Form Cg 5267 PDF Details

The CG-5267 form, under the auspices of the U.S. Department of Homeland Security and the U.S. Coast Guard, stands as a critical document for service members seeking assignment to military housing. Designed with clear instructions for completion, this form encapsulates a comprehensive array of personal and professional details vital for assessing the eligibility and accommodation needs of applicants. It encompasses sections requiring applicant data, sponsor information, dependency statuses—including detailed accounts of any special needs among dependents—as well as pet ownership particulars, thereby ensuring a thorough evaluation by housing authorities. Notably, the form emphasizes the importance of voluntariness in disclosure, while also underscoring the potential consequences of non-disclosure, which may delay or complicate the provision of suitable housing. Included within the document are key statements regarding privacy, directly addressing the user's rights and the legal basis for information solicitation, thereby affirming the form's adherence to regulatory standards and personal privacy protections. Additionally, the procedural steps outlined for both applicants and housing authorities facilitate a structured process, from application submission through to housing assignment, underscoring the form's role in efficiently managing military housing allocations. Consequently, the CG-5267 form embodies a crucial nexus between individual service members and the housing accommodations provided to them, reflecting a tailored approach to meeting the diverse needs of military personnel and their families.

QuestionAnswer
Form NameForm Cg 5267
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namescg form 4170, USC, 17a, 10b

Form Preview Example

 

U.S. DEPARTMENT OF

 

 

 

APPLICATION FOR ASSIGNMENT TO MILITARY HOUSING

 

HOMELAND SECURITY

 

 

 

 

U.S. COAST GUARD

 

 

 

 

 

(Instructions for preparation of this form are contained on page 2)

 

CG-5267 (01-09)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PRIVACY ACT STATEMENT

 

 

 

 

 

 

 

 

 

 

 

IN ACCORDANCE WITH 5 USC 552(E)(3), THE FOLLOWING INFORMATION IS PROVIDED TO YOU WHEN SUPPLYING PERSONAL INFORMATION TO THE U.S. COAST

 

GUARD.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. AUTHORITY:

 

SECTION 515 P.L. 84-161, AS AMENDED (10 USC 2674) AUTHORIZED SOLICITATION OF THE INFORMATION.

 

2. PRINCIPAL

 

TO DETERMINE EACH APPLICANT'S ELIGIBILITY FOR ASSIGNMENT TO SUITABLE MILITARY HOUSING ACCOMMODATIONS.

 

 

PURPOSE(S):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. ROUTINE

 

THE INFORMATION IS USED BY CG HOUSING OFFICE TO EVALUATE THE ASSIGNMENT OF HOUSING ACCOMMODATIONS.

 

 

USES:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. DISCLOSURE:

DISCLOSURE OF THE INFORMATION IS VOLUNTARY, BUT FAILURE TO PROVIDE THE INFORMATION MAY RESULT IN THE INABILITY

 

 

 

 

OF THE CG HOUSING OFFICE TO PROVIDE SUITABLE HOUSING TO THE APPLICANT AND AT THE MOST EXPEDITIOUS TIME.

 

 

 

 

DISCLOSURE OF THE INFORMATION HEREIN CONTAINED TO OTHER THAN THE AGENCY IS IN ACCORDANCE WITH THE FREEDOM

 

 

 

 

OF INFORMATION ACT.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION A - APPLICATION (To be completed by applicant)

 

 

 

 

 

 

 

1. APPLICANT'S NAME ( Last, first, middle initial)

 

 

2. EMPLOYEE IDENTIFICATION NUMBER

3. APPLICANT'S RANK/RATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. CURRENT DUTY STATION AND PHONE NUMBER

 

 

5. NEW DUTY STATION AND PHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6a. EST. DATE OF DEPARTURE

 

6b. EST. DATE OF ARRIVAL

 

7. ADDRESS AND PHONE NUMBER WHILE ON LEAVE ENROUTE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8. ENLISTMENT EXPIRES (Date)

 

9. ON LIST FOR PROMOTION

 

10a. ON CLASS "A" SCHOOL LIST

 

10b. IF SO, WHICH LIST

 

 

 

 

 

 

 

 

 

YES

NO

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPONSOR INFORMATION

 

 

 

 

 

 

 

 

 

 

 

11a. NAME OF SPONSOR

 

 

 

11b. RANK/RATE

 

11c. SPONSOR'S DUTY STATION AND PHONE NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEPENDENCY INFORMATION (Check appropriate box)

 

 

 

 

 

 

 

12. MARITAL STATUS

 

 

 

 

 

 

 

13. I AM SEPARATED FROM MY DEPENDENTS

 

 

MARRIED

 

 

SINGLE (CG-4170A not

applicable)

 

 

N/A

 

VOLUNTARILY

 

INVOLUNTARILY

 

 

 

 

 

 

 

 

DEPENDENTS RESIDING WITH ME (If more space is needed, continue on plain paper)

 

 

 

 

 

14a.

 

 

 

 

 

 

 

14b. DATE OF BIRTH

14c.

14d.

 

 

14e.

 

 

 

 

 

 

 

NAME (Last, First, Middle Initial)

 

 

 

(YYYY/MM/DD)

SEX

RELATIONSHIP

 

 

REMARKS, (handicap, health problems, expected

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

additions to family, etc.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOU MUST ATTACH COPY OF CG-4170A WHICH INDICATES DATES OF APPROVAL OF THOSE DEPENDENTS WHO WILL RESIDE WITH YOU.

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL DEPENDENT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15a. SPOUSE IN SERVICE

15b. IF SO, WHICH SERVICE

15c. CURRENT DUTY STATION AND PHONE NUMBER

 

15d. EXPECTED DATE HE/SHE WILL JOIN YOU

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16a. ARE YOU ENROLLED IN THE CG SPECIAL NEEDS

16b. IF SO, LIST DEPENDENTS WITH SPECIAL NEEDS.

 

 

 

 

 

 

 

 

PROGRAM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YES

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17a. DO YOU HAVE PETS

 

17b. IF SO, WHAT KIND

 

 

 

 

 

17c. AGE

 

17d. WEIGHT

 

 

YES

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GENERAL

UPON ARRIVAL AT YOUR NEW DUTY STATION, IT IS MANDATORY THAT YOU REPORT TO THE HOUSING AUTHORITY SERVING THE AREA PRIOR TO MAKING ARRANGEMENTS FOR ANY TYPE HOUSING. YOU SHOULD HAVE DD-1747 (previously issued) READY FOR PRESENTATION.

IN THE EVENT ASSIGNMENT TO MILITARY HOUSING BECOMES MANDATORY, THIS IS TO CERTIFY THAT:

I DO

I DO NOT DESIRE A WAIVER TO RESIDE IN CIVILIAN HOUSING

I CERTIFY THAT THE INFORMATION ABOVE IS CORRECT. I HAVE ATTACHED A COPY OF MY ORDERS AND APPROVED CG-4170A HERETO. CG-4170A N/A FOR SINGLE MEMBERS.

DATE SUBMITTED

APPLICANT'S SIGNATURE

 

 

PREVIOUS EDITION IS OBSOLETE

PAGE 2 OF CG-5267 (01-09)

SECTION B - HOUSING AUTHORITY ACTION

1.

APPLICATION EFFECTIVE DATE

2.

DATE APPLICATION RECEIVED

3.

DATE DD-1747 SENT TO APPLICANT

 

 

 

 

 

 

4.

WAITING LIST PLACED ON

5.

EFFECTIVE DATE

6.

APPLICANT NOT PLACED ON WAITING LIST (Reason)

 

 

 

 

 

 

7.

APPLICANT ASSIGNED TO (Housing unit )

8.

DATE OF ASSIGNMENT

9.

BAH TERMINATION EMAIL COMPLETED ON (Date)

 

 

 

 

 

 

 

 

 

INSTRUCTIONS

 

 

 

 

 

SECTION A - APPLICATION

 

ALL BLOCKS ARE SELF EXPLANATORY.

THE APPLICATION MUST BE DATED AND SIGNED BY MEMBER.

SECTION B - HOUSING AUTHORITY ACTION

TO BE COMPLETED BY HOUSING AUTHORITY WHO WILL ACKNOWLEDGE RECEIPT OF APPLICATION, MAIL DD-1747, AND PLACE MEMBER ON WAITING LIST (if applicable)

OR ADVISE REASONS MEMBER NOT PLACED ON WAITING LIST.

How to Edit Form Cg 5267 Online for Free

It's a piece of cake to prepare the 4170A. Our tool was made to be enable you to complete any PDF quickly. These are the four steps to take:

Step 1: The first thing should be to select the orange "Get Form Now" button.

Step 2: As soon as you've entered the editing page 4170A, you will be able to find each of the options readily available for the document inside the upper menu.

These particular segments are included in the PDF document you'll be completing.

stage 1 to filling out cg form 4170

Type in the necessary data in the box YOU MUST ATTACH COPY OF CGA WHICH, a SPOUSE IN SERVICE, b IF SO WHICH SERVICE c CURRENT, d EXPECTED DATE HESHE WILL JOIN YOU, ADDITIONAL DEPENDENT INFORMATION, YES, a ARE YOU ENROLLED IN THE CG, b IF SO LIST DEPENDENTS WITH, PROGRAM, YES, a DO YOU HAVE PETS, b IF SO WHAT KIND, c AGE, d WEIGHT, and YES.

cg form 4170 YOU MUST ATTACH COPY OF CGA WHICH, a SPOUSE IN SERVICE, b IF SO WHICH SERVICE c CURRENT, d EXPECTED DATE HESHE WILL JOIN YOU, ADDITIONAL DEPENDENT INFORMATION, YES, a ARE YOU ENROLLED IN THE CG, b IF SO LIST DEPENDENTS WITH, PROGRAM, YES, a DO YOU HAVE PETS, b IF SO WHAT KIND, c AGE, d WEIGHT, and YES blanks to complete

The system will ask you for data to easily prepare the part APPLICATION EFFECTIVE DATE, DATE APPLICATION RECEIVED, DATE DD SENT TO APPLICANT, WAITING LIST PLACED ON, EFFECTIVE DATE, APPLICANT NOT PLACED ON WAITING, APPLICANT ASSIGNED TO Housing, BAH TERMINATION EMAIL COMPLETED, INSTRUCTIONS SECTION A APPLICATION, ALL BLOCKS ARE SELF EXPLANATORY, and THE APPLICATION MUST BE DATED AND.

stage 3 to finishing cg form 4170

Step 3: Press the "Done" button. Now you may export the PDF form to your gadget. As well as that, it is possible to forward it by electronic mail.

Step 4: Make as much as a few copies of the document to remain away from any sort of future concerns.

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