NGB Form 22-5 PDF Details

Army National Guard Soldiers who must transfer between states are required to complete NGB Form 22-5 before the transfer becomes official. The form includes four sections that each cover a different part of the transfer process.

Part I collects Soldier data: full name, rank, Social Security Number, Primary Military Occupational Specialty (PMOS), Expiration Term of Service (ETS), unit of assignment, home address, and bonus or MGIB benefit information.

Part II records approval by both the losing and gaining state representatives. Both parties must sign before the transfer can proceed.

Part III contains the Soldier acknowledgment, confirming that the Soldier understands their reporting responsibilities, discharge conditions, and obligations to the gaining state unit.

Part IV is the attachments checklist. Required documents include the DA Form (Personnel Qualification Record), SF Medical Record, and any supplemental paperwork or remarks.

For related Army National Guard forms, also see NGB Form 22, NGB Form 22-3, and NGB Form 336.

QuestionAnswer
Form NameNGB Form 22-5 (22 5 Form)
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesAddendum to DD Form 4, NGB Form 22-5, ngb 22 5, 22 5 form

Form Preview Example

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

How to Edit 22 5 Form Online for Free

NGB Form 22-5 can be completed online in a few minutes using the FormsPal PDF editor. Follow these steps to fill out and download your completed form:

Step 1: Click the "Get Form" button at the top of this page to launch the PDF editor in your browser. No software download is required.

Step 2: In Part I, enter your Soldier data including full name, rank, Social Security Number, PMOS, ETS date, unit of assignment, home address, bonus type, and MGIB status. Double-check each entry before moving on.

ngb 22 5 form writing process outlined (portion 1)

Step 3: Complete Part II by entering the gaining and losing state representative information. Include names, grades, titles, and phone numbers. Both representatives must sign the form before it is valid.

Completing segment 2 in ngb 22 5 form

Step 4: Review and complete Part III, the Soldier acknowledgment section. Confirm all statements are accurate and sign to acknowledge your responsibilities under the transfer agreement.

The best ways to complete ngb 22 5 form portion 3

Step 5: Use the Part IV attachments checklist to gather all required documents. Required attachments typically include the DA Form (Personnel Qualification Record) and the SF Medical Record.

Filling in section 4 of ngb 22 5 form

Step 6: Review the completed form, click "Done," and download your PDF. FormsPal saves your work automatically so you can return to edit if needed. For related National Guard forms, see also NGB Form 500 and DD Form 1351-2.

ngb 22 5 form writing process described (portion 5)

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