If you're a veteran, or the dependent of a veteran, you may be eligible for certain tax benefits. Among these is the ability to file form 4755 to claim an exemption from federal income tax on your military retirement pay. In this post, we'll go over what you need to know about filing form 4755 and how to claim your exemption. Let's get started!
Question | Answer |
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Form Name | Da Form 4755 |
Form Length | 1 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 15 sec |
Other names | army da form 4755, da form 4755, DA, da 4755 form |
EMPLOYEE REPORT OF
ALLEGED UNSAFE OR UNHEALTHFUL WORKING CONDITIONS
For use of this form, see AR
This form is provided for the assistance of any complainant and is not intended to constitute the exclusive means by which a complaint may be registered with the local Safety Office (Ref OSHA Poster on rights of employees and their representatives).
The undersigned |
(check one) |
Employee |
Representative of employees |
believes that a job safety or health hazard exists at the following place of employment
Other (Specify)
Does this hazard (s) immediately threaten serious physical harm? |
Yes |
No |
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If "yes" checked, immediately contact your supervisor or safety representative. |
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Name of official in charge |
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Telephone |
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Operation/Activity |
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Exact location of worksite |
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1. Kind of operation
2. Describe briefly the hazard which exists there including the appropriate number of employees exposed to or threatened by such hazard
3.List by number and/or name the particular occupational safety and health standard(s) which may have been violated, if known
4.(a) To your knowledge, has this hazard been the subject of any union/management grievance or have you (or anyone you know) otherwise called it to the attention of, or discussed it with the employer or any representative thereof?
(b)If so, please give the results thereof, including any efforts by management to eliminate or reduce the severity of the hazard
5.Please indicate your desire:
I do not want my name revealed to the official in charge.
My name may be revealed to the official in charge.
WORK LOCATION |
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TELEPHONE NO. |
DATE |
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TYPED OR PRINTED NAME OF EMPLOYEE OR EMPLOYEE |
SIGNATURE |
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REPRESENTATIVE |
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DA FORM 4755, OCT 78
USAPPC V1.00