DA FORM 5960, JAN 2022 is the Basic Allowance for Housing (BAH) Authorization and Dependency Declaration. Its printed purpose is to start, adjust or terminate a Soldier's entitlement to basic allowance for housing (BAH) and to verify a Soldier's dependency status. For use of this form, see AR 637-1, and the proponent agency is DCS, G-1. The authority printed on the form is 37 USC 403, Basic allowance housing, and Army Regulation 637-1, Army Military Compensation and Entitlement Policy.
A Privacy Act Statement is printed on the form. For additional information see the System of Records Notice A0600-8-104 APS http://www.federalregister.gov/documents/2019/07/18/2019-15242/privacy-act-of-1974-system-of-records.
ROUTINE USES: to the Internal Revenue Service for tax purposes, to the U.S. Government Accountability Office for statistical management, to the members of Congress for inquiries, and to U.S. state courts and various law enforcement agencies by subpoena only. DISCLOSURE: Voluntary; however, form will not be processed without your DoD ID for pay purposes and nondisclosure may result in discrepancies with your BAH.
DA FORM 5960, JAN 2022 is the current edition, and Previous Editions Are Obsolete. The file is one page with 67 fillable fields. Fill and download the form, then sign the Member's Signature box in box 14 and have the Commander's Signature box 16 signed, each marked SIGN.
Box 1, Name (Last, First, MI): enter the name.
Box 2, DOD ID Number: enter the DoD ID; the form will not be processed without your DoD ID for pay purposes.
Box 3, Grade: enter the grade.
Box 4, Member's Physical Address (Street, City, State, and Zip Code): enter the Member's Physical Address.
Box 5, Duty Location (Unit Location or City, State, and Zip Code): enter the Duty Location.
Box 6, Effective Date Of Action (YYYYMMDD): enter the Effective Date Of Action.
Box 7, Type Of Action (Select Only One): check Start, Change, Stop, or Recertify.
Box 8, BAH Type (Select Only One): check Differential, With Dependents, or Without Dependents.
Box 9, Marital Status (Select Only One): check Divorced, Single, Married, Legally Separated, or Widowed.
Box 10, Spouse's Name (Last, First, MI): enter the Spouse's Name.
Box 11, Spouse's Physical Address (Street, City, State, and Zip Code): enter the Spouse's Physical Address and check YES or NO to "Has your spouse or former spouse ever served in a branch of the Uniformed Services?" (If Yes, complete blocks a, b, c & d).
Block 11a, Spouse's DOD ID Number: enter the Spouse's DOD ID Number.
Block 11b, Spouse's Branch Of Service: enter the Spouse's Branch Of Service.
Block 11c, Date Spouse Last Entered Service (YYYYMMDD): enter the Date Spouse Last Entered Service.
Block 11d, Date Spouse Last Separated Service (YYYYMMDD): enter the Date Spouse Last Separated Service.
Box 12, Other Dependent Information (Children and Secondary Dependents): for each dependent, fill Name, Relationship, Date Of Birth (YYYYMMDD), Physical Address, and Custody, checking Physical or Legal; Additional Dependents Will Be Listed On Additional Forms.
Box 13, Certification of Dependent Support: read each printed Read and Initial and initial it.
Box 14, Member's Signature: sign.
Box 15, Date (YYYYMMDD): enter the date.
Box 16, Commander's Signature: the Commander signs.
Box 17, Date (YYYYMMDD): enter the date.
Fill the form box by box. The form will not be processed without your DoD ID for pay purposes, so enter the DoD ID in box 2. Where the form prints (Select Only One), check only one.
Read and Initial what the form prints in Box 13, Certification of Dependent Support. Read and Initial: "I understand that the legal purpose of a housing allowance on behalf of a dependent is to partially reimburse a Service Member for the expense of providing a private sector residence for the dependents when Government Quarters are not provided. I further understand that a housing allowance for a dependent is not a bonus merely for the technical status of being married or a parent."
Read and Initial: "I understand that I am required to provide adequate support to those dependents on whose behalf I am receiving a housing allowance and if I fail to provide adequate support, the housing allowance that I received for that dependent will be recouped for nonsupport or inadequate support periods."
Read and Initial: "I understand that a legal separation agreement, court decree, judgment, or order that does not state the dependent support amount, or absolves me of my dependent support responsibility, does not of itself affect my housing allowance. I further understand that if I am authorized a housing allowance on behalf of a dependent that I must contribute to my dependent's support in an amount that is not less than the applicable BAH-DIFF rate."
Read and Initial: "I understand that if there is a court order or legal separation agreement stating the support amount, I must contribute to the dependent's support the amount specified therein, but in no case may the support payments be less than the applicable BAH-DIFF rate." The form also prints: "I certify that I provide or am willing to provide adequate support to the above named dependents."
"I certify ALL information regarding this authorization is correct. I will immediately notify the servicing Finance/Personnel Office of any changes in the information above, due to divorce, marriage, death, living in government quarters etc., which could affect my BAH entitlement."
The penalty for willfully making a false claim or a false statement in connection with claims is a maximum fine of $10,000 or imprisonment for 5 years, or both.
What it is: DA Form 5960 (JAN 2022), the Basic Allowance for Housing (BAH) Authorization and Dependency Declaration, is used to start, adjust or terminate a Soldier's entitlement to BAH and to verify a Soldier's dependency status.
Who signs: Under 14. Member's Signature, sign on the SIGN line and enter the 15. Date (YYYYMMDD). Under 16. Commander's Signature, the Commander signs on the SIGN line and enters the 17. Date (YYYYMMDD).
Enter the Name (Last, First, MI), the DOD ID Number and the Grade.
Disclosure: Voluntary; however, the form will not be processed without your DoD ID for pay purposes and nondisclosure may result in discrepancies with your BAH.
Enter the Member's Physical Address (Street, City, State, and Zip Code) and the Duty Location (Unit Location or City, State, and Zip Code).
Enter the Effective Date Of Action (YYYYMMDD).
Under Type Of Action, select only one: Start, Change, Stop or Recertify.
Under BAH Type, select only one: With Dependents, Without Dependents or Differential.
Under Marital Status, select only one: Single, Married, Divorced, Legally Separated or Widowed.
Enter the Spouse's Name (Last, First, MI) and the Spouse's Physical Address (Street, City, State, and Zip Code).
Mark YES or NO: has your spouse or former spouse ever served in a branch of the Uniformed Services? If Yes, complete blocks a, b, c & d: the Spouse's DOD ID Number, the Spouse's Branch Of Service, the Date Spouse Last Entered Service (YYYYMMDD) and the Date Spouse Last Separated Service (YYYYMMDD).
Under Other Dependent Information (Children and Secondary Dependents), enter the Name, Relationship, Date Of Birth (YYYYMMDD), Physical Address and Custody (Physical and Legal) of each dependent.
Additional Dependents Will Be Listed On Additional Forms.
Under Certification of Dependent Support, Read and Initial each of the following.
Read and Initial: you understand that the legal purpose of a housing allowance on behalf of a dependent is to partially reimburse a Service Member for the expense of providing a private sector residence for the dependents when Government Quarters are not provided. A housing allowance for a dependent is not a bonus merely for the technical status of being married or a parent.
Read and Initial: you understand that you are required to provide adequate support to those dependents on whose behalf you are receiving a housing allowance. If you fail to provide adequate support, the housing allowance that you received for that dependent will be recouped for nonsupport or inadequate support periods.
Read and Initial: you understand that a legal separation agreement, court decree, judgment, or order that does not state the dependent support amount, or absolves you of your dependent support responsibility, does not of itself affect your housing allowance. If you are authorized a housing allowance on behalf of a dependent, you must contribute to your dependent's support in an amount that is not less than the applicable BAH-DIFF rate.
Read and Initial: you understand that if there is a court order or legal separation agreement stating the support amount, you must contribute to the dependent's support the amount specified therein, but in no case may the support payments be less than the applicable BAH-DIFF rate.
Read and Initial: you certify that you provide or are willing to provide adequate support to the named dependents.
You certify ALL information regarding this authorization is correct. You will immediately notify the servicing Finance/Personnel Office of any changes in the information, due to divorce, marriage, death, living in government quarters etc., which could affect your BAH entitlement.
Making a false statement or claim against the U.S. Government is punishable by courts-martial. The penalty for willfully making a false claim or a false statement in connection with claims is a maximum fine of $10,000 or imprisonment for 5 years, or both (checked October 19, 2026).
Under 14. Member's Signature, sign on the SIGN line and enter the 15. Date (YYYYMMDD).
Under 16. Commander's Signature, the Commander signs on the SIGN line and enters the 17. Date (YYYYMMDD).
Previous editions are obsolete.
DA Form 5960 (JAN 2022), the Basic Allowance for Housing (BAH) Authorization and Dependency Declaration, is used to start, adjust or terminate a Soldier's entitlement to BAH and to verify a Soldier's dependency status. For use of this form, see AR 637-1. The proponent agency is DCS, G-1.
[1] Form DA 5960 (JAN 2022), Basic Allowance for Housing (BAH) Authorization and Dependency Declaration, U.S. Department of the Army (the Official source link on this page).