Dd Form 1375 PDF Details

In navigating the complexities surrounding the financial aspects of a loved one's final farewell, the DD 1375 form stands as a critical document for those bearing the weight of funeral and/or interment costs for individuals who served in the military. This form, officially titled "Request for Payment of Funeral and/or Interment Expenses," is designed to facilitate reimbursement to the next of kin or other responsible parties who have incurred such expenses. Under the authority of 10 USC Sections 1481 through 1488 and Executive Order 9397, it records the amount of funeral and interment expenses while ensuring compliance with the Paperwork Reduction Act as indicated by its OMB approval number. The form is divided into parts that require completion by military authorities as well as the claimant, guiding users through providing details about the deceased, the claimant, costs incurred, and payment details. Additionally, it emphasizes the voluntary nature of information disclosure, though it hints at the inability to process claims without it. With a stated average time to complete the form being 10 minutes, it seemingly simplifies an inherently emotional and complex process.

QuestionAnswer
Form NameDd Form 1375
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesSSN, dd form 1375 instructions, OMB, USC

Form Preview Example

REQUEST FOR PAYMENT OF FUNERAL AND/OR INTERMENT EXPENSES

OMB No. 0704-0030

OMB approval expires

 

May 31, 2006

 

 

The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0030). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO THE ADDRESS IN ITEM 2.

PRIVACY ACT STATEMENT

AUTHORITY: 10 USC Sections 1481 through 1488; EO 9397.

PRINCIPAL PURPOSE: To record amount of funeral and/or interment expenses incurred by next of kin.

ROUTINE USES: None.

DISCLOSURE: Disclosure of requested information is voluntary; however, if not furnished, claim cannot be paid.

PART I - TO BE COMPLETED BY MILITARY AUTHORITIES

1. MILITARY ACTIVITY PREPARING THIS FORM

 

2. MILITARY ACTIVITY FORM IS TO BE MAILED TO FOR PAYMENT

 

 

 

 

 

 

 

 

 

 

 

a. NAME

 

 

 

 

a. NAME

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

b. ADDRESS (Street, City, State and ZIP Code)

 

b. ADDRESS (Street, City, State and ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

 

3. NAME OF DECEDENT (Last, First, Middle Initial)

 

4. PAY GRADE/RANK

5. SERVICE NUMBER/SSN

 

 

 

 

 

 

 

 

 

 

 

6. PLACE OF DEATH (City, State, Country)

 

 

7. DATE OF DEATH (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

8. NAME OF CLAIMANT (Last, First, Middle Initial)

 

 

9. RELATIONSHIP

 

 

 

 

 

 

 

 

 

 

10. FUNERAL HOME AND/OR NATIONAL CEMETERY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. NAME

 

 

 

 

b. ADDRESS (Street, City, State and ZIP Code)

 

 

 

 

 

 

 

 

 

 

 

 

11. GOVERNMENT CONTRACT FOR CARE OF REMAINS IN EFFECT AT PLACE OF DEATH

 

 

 

 

 

NO

 

YES (Enter name of contracting activity)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PART II - TO BE COMPLETED BY CLAIMANT (Proper completion will expedite settlement.)

 

 

a. Complete Items 12 and 13.

c. Complete Item 17, when cost of shipment of remains is claimed in Item 15 or as Item 16.

b. Complete either Item 14, 15, or 16.

d. Attach copies of bills for all amounts claimed.

 

 

 

 

 

(Do not complete more than one.)

e. Mail completed form to addressee shown in Item 2.

 

 

 

 

 

 

 

 

 

 

 

12. CEMETERY, MAUSOLEUM OR OTHER DISPOSITION

 

 

 

13. DATE OF

 

 

 

 

 

 

 

 

 

 

INTERMENT

a. NAME

 

 

 

b. ADDRESS (Street, City, State and ZIP Code)

 

 

 

 

 

 

 

 

(YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14. INTERMENT COSTS (To be completed when claimant arranged for interment only.)

 

 

AMOUNT CLAIMED

 

Enter total amount paid or incurred for one or more of the following: Cost of single grave site, opening and closing

$

 

grave, burial vault, church service or clergy's fee, obituary notice, flowers, services of funeral director, including use of

 

funeral director's facilities, and motor service.

 

 

 

 

 

 

 

 

 

 

 

15. FUNERAL ARRANGEMENT COSTS (To be completed when claimant made all arrangements.)

 

 

AMOUNT CLAIMED

 

Enter total amount paid or incurred for one or more of the following: Casket, preservation (embalming) and related

 

 

services, cremation and urn, clothing for deceased, cost for interment (single grave site, opening and closing grave,

 

 

burial vault, church service or clergy's fee, obituary notice, flowers, services of funeral director, including use of funeral

$

 

director's facilities, and motor service), and shipment of remains (removal from place of death to preparation point,

 

delivery from preparation point to common carrier, shipping costs, removal from common carrier to receiving funeral

 

 

home, and delivery to cemetery).

 

 

 

 

 

 

16. SHIPPING COSTS OF REMAINS (To be completed when claimant paid or incurred cost for shipment of remains.)

AMOUNT CLAIMED

 

Enter total amount paid or incurred for one or more of the following: Removal from place of death to preparation

$

 

point, delivery from preparation point to common carrier, shipping costs, removal from common carrier to receiving

 

funeral home, and delivery to cemetery.

 

 

 

 

 

 

 

 

 

 

 

 

17. SHIPMENT OF REMAINS (Complete when shipping costs claimed.)

 

 

 

 

 

 

 

 

 

 

a. SHIPPED FROM (City and State)

 

b. SHIPPED TO (City and State)

c. MODE OF SHIPMENT (X one)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AIR

 

HEARSE

 

 

 

 

 

 

18. STATEMENT OF CLAIMANT: I have paid or incurred expenses in the amounts entered in Items 14, 15, and/or 16.

 

 

 

I desire that the amount allowable by the Government be paid to:

 

 

 

 

 

 

 

 

 

a. NAME OF PAYEE (Print or type)

 

 

b. TAXPAYER ID NUMBER OR SSN

 

 

 

 

 

c. ADDRESS OF PAYEE (Street, City, State and ZIP Code)

d. SIGNATURE OF CLAIMANT

 

 

e. DATE SIGNED

 

 

 

 

 

 

 

 

 

 

 

DD FORM 1375, OCT 2003

PREVIOUS EDITION IS OBSOLETE.

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As a way to fill out this PDF form, be sure to enter the information you need in every single blank:

1. It's essential to fill out the PAYEE accurately, so take care while filling out the areas including these fields:

Stage number 1 in filling in Respondents

2. The next step is usually to fill in these blanks: CEMETERY MAUSOLEUM OR OTHER, b ADDRESS Street City State and, INTERMENT COSTS To be completed, DATE OF INTERMENT YYYYMMDD, AMOUNT CLAIMED, AMOUNT CLAIMED, SHIPPING COSTS OF REMAINS To be, AMOUNT CLAIMED, SHIPMENT OF REMAINS Complete when, b SHIPPED TO City and State, c MODE OF SHIPMENT X one, AIR, HEARSE, STATEMENT OF CLAIMANT I have paid, and b TAXPAYER ID NUMBER OR SSN.

Respondents writing process detailed (step 2)

You can certainly make a mistake while filling in the AIR, thus make sure to look again prior to deciding to send it in.

3. Completing c ADDRESS OF PAYEE Street City, d SIGNATURE OF CLAIMANT, e DATE SIGNED, DD FORM OCT, and PREVIOUS EDITION IS OBSOLETE is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Completing part 3 in Respondents

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