Form Cg 2020 PDF Details

Embarking on the administrative journey of updating personal and dependent information within the U.S. Coast Guard can be navigated through the CG-2020 form, a crucial document crafted under the auspices of the U.S. Department of Homeland Security. This Dependency Worksheet serves as a comprehensive tool for members to initiate or modify essential data pertaining to dependents, which directly influences their entitlements and benefits. Whether it's adding a new family member following a significant life event or altering emergency contact details, the CG-2020 form facilitates these processes with structured sections for both entering and removing dependent information. Crucially, it intertwines with other systemic pillars, such as updating the DEERS system for medical and dental benefits, and adjusting beneficiary information for the Servicemen's Group Life Insurance (SGLI), underscoring the interconnected nature of service members' welfare and administrative upkeep. Moreover, the form meticulously outlines the requirement for supporting documentation, ensuring that any changes are substantiated, reflecting a rigorous adherence to validation for the well-being of Coast Guard members and their families. With privacy considerations and procedural instructions embeded throughout, the CG-2020 form stands as a testament to the structured approach undertaken by the U.S. Coast Guard in managing the essential aspects of its members' lives.

QuestionAnswer
Form NameForm Cg 2020
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesUSCG, cg 2020 form, uscg 2020a forms and instructions, 17a-1

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U.S. DEPARTMENT OF

HOMELAND SECURITY

U.S. Coast Guard

CG-2020 (Rev. 09-10)

1. Employee ID Number:

DEPENDENCY WORKSHEET

2. Name (Last, First, MI):

3 Permanent Unit:

Important

Emergency Contacts: To change your emergency contact information, please use the self-service menu in Direct Access.

SGLI: To change to your Servicemen’s Group Life Insurance (SGLI) beneficiary, you must complete a new SGLV-8286. You must also submit form SGLV-8286A, SGLI Family Election when reporting a marriage or divorce (http://www.insurance.va.gov/sgliSite/forms/forms.htm)

Beneficiary Data: To change your emergency contacts, beneficiaries for the gratuity pay, unpaid pay and allowances, or person to receive allotment of pay if missing or unable to transmit funds, complete form CG-2020D.

DEERS: Complete a DD-Form-1172 at ID card issuing facility to update DEERS. If adding dependents, failure to update DEERS will result in denial of medical/dental benefits. If deleting dependents, failure to update DEERS could result in continued deductions of premiums for the Family Member Dental Plan (FMDP) or medical/dental benefits being provided to a person who is no longer eligible.

Use this worksheet to add/remove up to two dependents, complete additional worksheets as necessary

 

I want to:

 

 

 

4. Add dependent, (see documentation requirements on reverse)

 

 

 

 

5. Remove dependent (Attach documentation as applicable and enter reason below)

 

 

 

 

 

 

 

 

 

 

 

 

_____________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6. Name (Last, First, MI):

 

 

 

 

 

 

 

 

 

 

7. SSN:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. Address (Street, City, State, Zip):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9. AC & Home Phone:

 

10. AC & Work Phone:

 

 

 

 

 

11. Relationship (If spouse and in the service complete blocks 19 & 20 below)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12. Date of Birth:

 

13. Dependency Date:

 

14. Date of Marriage:

 

 

15. Notify in case of emergency?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16. Name of Custodian:

 

 

 

 

 

 

 

 

If adding a child who is not in your custody provide:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17. Is custodian/spouse in the service?

18. SSN

 

19. Branch

 

20. Unit

 

 

 

NO

YES (complete 17-1, 17-2, 18,19 & 20).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17-1. Is custodian/spouse receiving Basic Allowance for Housing with dependents?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

YES

21. Monthly amount of support

 

22. Method of support (allotment,

 

23. Date of divorce/separation (if

 

 

$

 

 

 

 

 

 

check, cash):

 

applicable):

 

 

17-2. Is custodian/spouse assigned to government owned/leased quarters?

 

 

 

 

 

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I want to:

 

 

 

4a. Add dependent, (see documentation requirements on reverse)

 

 

 

5a. Remove dependent (Attach documentation as applicable and enter reason below)

 

 

 

 

 

 

 

 

 

 

 

 

_____________________________________________________________________

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6a. Name (Last, First, MI):

 

 

 

 

 

 

 

 

 

 

7a. SSN:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8a. Address (Street, City, State, Zip):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9a. AC & Home Phone:

 

10a. AC & Work Phone:

 

 

 

 

 

11a. Relationship (If spouse and in the service complete blocks 19 & 20 below)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

12a. Date of Birth:

 

13a. Dependency Date:

 

14a. Date of Marriage:

 

 

15a. Notify in case of emergency?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16a. Name of Custodian:

 

 

 

 

 

 

 

 

If adding a child who is not in your custody provide:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17a. Is custodian/spouse in the service?

18a. SSN or Employee ID (CG Members)

19a. Branch

 

20a. Unit

 

 

 

NO

YES (complete 17a-1, 17a-2, 18a, 19a & 20a).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17a-1. Is custodian/spouse receiving Basic Allowance for Housing with dependents?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

YES

21a. Monthly amount of support

 

22a. Method of support (allotment,

 

23a. Date of divorce/separation (if

 

 

$

 

 

 

 

 

 

check, cash):

 

applicable):

 

 

17a-2. Is custodian/spouse assigned to government owned/leased quarters?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

NO

YES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIVACY ACT STATEMENT

In accordance with 5 USC Section 522a(e)(3), the following information is provided to you when supplying personal information to the U. S. Coast Guard: Authority - 37 USC Section 403 and E.O. 9397. Principal Purpose(s) - Used to indicate start or change in dependency.

Routine uses – Information will be used by USCG payment approving officials to add or delete BAH eligible dependent(s). In addition, this information may be shared with the Defense Manpower Data Center (DMDC) to facilitate enrollment in dependent benefit programs.

Disclosure - Furnishing this information (including your dependent’s SSN) is voluntary, but without disclosure inaccuracies may occur with member’s current dependent status, which in turn may effect the member’s pay and delay delivery of benefits to dependents.

Any “collection of information” as defined in the Paperwork Reduction Act of 1995 (codified at 44 U.S.C. 3501 et seq) on this form has not been approved by the Director of the Office of Management and Budget (OMB) and does not display a valid control number assigned by the Director. Therefore, no person shall be subject to any penalty for failing to comply with any such collection of information."

24. Member’s Signature:

25. Date:

26. Command Approval:

27. Date:

U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-2020 (Rev. 09-10)

Continued on Reverse

Reverse of CG-2020 (Rev. 09-10)

DEPENDENCY DOCUMENTATION REQUIREMENTS

RULES:

♦The member must furnish documentary proof of dependency.

♦Unless otherwise specified, legible photostatic certified true copies of original or properly notarized legible copies of original documents are acceptable.

♦Costs associated with obtaining, certifying or translating documents are the responsibility of the member. Documents will be returned to the member upon request (SPO can retain photo copies in PDR).

♦To delete a dependent, submit divorce or annulment decree, death certificate, etc...

♦To add a dependent submit the appropriate documentation as indicated below.

♦The Direct-Access generated BAH/Dependency Report Form replaces CG Form 4170A. SPOs shall enter claimed dependents in Direct- Access and print the BAH/Dependency Report Form for the member’s signature before forwarding documentation to PPC (LGL) when dependency determination is required.

♦See COMDTINST M5512.1A (Identification Cards for Members of the Uniformed Services, Their Eligible Family Members, and Other Eligible Personnel), Attachment 5 (Basic Documentation Requirements), Note 7 for acceptable “temporary” documentation when awaiting receipt of certified documents from the records custodian/issuing authority.

Relationship

And

Documentation to be submitted

SPOUSE

U. S. MARRIAGE

Marriage certificate

Note: You must also

 

 

*FOREIGN MARRIAGE

Translated marriage certificate and Direct-Access generated BAH/Dependency Report Form

submit form SGLV-

 

 

 

8286A, SGLI Family

*COMMON LAW

Affidavit and Direct-Access generated BAH/Dependency Report Form

Election when

 

 

 

reporting a marriage.

PREVIOUSLY MARRIED

Final divorce/annulment decree

 

 

 

 

 

IN SERVICE

Provide SSN, Branch of Service and Duty Station

 

 

 

LEGITIMATE CHILD

 

Birth certificate

 

 

 

ADOPTED CHILD

 

*Amended birth certificate and adoption decree (final or interlocutory)

 

 

 

CHILD PLACED FOR

 

*Birth certificate, court order, and documents from placement agency

ADOPTION

 

 

 

 

 

STEPCHILD

 

Birth certificate, marriage certificate and spouse’s divorce decree

 

 

 

ILLEGITIMATE

MEMBER-MOTHER HAS

Birth certificate

CHILD

CUSTODY

 

 

 

 

 

MEMBER FATHER HAS

Birth certificate, proof of parentage, and Direct-Access generated BAH/Dependency Report Form

 

CUSTODY

 

 

 

 

 

*MEMBER-MOTHER DOES

Birth certificate, Support Statement (CG-2020A), and Direct-Access generated BAH/Dependency

 

Report Form

 

NOT HAVE CUSTODY

 

 

 

*MEMBER-FATHER DOES NOT

Birth certificate, proof of parentage, Support Statement (CG-2020A) and Direct-Access generated

 

BAH/Dependency Report Form

 

 

 

HAVE CUSTODY

 

 

 

 

WARD

*DEPENDENT ON THE

Support Statement (CG-2020A), birth certificate, court order, and Direct-Access generated

 

BAH/Dependency Report Form.

 

MEMBER FOR OVER ½ OF

 

 

 

SUPPORT

 

 

 

 

CHILD OVER AGE 21

*INCAPACITATED

Doctor’s statement, birth certificate, Support Statement (CG-2020A), court order or adoption

 

decree, and Direct-Access generated BAH/Dependency Report Form

 

 

Legitimate, Illegitimate,

FULL TIME STUDENT UNDER

Birth certificate, Support Statement (CG-2020A), Statement of Support for Full-Time Student

AGE 23

(CG-2020B), proof of full-time student status, court order or adoption decree (if necessary)

adopted, stepchild or

 

 

ward

 

 

PARENT, PARENT-

*DEPENDENT ON THE

Support Statement (CG-2020A), a statement showing member’s financial contributions for the

IN-LAW, PARENT IN

past six months, and Direct-Access generated BAH/Dependency Report Form

MEMBER FOR OVER ½ OF

LOCO PARENTIS,

 

SUPPORT

 

STEPPARENT,

 

 

 

PARENT BY

 

 

ADOPTION

 

 

 

 

 

Note: For all children, proof of support is also required if the child is not in the custody of the member and, if the custodian is in the service; the custodian’s SSN (or Employee ID for CG members), Branch of Service, and Duty Station must be provided.

(*): These claims must be reviewed and approved by CO, PPC (LGL). Send this worksheet along with other supporting documentation to your SPO first. They will update your Direct-Access Generated BAH/Dependency Report Form and forward it to PPC for approval. The Direct-Access generated BAH/Dependency Report Form replaces CG Form 4170A. SPOs shall enter claimed dependents in Direct-Access and print the BAH/Dependency Report Form for the member’s signature before forwarding documentation to PPC (LGL) when dependency determination is required.

Do not send this worksheet directly to PPC forward it to your SPO along with the required supporting documentation.

U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-2020 (Rev. 09-10)

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Step no. 1 in completing PPC

2. Given that this part is done, you should include the essential specifics in Note You must also submit form, LEGITIMATE CHILD, ADOPTED CHILD, CHILD PLACED FOR ADOPTION, STEPCHILD, ILLEGITIMATE CHILD, WARD, FOREIGN MARRIAGE, COMMON LAW, Translated marriage certificate, Affidavit and DirectAccess, PREVIOUSLY MARRIED, Final divorceannulment decree, IN SERVICE, and Provide SSN Branch of Service and allowing you to progress further.

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