Form Fsa Dd 1561 PDF Details

The FSA DD 1561 form plays a pivotal role in the lives of United States military personnel seeking Family Separation Allowance (FSA), acting as the formal documentation required to substantiate entitlement. Rooted in Title 37 of the U.S. Code, Section 427, the form's principal purpose is to thoroughly evaluate a service member's application for FSA, ensuring that all claims for this allowance are duly substantiated and properly audited. It not only serves as a key piece of evidence for FSA payments but also integrates into the member's pay account, providing a clear audit trail to validate the propriety of payments. Moreover, it assists in the recovery of erroneous payments and maintains a record in the service member's pay account for future reference. The form covers various conditions under which FSA may be claimed, such as temporary, restricted, or ship-based separations, and addresses the living arrangements and dependency status of the service member's family. It highlights the importance of disclosing personal information, including social security numbers, to process the claim but also notes that this disclosure is voluntary, albeit essential for consideration of FSA.

QuestionAnswer
Form NameForm Fsa Dd 1561
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesdd form 1561 fillable pdf, dd1561, dd form 1561 dec 2017 pdf, dd 1561

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STATEMENT TO SUBSTANTIATE PAYMENT OF FAMILY SEPARATION ALLOWANCE (FSA)

PRIVACY ACT STATEMENT

AUTHORITY: Title 37, U.S. Code, Section 427.

PRINCIPAL PURPOSE: To evaluate member's application for FSA.

ROUTINE USES: a. Serves as substantiating document for FSA payments and input into the member's pay account.

b.Provides an audit trail for validating propriety of payments and to assist in collecting erroneous payments.

c.Provides a record in service member's pay account and for safekeeping.

DISCLOSURE: Disclosure of your social security number and other personal information is voluntary. However, if requested information is not provided, FSA will not be considered.

1.NAME OF MEMBER (Last, First, Middle Initial)

2. GRADE

3. SOCIAL SECURITY NUMBER 4. BRANCH AND ORGANIZATION

PART I - MEMBER COMPLETES THIS SECTION TO SUBSTANTIATE ENTITLEMENT TO FSA

5.TYPE II (X as applicable)

FSA-T (Temporary)

FSA-R (Restricted)

FSA-S (Ship)

7.DATE (DDMMYY) DEPARTED RESIDENCE TO UNIT HOME STATION (Mobilized Members)

6. COMPLETE CURRENT ADDRESS(ES) OF DEPENDENT(S)

8. I CERTIFY TO THE FOLLOWING FACTS (X applicable box(es))

a. I am not divorced or legally separated from my spouse.

b. My dependent child (children) was (were) not in the legal custody of another person when I received my military orders.

c. My dependent (other than my spouse; see line f. below) is not a member of the military service on active duty.

d. My sole dependent is not in an institution for a known period of over 1 year or a period expected to exceed 1 year.

e.I am claiming FSA for my parent(s) for whom I have a current and approved dependency status and am residing with, and I maintain a residence(s) for my dependent(s). I have assumed the liability and responsibilities thereof at the address(es) shown above, where I likely reside during periods of leave or such other times as my duty assignment may permit.

f.I am married to another military member currently serving on active duty and my spouse before being separated by execution of my military orders.

was

was not residing with me immediately

Spouse's SSN:

g. My last TDY or deployment, if any,

was

Branch and Component:

was not within the last 30 days from this TDY or deployment.

9.I understand that I must notify my commanding officer immediately upon any change in dependency status and if my sole dependent or all of my dependents move to or near this station or if my dependent(s) visit at or near this station for more than 90 continuous days (more than 30 continuous days in the case of FSA-T (Temp) or FSA-S (Ship) while I am in receipt of FSA.

a.DATE (DDMMYY)

b. SIGNATURE OF MEMBER

PART II - CERTIFYING OFFICER COMPLETES THE APPROPRIATE SECTION(S) BELOW

10.TYPE II - FSA-T. Member has been ordered to and has performed temporary duty (TDY) at the location(s) shown below for more than 30 continuous days. This (these) location(s) is (are) outside a reasonable commuting distance from the member's permanent duty station (PDS pertains to active component) or the home of residence (HOR pertains to reserve component). A distance of 50 miles, one way, is normally considered to be within a reasonable commuting distance of a PDS or HOR. "Within a reasonable commuting distance" also may include distances of less than 50 miles and the time required to travel, under unusual conditions, does not exceed 1-1/2 hours. (Attach a blank page for continuation if necessary.)

a. LOCATION

b. INCLUSIVE DATES OF TDY/T (From/To)

c. NO. OF DAYS

11. TYPE II - FSA-R. Member departed (PCS/detached) from

 

 

 

 

 

 

on

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Last permanent duty station)

 

 

 

(DDMMYY)

and was on leave en route

, proceed time

 

 

 

 

 

 

(Inclusive leave dates - DDMMYY)

 

 

 

 

(Inclusive dates)

and the member reported to

 

on

 

. Transportation of

 

 

 

 

 

 

 

 

 

 

 

 

 

(PDS)

 

 

 

(DDMMYY)

 

 

 

 

dependent(s) is not authorized at government expense to this station or to a place near this station.

12.

TYPE II - FSA-S. Member was serving on orders, on board ship, away from homeport commencing (DDMMYY)

.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

a. NAME OF SHIP/UNIT

b. HOMEPORT

 

 

 

 

 

 

 

 

 

 

13.

Travel performed under authority of orders

 

, dated

.

 

 

 

 

 

 

 

 

14.Member claiming Type II FSA, is receiving basic allowance for housing (BAH) (or residing in government type quarters) as a member with dependents or member married to a military member.

15.DATE (DDMMYY)

16. CERTIFYING OFFICER

a. TYPED NAME (Last, First, Middle Initial)

b. TITLE

c. ORGANIZATION

d. SIGNATURE

DD FORM 1561, NOV 2006

PREVIOUS EDITION IS OBSOLETE

Adobe Professional 7.0

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dd form 1561 fillable pdf conclusion process detailed (portion 1)

2. After this section is filled out, go to enter the suitable information in all these - a LOCATION, b INCLUSIVE DATES OF TDYT FromTo, c NO OF DAYS, TYPE II FSAR Member departed, and was on leave en route, and the member reported to, Inclusive leave dates DDMMYY, proceed time, Inclusive dates, Transportation of, Last permanent duty station, DDMMYY, dependents is not authorized at, PDS, and DDMMYY.

b INCLUSIVE DATES OF TDYT FromTo, DDMMYY, and dependents is not authorized at inside dd form 1561 fillable pdf

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