Da Form 3715 PDF Details

The military provides a wide range of benefits and services to its members, both during and after their service. One such benefit is the disability rating system, which assigns a percentage rating to any diagnosed physical or mental health condition that limits a service member's ability to perform their usual duties. A veteran who has been given a disability rating may be eligible for certain benefits and services, including compensation, health care, and education assistance. The Disability Benefit Calculator can help veterans determine their eligibility for benefits and estimate the amount of compensation they may receive. The calculator takes into account the veteran's rank, years of service, and severity of the disability to provide an estimate of monthly compensation payments. Visit the Benefits section of our website to learn more about this and other benefits available

QuestionAnswer
Form NameDa Form 3715
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesretirement letter to employer, army retirement form, us army retirement documents, us army document form

Form Preview Example

 

 

 

 

 

US ARMY NONAPPROPRIATED FUNDS - DISPOSITION OF RETIREMENT BENEFITS

 

 

 

 

 

 

 

For use of this form, see AR 215-3; the proponent agency is DCS, G1.

 

 

 

 

 

 

 

 

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY:

National Defense Authorization Act for Fiscal Year 1996; 26 U.S.C. 401, Qualified Pension, Profit-sharing, and Stock Bonus Plans;

 

 

 

Army Regulation 215-3, Nonappropriated Funds Personnel Policy; and E.O. 9397 (SSN), as amended.

PRINCIPAL PURPOSE: The information you provide is for the purpose of preparing a refund of contribution or to process a retirement annuity.

ROUTINE USES:

This information is used to prepare a refund or deferred annuity as requested from terminating employees; process a monthly

 

 

 

 

annuity payment for retiring employees, and to process survivor benefits. In addition to those disclosures generally permitted

 

 

 

 

under 5 USC 552a (b) (Privacy Act), the information contained therein may specifically be disclosed outside the Department

 

 

 

 

 

of Defense as routine pursuant to 5 U.S.C. 552a (b) 3 as follows: Information may be disclosed to appropriate federal

 

 

 

 

 

agencies, such as Department of Labor and the Equal Employment Opportunity Commission, to resolve and/or adjudicate

 

 

 

 

 

matters falling within their jurisdiction. Records may also be disclosed to labor organizations in response to requests for

DISCLOSURE:

 

 

names of employees and identifying information.

 

 

 

 

 

 

 

 

 

Voluntary. However, failure to provide the information within one year of termination of employment will result in automatic

 

 

 

 

 

refund of contributions and denial of annuity.

 

 

 

 

 

 

 

CITATION:

 

A0215-3 SAMR, NAF Personnel Records (June 1, 2000, 65 FR 35054).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION I - GENERAL INFORMATION

1. EMPLOYEE'S NAME (Last, first, MI)

 

 

 

 

2. SOCIAL SECURITY NUMBER

3. DATE OF BIRTH (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

4a. COMPLETE MAILING ADDRESS

 

 

 

 

 

 

 

4b. E-MAIL ADDRESS

 

 

 

 

 

 

 

 

 

5a. AREA CODE/TELEPHONE NUMBER

 

5b. FAX TELEPHONE NUMBER

 

6. SERVICE COMPUTATION DATE (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

7. DATE OF SEPARATION AND REASON (YYYYMMDD)

 

 

 

 

8. ACCUMULATED SICK LEAVE HOURS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. EMPLOYING NAF:

 

 

 

 

 

 

 

 

 

 

 

10. STANDARD NAF NUMBER

 

 

 

 

 

 

 

 

 

 

 

11. MARITAL STATUS

 

 

 

 

 

 

 

12. NAME OF LEGAL SPOUSE (Last, First, MI)

 

 

NOT MARRIED

 

 

MARRIED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. SOCIAL SECURITY NUMBER OF LEGAL SPOUSE

 

14. DATE OF BIRTH OF LEGAL SPOUSE

15. DATE OF MARRIAGE (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The date of marriage has been verified by satisfactory evidence

and the benefit authorized. A certified copy of the Death Certificate and Statement of

Survivor's Social Security Entitlements are attached.

Annuity Benefits resulting from the death of the employee are payable in accordance with the Army NAF Retirement Plan.

SECTION II - RETIREMENT FUND OPTIONS

16.CHECK ONE:

In accordance with AR 215-3

(

 

 

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I request a refund of my contributions and accumulated interest in full satisfaction of all annuity payable.

(

 

 

)

I request my contributions remain in deposit for a maximum of 5 years.

(

 

 

)

I request an immediate Annuity (Normal or Early Retirement)

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I request a Deferred Annuity payable at age 62.

(

 

 

)

I request Disability Retirement.

(

 

 

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I request Disability Retirement due to work related injury.

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)

I request Survivor Benefits.

 

SECTION III - EMPLOYEE'S OR SURVIVOR SIGNATURE

17.

SIGNATURE OF EMPLOYEE/SURVIVOR

 

18. DATE (YYYYMMDD)

 

 

 

 

 

SECTION IV - VERIFICATION AND CPU MAILING ADDRESS AND SIGNATURE

19.

The above information has been verified from the employee's personnel records and DA Form 3473 coded 04 is attached.

 

 

 

 

a. CPU SIGNATURE

 

 

b. DATE (YYYYMMDD)

 

 

 

 

c. MAILING ADDRESS

 

 

d. E-MAIL ADDRESS

 

 

 

 

 

 

DO NOT USE - FOR OFFICIAL USE ONLY

20.

DATE RECEIVED (YYYYMMDD)

21. DATE PROCESSED (YYYYMMDD)

22. PROCESSED BY

 

 

 

 

 

DA FORM 3715, AUG 2019

PREVIOUS EDITIONS ARE OBSOLETE.

APD LC v1.00ES

 

 

How to Edit Da Form 3715 Online for Free

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Filling in part 1 in retirement letter template

2. Soon after performing the last section, go on to the subsequent part and enter all required particulars in these blanks - In accordance with AR, I request a refund of my, SIGNATURE OF EMPLOYEESURVIVOR, DATE YYYYMMDD, SECTION III EMPLOYEES OR SURVIVOR, The above information has been, SECTION IV VERIFICATION AND CPU, a CPU SIGNATURE, c MAILING ADDRESS, b DATE YYYYMMDD, d EMAIL ADDRESS, DATE RECEIVED YYYYMMDD, DATE PROCESSED YYYYMMDD, PROCESSED BY, and DO NOT USE FOR OFFICIAL USE ONLY.

Completing section 2 in retirement letter template

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