DD Form 2789: Waiver/Remission of Indebtedness Application

In box 1, TYPE OF CLAIM (X one), mark WAIVER or REMISSION. REMISSION is not applicable for civilians. If Army, use DA Forms 3508 and 2823.

Enter your Name (Required) in box 2 and the debtor's Social Security Number (Required) in box 4.

In box 3, Rank/Grade (status at the time of debt) (Required): Civilians: Grade. Military: Rank. Retirees: Retired rank/rate. Annuitants: Not applicable.

In box 5, Agency/Service (Required): Civilian: Check Agency and specify what Agency at the time of debt. Military: Mark branch of Service. Retirees: Mark branch of Service. Annuitants: Mark Agency and specify Annuitant.

In box 6, Status at the time of debt (Required), X the applicable box and provide date (YYYYMMDD) for separation (DOS), retirement (DOR), or service computation date (SCD), as appropriate. Active: Fill in DOS. Guard/Reserve: Fill in DOS. Retired: Fill in DOR. Separated: Fill in DOS. DOW Civilian: Fill in SCD. Annuitant: Only need to X the box, no date needed.

Enter your Current mailing address (Required) in box 7. In box 9, enter the Work telephone number (if applicable) and the Home telephone number, Required if no work phone, and a .gov or .mil e-mail address, which is preferred.

In box 8, Place of assignment or Employment: Civilian: Employing Agency. Military: Employing Agency/Assignment. Retirees: Not applicable (Mark N/A). Annuitants: Not applicable (Mark N/A).

In TYPE OF DEBT OR ERRONEOUS PAYMENT, enter a brief description of debt as stated in the debt notification letter. In box 11, enter the Gross Debt Amount (Required) provided on the debt notification letter.

In box 12 (Required), enter the date the debt notification letter (or other correspondence, if applicable) was received, and attach a copy of the notification letter or other correspondence.

In box 13 (Required), if you were aware of the debt or erroneous payment, explain any actions taken to correct the debt or prevent debt from occurring. If needed, the explanation can continue on additional pages.

In REASON FOR REQUESTING WAIVER/REMISSION (box 14) (Required), explain why you think your Remission/Waiver request should be approved, and submit any additional documentation with the completed form. Financial hardship applies ONLY to REMISSION and if claimed, a financial statement must be attached to include all supporting documentation.

In box 15 (Required), Retirees: Not Applicable (Mark N/A). Annuitants: State deceased spouse/sponsor's full name, SSN, and date of death.

In box 16a, attach copies of all pertinent documents (Required): any supporting documentation from parts #12 through #14, such as Request for BAH, Statement of Service, Separation Worksheet, DD Form 214, Travel Voucher, Notification of Personnel Action. If not available, please explain.

In boxes 16b and 16c, HR Point Of Contact (POC) (Civilian employees only) (Required): write the HR contact and Telephone number.

In box 17, provide copies of all pay records (LES/RAS/AAS) including 3 pay periods before and after the debt period (if applicable) (Required). Documents required to match time period of the Debt Letter.

In box 17a, write the dates in "I attest I have attached all copies of available pay records from ___ (date) to ___ (date)." In box 17b, check Yes or No confirming records provided cover the entire debt period.

Box 18, Have you filed for a Correction of Military Records? (Required) Military and Retirees: Mark Yes if you have filed for a Correction to Military Record (Please provide all documentation from the Board of Corrections concerning their findings). Mark No if you have not filed for a Correction to Military Record. Annuitants can request a change through Annuity Pay Office.

In box 19a, Signature (Electronic or Handwritten) (Required): sign the form if you certify that your statements on this form are true and correct to the best of your knowledge. An unsigned form is considered invalid, cannot be processed, and will be returned.

In box 19b, Job Title/Career Field: Civilian and Military: Career Field. Retirees: Mark Retired. Annuitants: Mark Annuitant. In box 19c, mark the date the form was completed and signed (Required).

Instructions for completing DD Form 2789, Waiver/Remission of Indebtedness Application: If you do not agree with the validity of your debt, a waiver request cannot be processed. You must first agree that the debt is valid.

Please have your commanding officer provide a statement expressing his or her opinion of the Waiver/Remission request. Box 20, the Commander's Endorsement, is required for Space Force, Air Force, and Navy active duty and reserve members. Federal civilian employees and service members (including guard and reserves) of the Army, and USMC are not required to provide a supervisor or commander endorsement, but have the option to do so.

SECTION II - REPORT OF INVESTIGATION is to be completed and signed by appropriate payroll/travel office. (Not applicable for retirees, annuitants, or out-of-service military members.)

DD Form 2789 is the Waiver/Remission of Indebtedness Application, OMB No.0730-0009. Civilian employees (current, former, or retired), military members (active, separated or retired), and annuitants use this form to request waiver of indebtedness collection for erroneous payments of salary or pay and allowances and expense reimbursement or allowances for travel, transportation, and relocation; or in the case of enlisted members, remission of debts. Remissions authority: Navy 10 U.S.C. 6161; Air Force 10 U.S.C. 9837.

Current Active Duty Military, Guard, Reserve, Retired or Annuitant Pay Recipients, Civilian Employees: Complete Fields 1-19 for completion of the second page of the form, and return the form to DFAS-IN DEPT 3300 (WAIVER/REMISSION), 8899 East 56TH Street, Indianapolis, IN 46249-3300, unless instructed to send to a different address on the debt notification letter. Separated Military or Former Civilian Employees complete fields 1-19 and send the form to DFAS-IN DEPT. 3300 (WAIVER/REMISSION), 8899 East 56TH Street, Indianapolis, IN 46249-3300.

You understand the penalty for a false claim is a maximum fine of $10,000 or a maximum imprisonment of 5 years, or both (checked October 31, 2026), and a typed signature is not accepted.