CLAIM FOR RETROACTIVE STOP LOSS PAYMENT
OMB No. 0704-0464
(Read Privacy Act Statement and Instructions before completing form.)
The public reporting burden for this collection of information is estimated to average 30 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, Information Management Division, 1155 Defense
Pentagon, Washington, DC 20301-1155 (0704-0464). 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 BY FIRST CLASS MAIL, EMAIL OR
FAX TO THE SERVICE UNDER WHICH YOU SERVED WHILE ON ACTIVE DUTY AT THE ADDRESS LISTED ON THE FOLLOWING PAGE.
PRIVACY ACT STATEMENT
AUTHORITY: Public Law 111-32, Section 310; E.O. 9397.
PRINCIPAL PURPOSE(S): Solicitation of information contained herein may be used as a basis for retroactive stop loss pay determinations. Your
information will be used by the Services, for verification of eligibility and then by the Defense Finance and Accounting Service for payment of
Retroactive Stop Loss payments. The Military Departments describe how your information will be maintained in their Privacy Act System of Record
The DoD "Blanket Routine Uses" apply.
DISCLOSURE: Voluntary; however, failure to provide information requested on this form may result in the government's inability to provide benefits
under the stop loss pay program. Your Social Security Number is being requested pursuant to E.O. 9397. The SSN and other identifying
information are needed to pay the proper person, ensure entitlement to benefits, and for tax purposes.
This form collects information for Military Department programs for Retroactive Stop Loss Special Pay as authorized and appropriated in Section
310 of Public Law 111-32. This program compensates Service members, including members of the Reserve components, as well as former and
retired members under the jurisdiction of the Secretary who, at any time during the period beginning on September 11, 2001, and ending on
September 30, 2009, served on active duty while the Service member's enlistment or period of obligated service was extended, or whose eligibility
for retirement was suspended pursuant to any provision of law authorizing the President to extend any period of obligated service, or suspend
eligibility for retirement, of a Service member in time of war or of national emergency declared by Congress or the President. Only Service members
who were honorably discharged from the Service and were under Stop Loss Authority while on Active Duty are eligible to apply for this special
payment program. Service members who voluntarily reenlisted or extended their service or suspended their retirement and received a bonus for
such reenlistment or extension of service are not eligible to receive the Retroactive Stop Loss Special Pay.
GENERAL BACKGROUND STATEMENT.
Under the "Supplemental Appropriations Act, 2009", Public Law 111-32, the Military Departments are authorized to collect the information
needed to certify the claimant's eligibility to collect payment while under Stop Loss Authority. The Military Departments need this information to
accurately determine the time, amount, and taxability of the claim submitted for payment. If the claim is denied, the claimant can contact the Service
they served in to submit their appeal. Final determination on granting benefits under this program is the responsibility of the Military Departments.
You may be provided the opportunity personally to explain, refute, or clarify any information before a final decision is made. If you made claim to
Stop Loss payment under any other Public Law over the last two years, then you are not eligible to make a claim for the same time period under this
If discharged, the Service member must have been honorably discharged. Veterans: The claimant is the veteran or an eligible recipient of the
veteran's estate of a deceased veteran. If claimant is incompetent, please include conservator documentation with this form. In addition, if payment
is being made to the veteran's estate, proper supporting documentation must also be submitted with this form. Non-submission of this
documentation will delay payment.
In addition to this form, submit documentation as listed below. The Military Departments may request additional documentation as necessary.
1. DD Form 214, Certificate of Release or Discharge from Active Duty and/or DD Form 215, Correction to DD Form 214.
2. Personnel record or enlistment or reenlistment document recording original expiration of service date.
3. Approved retirement memorandum or orders establishing retirement prior to actual date of retirement as stipulated on DD Form 214 or DD Form
4. Approved resignation memorandum or transition orders establishing a separation date prior to actual date of separation as stipulated in DD Form
214 or DD Form 215.
5. Signed documentation or affidavit from knowledgeable officials from the individual's chain of command acknowledging separation/deployment,
Attachments included (X one)
DD FORM 2944 INSTRUCTIONS, MAR 2010
PREVIOUS EDITION IS OBSOLETE.
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