Statement for Family Separation Allowance Payment
This document is used to substantiate the payment of Family Separation Allowance (FSA) for military personnel. It contains sections for member information, entitlement certification, and certifying officer validation. Completing this form accurately ensures proper processing and payment of FSA.
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How do I fill this out?
To fill out this form, carefully provide all required information in the relevant sections. Ensure that you certify your entitlement to the Family Separation Allowance (FSA) by checking the applicable boxes and providing accurate details. Your certifying officer will then validate your submission.
How to fill out the Statement for Family Separation Allowance Payment?
1
Gather all necessary personal and dependent information.
2
Complete Part I with your personal details and FSA entitlement certification.
3
Ensure all applicable boxes are checked and required information is provided.
4
Sign and date the form in the designated section.
5
Submit the form to your certifying officer for validation.
Who needs the Statement for Family Separation Allowance Payment?
1
Active duty military members who are separated from their family due to orders.
2
Reservists who are mobilized and separated from their family.
3
Members with dependents who are not able to accompany them to their duty station.
4
Service members on temporary duty (TDY) for more than 30 days.
5
Married military members whose spouse is also on active duty and separated by orders.
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What are the instructions for submitting this form?
Submit the completed form to your certifying officer for validation. Ensure all sections are accurately filled out and signed before submission. For additional guidance, contact your unit's administrative office or email [milpay@department.mil](mailto:milpay@department.mil). You may also fax the form to 555-123-4567 or submit it online through the designated military portal.
What are the important dates for this form in 2024 and 2025?
Important dates for FSA submissions in 2024 and 2025 will vary based on individual circumstances. Ensure you are aware of deadlines relevant to your specific orders and duty assignments to avoid delays in processing.
What is the purpose of this form?
The purpose of this form is to substantiate the payment of Family Separation Allowance (FSA) for eligible military personnel. This allowance compensates service members for the extra expenses incurred when they are separated from their dependents due to military orders. By accurately completing this form, service members ensure proper documentation and validation of their entitlement to FSA, leading to timely and correct payments.
Tell me about this form and its components and fields line-by-line.
- 1. Name of Member: Enter the last name, first name, and middle initial of the service member.
- 2. Grade: Provide the military grade or rank of the service member.
- 3. Social Security Number: Enter the social security number of the service member.
- 4. Branch and Organization: Specify the branch of service and unit or organization of the service member.
- 5. Type of FSA: Indicate the type of FSA being claimed: Temporary (FSA-T), Restricted (FSA-R), or Ship (FSA-S).
- 6. Address of Dependent(s): Provide the complete current address of the dependent(s).
- 7. Date Departed Residence: Enter the date the service member departed residence for unit home station or mobilization.
- 8. Certification of Facts: Certify the provided facts by checking the applicable boxes and providing any necessary details.
- 9. Signature of Member: Sign the form to certify the information provided.
- 10. Certifying Officer Section: Complete the appropriate section(s) for the certifying officer to validate the form.
What happens if I fail to submit this form?
Failure to submit this form may result in delays or denial of Family Separation Allowance (FSA) payments.
- Delayed Payments: Without proper documentation, there may be delays in receiving FSA payments.
- Denial of Allowance: Failure to submit the form may result in denial of the Family Separation Allowance.
- Inaccurate Records: Incomplete submissions can result in inaccurate records and issues with auditing and validation of payments.
How do I know when to use this form?
- 1. Active Duty Separation: When an active duty member is separated from their family for FSA eligibility.
- 2. Reservist Mobilization: When a reservist is mobilized and separated from their family for an extended period.
- 3. Long-term Temporary Duty (TDY): When a service member is on temporary duty away from their family for more than 30 days.
- 4. Spouse on Active Duty: When both spouses are on active duty and separated due to execution of orders.
- 5. Dependent Custodial Changes: When there are changes in custodial arrangements for dependents that affect FSA eligibility.
Frequently Asked Questions
How do I fill out this form?
Provide all required personal and dependent information, check the applicable boxes, sign and date the form, and submit it for validation.
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Yes, you can upload the PDF to PrintFriendly and use our PDF editor to make changes.
How do I sign the PDF using PrintFriendly?
Upload the PDF, use the signature tool to add your signature, and save the signed document.
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Yes, you can share the PDF via email or generate a shareable link using PrintFriendly's sharing options.
Do I need to provide my social security number?
Providing your social security number is voluntary, but failure to do so may result in the FSA not being considered.
What is the purpose of this form?
This form is used to substantiate the payment of Family Separation Allowance (FSA) for eligible military personnel.
Who needs to fill out this form?
Service members separated from their dependents due to military orders, including active duty, reservists, and members on TDY for more than 30 days.
What is the role of the certifying officer?
The certifying officer validates the information provided by the member and ensures proper documentation and processing of the FSA.
What happens if there are errors in the form?
Errors may result in delays or denial of FSA payments. Ensure all information is accurate before submission.
How do I know when to use this form?
Use this form when you are separated from your dependents due to military orders and are eligible for Family Separation Allowance (FSA).
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