22 5 Form PDF Details

When members of the Army National Guard face the necessity of transferring between states, navigating the process efficiently and with full understanding is crucial. The 22-5 form, officially known as the Addendum to DD Form 4 for Approval and Acceptance by Service Representative for Interstate Transfer in the Army National Guard, streamlines this transition. Authorized by Title 5 USC 301 and Executive Order 9397, this document serves multiple pivotal roles throughout the transfer process. It not only facilitates the coordination of interstate transfers but also ensures that a soldier's commitment to uphold the Constitution and obey orders remains steadfast, irrespective of state lines. The enlistment's original terms, including the expiration term of service, are preserved, and all actions are recorded in both the soldier's Official Military Personnel File and state records, affirming the seriousness and continuity of their service. This form encapsulates a soldier's acknowledgment of the interstate transfer, with all related vows, while also laying the groundwork for administrative tasks such as updating unit assignments and contact information. Understanding the provisions and responsibilities outlined in this form is essential for a smooth transition and continued service in the Army National Guard.

QuestionAnswer
Form Name22 5 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namestransfer national states online, ngb 22 5, 22 5 form, ngb form 22 5

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ADDENDUM TO DD FORM 4

APPROVAL AND ACCEPTANCE BY SERVICE REPRESENTATIVE FOR

INTERSTATE TRANSFER IN THE ARMY NATIONAL GUARD

The proponent agency is ARNG-HRH. The prescribing directive is NGR 600-200.

PRIVACY ACT STATEMENT

AUTHORITY: Title 5 USC 301 and Executive Order 9397.

PURPOSE: Used to coordinate transfers of Army National Guard Soldiers between States. This addendum becomes a part of the DD Form 4. The original will be maintained in the soldiers Official Military Personnel File (OMPF) or electronically filed in a DoD approved system. A copy will be maintained by the MILPO for state records. For organizational use only.

ROUTINE USES: None.

DISCLOUSRE: Voluntary; However, if SSN is not provided, you will not be accepted for enlistment in the Army National Guard.

NAME: (Last, First, MI)

SSN:

 

 

(Month, YYYY)

I do hereby acknowledge to have voluntarily transferred interstate this

day of

to the State* of

Army National Guard with continued membership in the

Army National Guard of the United States and as a Reserve of the Army for the period remaining on my current enlistment,

with expiration term of service (ETS) of

under conditions prescribed by law, unless sooner discharged

by proper authority. The original period of enlistment will not change on an interstate transfer.

I, (Recite Name)

do solemnly swear (or affirm)

that I will support and defend the Constitution of the United States and the State* of

against all enemies

foreign and domestic; that I will bear true faith and allegiance to the same; and that I will obey the orders of

the President of the United States and the Governor of

and the orders of the officers appointed over me,

according to law and regulations.

 

I further agree to fulfill all prior contractual agreements on an Interstate Transfer. So help me God.

I acknowledge that the above oath has been administered to me and that I have sworn or affirmed to the same.

SIGNATURE OF INDIVIDUAL

DATE

*(Commonwealth, District, Territory)

I acknowledge that the above oath, as filled in, was administered, subscribed, and duly sworn or affirmed

(DD, Month, YYYY)

before me on

NAME, GRADE, AND ORGANIZATION OF ENLISTING OFFICER

SIGNATURE OF ENLISTING OFFICER

NGB 22-5, 20141001 (EF) (IMT)

(PREVIOUS EDITIONS ARE OBSOLETE.)

Page 1 of 2

PART I - SOLDIER DATA

1. NAME: (Last, First, MI)

 

 

 

 

 

 

SSN:

 

 

 

 

 

 

 

 

 

 

3. RANK:

 

4. PMOS:

 

 

 

5. CRITICAL SKILL:

YES

NO

 

 

 

 

 

 

 

 

 

6. BONUS TYPE:

 

7. ETS:

 

 

 

8. MGIB:

YES

NO

 

 

 

 

 

 

 

 

 

9a. HOME ADDRESS:

 

 

 

 

 

9b. HOME PHONE:

 

 

 

 

 

 

 

 

 

 

 

10a. CURRENT UNIT OF ASSIGNMENT:

 

 

 

 

 

10b. UNIT PHONE :

 

 

 

 

 

 

 

 

 

 

 

10c. UNIT ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

11a. STATE REPRESENTATIVE WHO COORDINATED TRANSFER:

(Name, Grade, Title)

 

11b. REPRESENTATIVE PHONE:

 

 

 

 

 

 

 

 

 

 

 

 

 

PART II - TRANSFER DATA

 

 

 

 

 

 

 

 

 

 

 

 

12a. NEW UNIT OF ASSIGNMENT:

 

 

 

 

 

12b. UNIT PHONE:

 

 

 

 

 

 

 

 

 

 

 

12c. UNIT ADDRESS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13a. UIC:

13b. PRN:

 

13c. PARA/LINE:

13d. DMOS:

 

 

 

 

 

 

 

 

 

 

14a. UNIT POC: (Name, Grade, Title)

 

 

 

 

 

14b. POC PHONE :

 

 

 

 

 

 

 

15a. STATE REPRESENTATIVE WHO RECEIVED TRANSFER: (Name, Grade, Title)

 

15b. REPRESENTATIVE PHONE:

 

 

 

 

 

 

 

16a. EFFECTIVE DATE OF TRANSFER: (Date of enlistment)

 

16b. EFFECTIVE LOSS DATE: (From losing state)

 

 

 

 

 

 

 

 

 

 

 

PART III - SOLDIER ACKNOWLEDGMENT

 

 

 

 

 

 

 

 

I do hereby acknowledge that I have been accepted for an interstate transfer by the State of

 

 

 

I understand that I must report to my new unit of assignment within 60 days of enlistment;

Not later than:

 

 

It is my responsibility to contact my new unit if I will be delayed. I further understand that if I fail to report,

 

 

I will be discharged with a reentry eligibility code of 3, which will disqualify me for enlistment unless a waiver is approved.

 

I understand that my failure to report also subjects me to possible administrative and judicial action.

 

 

I understand that I am not authorized to enter into a service agreement with another military unit/component

 

 

during the period of transfer.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17. SIGNATURE OF SOLDIER:

 

 

 

 

 

DATE:

 

 

 

 

 

 

 

 

 

18. SIGNATURE OF UNIT REPRESENTATIVE:

 

 

 

DATE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART IV - ATTACHMENTS

 

 

 

DA FORM 2-1, PERSONNEL QUALIFICATION RECORD; (SIDPERS) GPFR-1790

SF 88, MEDICAL RECORD - REPORT OF MEDICAL EXAMINATION

OTHER/REMARKS:

NGB 22-5, 20141001 (REVERSE) (IMT)

Page 2 of 2

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ngb 22 5 form writing process outlined (portion 1)

2. When this section is done, you're ready to put in the needed particulars in I acknowledge that the above oath, DD Month YYYY, before me on, NAME GRADE AND ORGANIZATION OF, SIGNATURE OF ENLISTING OFFICER, NGB EF IMT, PREVIOUS EDITIONS ARE OBSOLETE, and Page of so you're able to progress further.

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