Form Preview Example

APPLICATION FOR REMISSION OR CANCELLATION OF INDEBTEDNESS	Use additional blank sheet for continuation
For use of this form, see AR 600-4; the proponent agency is DCS, G-1.	of items identifying each item by number.

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY: PRINCIPAL PURPOSE: ROUTINE USES:

DISCLOSURE:

10 USC Section 4837 and 32 USC Section 710.

To evaluate an application from a military member for remission and cancellation of debt to the United States.

Information provided in this form, and other supporting documentation (including message applications), serves to substantiate your request, and will be used as a basis to support recommendation for approval or disapproval. This documentation will be maintained as part of your Personal Financial record.

Voluntary. However, failure to supply all pertinent information may result in the request being returned without action.

INSTRUCTIONS: Answer each question. (Questions that are not applicable, state NA.)

SECTION 1

1. TO: (Complete address and telephone number of unit Cdr.)

FROM:

3. SERVICE DATA

(Include DSN (Not applicable for out of service Soldiers)).

a. NAME (Last, first, MI)

a. ETS

MRD

b. RANK

c. PAY GRADE

Date of Separation (YYYYMMDD)

b. BASD

d. SSN

c. PEBD

e. E-MAIL ADDRESS

d. PMOS

DMOS

BASIC BRANCH

CNTL BRANCH

4. PRESENT ORGANIZATION, STATION ADDRESS, DSN

5a. STATION/UNIT WHERE DEBT INCURRED (INCLUDE THE STATE)

6. INTEND TO (Enlisted Soldiers only)

AND COMMERCIAL NUMBER (INCLUDING AREA CODE)

a. REENLIST

YES

OR CURRENT HOME ADDRESS/TELEPHONE NUMBER

b. EXTEND

YES

b. DATE DEBT INCURRED

(YYYYMMDD)

c. UNDECIDED

YES

c. DSSN/ADSN AT TIME OF DEBT INCURRED

b. DSN

7. MARITAL STATUS

MARRIED

NEVER MARRIED

WIDOWED

DIVORCED

LEGALLY SEPARATED

SEPARATED

8. NAME OF SPOUSE (Last, first, MI, maiden)

9. DOES SPOUSE RESIDE WITH SOLDIER?

10. IS SPOUSE IN MILITARY?

11. WAS SPOUSE IN MILITARY?

YES

NO (If no, explain)

YES (If yes, list spouse's SSN, BASD, ETS/MRD)

YES (If yes, list spouse's SSN, BASD, ETS/

Date of Separation)

a. SSN

b. BASD

a. SSN

b. BASD

c. ETS/MRD/DATE OF SEPARATION

c. ETS/DATE OF SEPARATION

12. NAME OF FAMILY MEMBERS

RELATIONSHIP

DATE OF BIRTH

RESIDE WITH SOLDIER

(Other than spouse)

(YYYYMMDD)

(If no, explain in item 48)

YES

13. INITIAL AMOUNT AND CATEGORY OF INDEBTEDNESS

14. DATE APPLICANT NOTIFIED OF INDEBTEDNESS

15. APPLICATION BASED ON

(i.e., BAQ; BAS; FSA; COLA;SHA; HHG; EB; RRB; Report of Survey, etc.)

(YYYYMMDD)

AMOUNT

CATEGORY

COMPLETION OF SECTION II, III, IV, V, AND VI NOT REQUIRED IF APPLICATION IS BASED

ON INJUSTICE ONLY. TURN TO SECTION VII

TOTAL

DA FORM 3508, OCT 2007

PREVIOUS EDITIONS ARE OBSOLETE.

PAGE 1 OF 6

APD PE v1.00ES

	SECTION II -	(INCOME)				DO NOT LIST ANY ONE EXPENSE IN TWO DIFFERENT LOCATIONS

						SECTION III -	(EXPENSES)
						SECTION III -	(EXPENSES)

	AVERAGE MONTHLY INCOME		HUSBAND	WIFE		AVERAGE MONTHLY EXPENSES

16a.	MONTHLY GROSS MILITARY SALARY		$	$	21.	RENT OR MORTGAGE PAYMENT		$

16b.	MONTHLY GROSS CIVILIAN SALARY		$	$	22.	FOOD		$

16c.	TOTAL GROSS SALARY		$	$	23.	TELEPHONE		$

17a.	DEDUCTION				24.	UTILITIES		$
			$	$
	FEDERAL, STATE, AND LOCAL INCOME TAXES		$	$	25.	LAUNDRY		$

17b.	SGLI/SOLDIER'S HOME		$	$	26.	CLOTHING		$

17c.	FICA		$	$	27.	MEDICAL (Nonreimbursable)		$

17d.	OTHER (Specify) (Do not list allotments or debt				28.	CAR OPERATING EXPENSE (Gas, etc)		$
	payments - list only normal deductions)
	payments - list only normal deductions)				29a. CAR INSURANCE			$
					29a. CAR INSURANCE			$

					b. OTHER INSURANCE - NOT INCLUDED IN 17d. (Specify)			$

					30.	OTHER TRANSPORTATION EXPENSE (bus, train, etc.)		$

17e.	TOTAL DEDUCTIONS (Item 17a through 17d)		$	$	31.	OTHER LIVING EXPENSES NOT LISTED IN SECTION IV	(Specify)	$

18.	NET TAKE HOME PAY (Subtract item 17e from		$	$
	item 16c)
	item 16c)				32.	SUB TOTAL		$
					32.	SUB TOTAL		$

19.	PENSION COMPENSATION, CHILD SUPPORT,		$	$	33. ALLOTMENTS (Total from Section IV, item 37g)			$
	ALIMONY, VA BENEFITS, OR OTHER INCOME
	(Specify)
	(Specify)				34.	MONTHLY PAYMENTS ON INSTALLMENT CONTRACTS AND		$
					34.	MONTHLY PAYMENTS ON INSTALLMENT CONTRACTS AND		$
						OTHER DEBTS (Total from Section IV, item 36f)
20.	TOTAL MONTHLY NET INCOME (Item 18 plus		$	$		OTHER DEBTS (Total from Section IV, item 36f)
20.	TOTAL MONTHLY NET INCOME (Item 18 plus		$	$
	item 19)				35.	TOTAL MONTHLY EXPENSES (Items 32 through 34)		$
					35.	TOTAL MONTHLY EXPENSES (Items 32 through 34)		$

SECTION IV

(INSTALLMENT CONTRACT AND OTHER DEBTS)

Show here ALL debts which you are required to pay in regular monthly installments, such as Government debt, car, television, washing machine, payments to retailers, banks, finance companies, repayment of money borrowed for any purpose, doctor bills, hospital bills, etc. DO NOT include living expenses or allotments. NOTE: If payment of a debt is not on a monthly basis, write "O" in column f and describe arrangements in Section VII - REMARKS.

NAME AND ADDRESS OF CREDITOR	DATE DEBT	PURPOSE OF	ORIGINAL AMOUNT	UNPAID	AMOUNT DUE	AMOUNT PAST	LIQUIDATION
	INCURRED	PURPOSE OF	ORIGINAL AMOUNT	UNPAID	AMOUNT DUE	AMOUNT PAST	DATE
	INCURRED	DEBT	OF DEBT	BALANCE	MONTHLY	DUE (If any)	DATE
	(YYYYMMDD)	DEBT	OF DEBT	BALANCE	MONTHLY	DUE (If any)	(YYYYMMDD)
	(YYYYMMDD)						(YYYYMMDD)
a	b	c	d	e	f	g	h*

36a.			$	$	$	$

36b.

36c.

DA FORM 3508, OCT 2007	PAGE 2 OF 6

APD PE v1.00ES

SECTION IV - (Continued)

	DATE DEBT	PURPOSE OF	ORIGINAL AMOUNT	UNPAID	AMOUNT DUE	AMOUNT PAST	LIQUIDATION
NAME AND ADDRESS OF CREDITOR	INCURRED						DATE
		DEBT	OF DEBT	BALANCE	MONTHLY	DUE (If any)
	(YYYYMMDD)						(YYYYMMDD)

a	b	c	d	e	f	g	h*
36d.			$	$	$	$

36e.

36f.TOTAL

*IF REVOLVING ACCOUNT, STATE ACTUAL DATE ACCOUNT WILL BE LIQUIDATED IF NO OTHER PURCHASES ARE MADE

(ALLOTMENTS CURRENTLY IN EFFECT)

	DATE	PURPOSE			ESTIMATED EXPIRATION DATE
	STARTED				ESTIMATED EXPIRATION DATE
CLASS			PAYEE	AMOUNT	(Provide date obligation will be paid
		(i.e., car, furniture, savings)

	(YYYYMMDD)				in full)
	(YYYYMMDD)				in full)
a	b	c	d	e	f

37a.		SUPPORT		$
		a.
		a.
		b.
		c.

37b.		INSURANCE		$
		a.
		a.
		b.
		c.

37c.		FINANCIAL INSTITUTION (Specify - Institution and Purpose)		$
		a.
		a.
		b.
		c.

37d.		OTHER (i.e., red Cross, AER, etc.)		$
		a.
		a.
		b.
		c.

37e. SUBTOTAL (Add 37a through 37d)

37f. PROVIDE TOTAL AMOUNT FORM 37a THROUGH 37d THAT GOES INTO SAVINGS ACCOUNT

37g. TOTAL (Subtract line 37f from 37e)

DA FORM 3508, OCT 2007	PAGE 3 OF 6

APD PE v1.00ES

SECTION V

(ADDITIONAL DATA)

38a.

HAVE YOU EVER DECLARED BANKRUPTCY

b. DATE DISCHARGED FROM BANKRUPTCY (YYYYMMDD)

c. LOCATION OF COURT

d. DOCKET NUMBER OF KNOWN

(City and State)

39.

ENLISTMENT OR REENLISTMENT BONUS, LIST EACH INCREMENT OF SRB BONUS. PROVIDE INFORMATION FOR ANY BONUS RECEIVED DURING THIS ENLISTMENT/ REENLISTMENT AND ANY

KNOWN AMOUNTS TO BE RECEIVED IN THE FUTURE. OFFICERS INCLUDE OFFICER ACCESSION BONUS AND OFFICER AFFLIATION BONUS IN BLOCK 39D(if applicable)

TYPE OF BONUS

AMOUNT RECEIVED

DATE(s) RECEIVED

AMOUNT TO BE RECEIVED

DATE(s) (YYYYMMDD)

INCREMENTS WILL BE RECEIVED

(YYYYMMDD)

a. EB

b. SRB

c. RRB

d. OTHER

e. TOTAL

40. CASH (Item a-g: Provide total amount, not monthly amount for each category)

41. REAL ESTATE OWNED OR BEING PURCHASED (Approximate retail value)

a. CHECKING

b. SAVINGS

c. BUILDING AND LOAN

d. US SAVINGS BONDS (Current value)

e. OTHER BONDS (i.e. Municipal)

42. PURCHASES SINCE AWARENESS OR NOTIFICATION OF INDEBTEDNESS (Specify: TV; CB;

Stereo; Appliances; Furniture; Jewelry; Photographic equipment, etc. and cost.)

f. OTHER (Specify)

g. CASH ON HAND

h. TOTAL

43.

VEHICLES (List all)

MAKE

YEAR

MODEL

MILEAGE

DATE PURCHASED

(YYYYMMDD)

AUTOMOBILE

TRUCK

MOTOR CYCLE

TRAILER

CAMPER

BOAT

44. OTHER ASSETS (Not listed in item 43)

DA FORM 3508, OCT 2007

PAGE 4 OF 6

APD PE v1.00ES

SECTION VI

SUMMARY

45a. COMBINED MONTHLY INCOME (Section II, item 20)

b. COMBINED MONTHLY EXPENSES (Section III, item 35)

c. BALANCE (Subtract 45b from 45a)

TOTAL FOR APPLICANT AND SPOUSE $

46.HOW MUCH OF THE BALANCE IN ITEM 45c CAN YOU APPLY TO YOUR DEBT TO THE US GOVERNMENT ON A MONTHLY BASIS

47. IF TOTAL MONTHLY EXPENSES EXCEED MONTHLY INCOME, HOW DO YOU PAY THE DIFFERENCE

SECTION VII

REMARKS

48.USE THIS SPACE AND ADDITIONAL SHEETS IF NECESSARY TO SUPPLY ANY OTHER PERTINENT INFORMATION AND TO CONTINUE YOUR ANSWERS TO PREVIOUS ITEMS. INDICATE ITEM NUMBER(s)TO WHICH YOUR COMMENTS APPLY. (DO NOT USE FOR SWORN STATEMENT)

DA FORM 3508, OCT 2007

PAGE 5 OF 6

APD PE v1.00ES

SECTION VIII

CERTIFICATION

49.I (we) AFFIRM THAT THE INFORMATION CONTAINED HEREIN IS TRUE, CORRECT AND COMPLETE TO THE BEST OF MY (our) KNOWLEDGE AND BELIEF. THE SWORN STATEMENT AND REQUIRED INCLOSURES ARE ATTACHED. (Spouse's signature is not required when application is based on injustice only).

DATE (YYYYMMDD)

APPLICANT'S SIGNATURE

DATE (YYYYMMDD)

SIGNATURE OF SPOUSE

PENALTY - THE LAW PROVIDES SEVERE PENALTIES WHICH INCLUDE FINE AND IMPRISONMENT, OR BOTH FOR THE WILLFUL SUBMISSION OF ANY STATEMENT OR EVIDENCE OF A MATERIAL FACT, KNOWING IT TO BE FALSE. (18 USC 1001 provides a penalty as follows: A maximum fine of $10,000 or maximum imprisonment of 5 years, or both.)

50.VERIFICATION BY IMMEDIATE COMMANDER OF FINANCIAL DATA (for Active Soldiers only).

IF SOLDIER IS OUT OF SERVICE, DFAS WILL VERIFY DATA.

a. I have seen documentation which substantiates that the financial data is correct.				YES	NO	NA	b. I will	have	prepare(d) a military letter per para 3-1, AR 600-4.

DATE (YYYYMMDD)	NAME OF IMMEDIATE COMMANDER (Type or print)					SIGNATURE

				SECTION IX

				FOR FAO OR USPFO USE

51. COLLECTION OF DEBT SUSPENDED		YES	NO		$
a. AMOUNT COLLECTED PRIOR TO SUSPENSION					$
a. AMOUNT COLLECTED PRIOR TO SUSPENSION
b. AMOUNT BEING COLLECTED MONTHLY					$
c. AMOUNT UNCOLLECTED DATE OF COMMANDER'S SIGNATURE (Item 50)					$

d. AMOUNT UNCOLLECTED THIS DATE	$

DATE (YYYYMMDD)

SIGNATURE (FAO OR USPFO)

52. VERIFICATION BY FAO OR USPFO (Checklist) (All items listed below must be completed or attached, as applicable.)

ALL APPLICABLE ITEMS OF THE APPLICATION HAVE BEEN COMPLETED.

APPLICATION HAS BEEN SIGNED BY APPLICANT AND SPOUSE, IF APPLICABLE.

APPLICATION HAS BEEN VERIFIED BY IMMEDIATE COMMANDER OR DFAS FOR OUT OF SERVICE SOLDIERS.

APPLICANT'S SWORN STATEMENT.

A COPY OF THE APPLICANT'S MILITARY LEAVE AND EARNINGS STATEMENT.

DOCUMENTS DISCLOSING CAUSE, REASON, CATEGORY, AMOUNT AND INCLUSIVE PERIOD OF INDEBTEDNESS (i.e., DD Form 139). SEE PARA 2-4a(3) FOR ADDITIONAL EXAMPLES.

A COPY OF THE APPLICANT'S LAST LEAVE AND EARNINGS STATEMENT FOR ANNUAL TRAINING, IF APPLICABLE.

A COPY OF THE APPLICANT'S LAST W-2 FROM HIS OR HER FULL-TIME EMPLOYER, IF APPLICABLE.

ADDITIONAL INCLOSURES THAT ARE APPLICABLE ( i.e., copy of documentation submitted which authorized receipt of the erroneous payment). SEE PARA 2-4b, FOR ADDITIONAL EXAMPLES.

MILITARY LETTER BY IMMEDIATE COMMANDER WITH RECOMMENDATION PER PARA 3-1. (if applicable or Soldiers on active duty).

INDORSEMENT BY COMMANDER HAVING SPECIAL COURT-MARTIAL JURISDICTION OR ARNG NEXT HIGHER FIELD GRADE COMMANDER WITH

RECOMMENDATION PER PARA 3-2 (if applicable or Soldiers on active duty).

INDORSEMENT BY COMMANDER HAVING GENERAL COURT-MARTIAL JURISDICTION OR STATE ADJUTANT GENERAL PER PARA 3-4, IF APPLICABLE.

INDORSEMENT BY FAO OR USPFO PER PARA 3-3.

DA FORM 3508, OCT 2007	PAGE 6 OF 6

APD PE v1.00ES

Question	Answer
Form Name	Da Form 3508
Form Length	6 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min 30 sec
Other names	form 3508 ez fillable, da form 3508, form 3508 application, form 3508 da

Da Form 3508 – Fill Out and Use This PDF

Da Form 3508 PDF Details

Form Preview Example

Da Form 3508 isn’t the one you’re looking for?

Da Form 3508 – Fill Out and Use This PDF

Da Form 3508 PDF Details

Form Preview Example

Da Form 3508 isn’t the one you’re looking for?

Related Documents