Identify all actions within the last 60 days before the Soldier's departure date and complete the items below. Failure to provide this information will
cause the withholding of 45 percent of the Soldier's final pay at transition, pending DFAS final verification of outstanding transactions.
SECTION A - PERSONNEL DATA (To be completed by the commander, BNS1, out-processing center, or appointed official)
(Last, First, Middle)
1. NAME
2. RANK
3. ORDERS NO.
4. GAINING UNIT
5. LOSING UNIT
6. DATE OF ORDERS (YYYYMMDD)
7. REASON FOR CLEARING
8. DEPARTURE DATE (YYYYMMDD)
PCS
ETS
RETIREMENT
OTHER (Specify)
SECTION B - DEBT VERIFICATIONS
9.
a.
b.
c.
d.
LOG NUMBER OR ORDER NUMBER
DUTY STATUS
TYPE OF ABSENCE
START DATE (YYYYMMDD)
RETURN DATE (YYYYMMDD)
(When Applicable)
Indicate all leave, TDY,
hospitalization, field duty, lost
time, AWOL, and confinement
within 60 days prior to
issuance of the clearance
forms.
SECTION C - ADVERSE ACTIONS
10.
a.
b.
c.
d.
e.
EFFECTIVE DATE
DATE OF SOURCE
COMPLETION DATE
TYPE OF ACTION
PUNISHMENT
ADVERSE ACTIONS
(YYYYMMDD)
(YYYYMMDD)
DOCUMENT (YYYYMMDD)
A ll that have occurred within
60 days prior to issuance of
clearance forms. Include
UCMJ actions, courts martial,
administrative reductions, and
administrative discharges.
Page 1 of 2
DA FORM 137-1, FEB 2015
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.01ES
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