DEPENDENCY STATEMENT - WARD OF A COURT
OMB No. 0730-0014
OMB approval expires
May 31, 2021
PRIVACY ACT STATEMENT
INSTRUCTIONS: This form is used to determine Basic Allowance for Housing (BAH), travel allowances, and/or Uniformed Services Identification
and Privilege (USIP) card benefits for wards of a court. The member must complete the form as stated in Item 3, sign and date the form, and
have it notarized. Answer every question. If any question does not apply, write "NOT APPLICABLE" or "N/A" in that block. Report and verify any
income in gross amounts. Verification of income, proof of support and a copy of guardianship documents are required. In the case of a ward who is
a full-time student, supporting documentation must include a letter from the accredited college or university verifying the ward's full- time enrollment,
documentation of expenses, and any educational assistance that ward may receive. If the ward is incapacitated and over the age of 21, a
medical sufficiency statement from a military medical treatment facility is required.
1. ENTITLEMENTS REQUESTED (X and complete as applicable)
b. FIRST APPLICATION?
YES (If "NO," give date of last application)
c. LAST APPLICATION WAS
2. MEMBER INFORMATION
a. NAME (Last, First, Middle Initial) b. DoD ID NUMBER c. RANK
d. STATUS (X and complete as applicable)
DECEASED (Date of death) (YYYYMMDD)
e. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)
f. COMPLETE MILITARY ADDRESS (Include assignment: squadron and base)
g. TELEPHONE NUMBERS (Include DSN or Area Code)
(1) WORK (2) HOME
i. MARITAL STATUS (X)
3. WARD INFORMATION
a. NAME (Last, First, Middle Initial) b. DoD ID NUMBER c. DATE OF BIRTH
d. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)
e. STATUS (X and complete as applicable)
UNMARRIED UNDER 21 YEARS OF AGE (Complete Items 1 - 8 and 13 - 16.)
21-22 YEARS OF AGE AND A FULL-TIME STUDENT (Complete Items 1 - 9 and 12 - 16.)
INCAPACITATED OVER AGE 21 (Complete Items 1 - 8 and 10 - 16.)
HAS WARD EVER BEEN MARRIED? (If "Yes," attach copy of annulment decree, final divorce decree, or death certificate of ward's spouse.)
DD FORM 137-7, MAR 2018
PREVIOUS EDITION IS OBSOLETE.
h. E-MAIL ADDRESS
The public reporting burden for this collection of information, 0730-0014, is estimated to average 30-60 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 the burden estimate or burden reduction suggestions to
the Department of Defense, Washington Headquarters Services, at email@example.com. 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.
RETURN COMPLETED FORM TO YOUR LOCAL SERVING PERSONNEL/PAYROLL OFFICE.
Page 1 of 5 Pages
Adobe Professional X
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 37 U.S.C., Pay and Allowances of the Uniformed Services; DoD Directive 5154.29, DoD
Pay and Allowances Policy and Procedures; DoD 7000.14-R, DoD Financial Management Manual, Volume 7A, Military Pay Policy and Procedures –
Active Duty and Reserve Pay; and Joint Travel Regulations (JTR) current edition.
PURPOSE(S): The information will be used to determine the relationship and dependency of the claimed dependents and determine the member's
entitlement of authorized benefits.
ROUTINE USE(S): To the Treasury Department to provide information on check issues and electronic funds transfers. To Federal, state, and local
governmental agencies in response to an official request for information with respect to law enforcement, investigatory procedures, criminal
prosecution, civil court action and regulatory order. Additional routine uses can be found within the applicable system of records notices, T7344,
Defense Joint Military Pay System-Reserve Component; T7340, Defense Joint Military Pay System-Active Component; and M01040-3, Marine Corps
Manpower Management Information System Records, located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary: however, failure to provide this information will result in a suspension of the dependent entitlements until the member can
provide the required certificate.