Da Form 5811 R PDF Details

The Department of Defense form 5811R is used to request a delay or waiver of the collection of debt. This can be used if you are unable to pay your debt or if there is some other reason why you cannot pay the debt at this time. There are several factors that will be considered when the military decides whether or not to grant a delay or waiver, so it is important to understand what these are and how to present your case. In this blog post, we will discuss the Department of Defense form 5811R and what you need to do in order to have a chance at getting a delay or waiver for your military debt. As always, if you have any questions, please don't hesitate to reach out to us. We

QuestionAnswer
Form NameDa Form 5811 R
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesda form 5811 fillable, da 5811 r fillable, 5811 r, da 5811 instructions

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CERTIFICATE - LOST OR DAMAGED CLASS 5 AMMUNITION ITEMS

For use of this form, see DA PAM 710-2-1; the proponent agency is DCSLOG

PART I - CERTIFICATION

I certify that the item(s) described in blocks 1-5 below were as stated. Circumstances of the loss or damage are accurately described below.

1.

STOCK NO.

2.

DESCRIPTION

3.

QUANTITY

4. ITEM WAS (Check)

a. LOST

b. DAM-

 

AGED

 

 

5DAMAGED BY NEGLIGENCE? (Check)

a YES

b NO

 

 

6.CIRCUMSTANCES OF LOSS OR DAMAGE

7a. SIGNATURE

7b. DATE

PART II - ACTION

8. I have reviewed the evidence pertaining to the loss or damage as stated. I agree

do not agree

that the loss or damage to the class 5 item(s) was

was not

due to negligence, willful

misconduct, or deliberate unauthorized use. The following actions shall be taken.

 

CHECK ALL THAT APPLY

 

 

 

9.No further action is required.

10.An administrative adjustment shall be made in the property book for the class 5 item (s) that were not lost through negligence, willful misconduct, or deliberate unauthorized use.

11.The damaged class 5 item(s) shall be repaired as fair wear and tear as the damage was not caused by negligence, willful misconduct, or deliberate unauthorized use.

12.The circumstances surrounding the loss or damage warrant the processing of a formal Report or Survey that will be initiated immediately by the responsible property officer.

13a. SIGNATURE

13b. TITLE

13c. DATE

DA FORM 5811-R, AUG 89

USAPPC V1.01