JUNIOR RESERVE OFFICER TRAINING CORPS (JROTC) INSTRUCTOR
PAY CERTIFICATION WORKSHEET FOR ENTITLEMENT COMPUTATION
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 2031, as amended, Junior Reserve Officers' Training Corps, Reserve Officers' Training Corps Program for Secondary
Educational Institutions; 37 U.S.C. 403, Basic allowance for housing; 37 U.S.C. 405, Travel and Transportation Allowances; DoDI 1205.13, Junior
Reserve Officer Training Corps (JROTC) Program; and DoDFMR 7000.14-R, Vol. 10, Chapter 21, JUNIOR RESERVE OFFICER TRAINING CORPS
(JROTC) INSTRUCTOR PAY.
PRINCIPAL PURPOSE: To obtain data used to determine Junior ROTC Instructor corresponding active duty entitlements. These entitlement
amounts will be used in the computation of the amount to be reimbursed to the school district on behalf of that instructor.
ROUTINE USE(S): To the Treasury Department to provide information on check issues and electronic funds transfers; Internal Revenue Service to
report taxable earnings and taxes withheld; Federal. State and local agencies to conduct computer matching programs; Social Security Administration
to report earned wages. 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 the requested information may impede, delay, or reduce the amount of BAH, OHA, and COLA
to be used in the reimbursement computation.
INSTRUCTIONS
This form will be used to certify Basic Allowance for Housing (BAH), Overseas Housing Allowance (OHA), and Cost of Living Allowance (COLA).
Part A must be completed by instructors employed within CONUS; Part A, and Section II of Part B must be completed by instructors in Alaska and
Hawaii; Part A, and all of Part B must be completed by instructors employed overseas. Specific instructions are provided for several items.
Supporting documentation required to be submitted with this form by each instructor is listed for each section.
PART A
BAH (Applies to CONUS and Overseas Locations)
1. NAME (Last, First, Middle Initial) 2. RETIRED GRADE
4. BRANCH OF SERVICE RETIRED FROM
ARMY NAVY
AIR FORCE MARINES
5. CURRENT ADDRESS OF INSTRUCTOR
a. STREET (Include apartment or suite number) b. CITY c. STATE d. ZIP CODE
6. EMPLOYING SCHOOL INFORMATION
a. NAME AND ADDRESS OF SCHOOL (Include ZIP Code) b. NAME AND ADDRESS OF SCHOOL DISTRICT (Include ZIP Code)
c. SCHOOL (UNIT) IDENTIFICATION
(1) TELEPHONE NUMBER (Include Area
Code)
7. MARITAL STATUS (X one)
(If not married, go to Item 9)
MARRIED DIVORCED
SINGLE SEPARATED
8. STATUS OF SPOUSE (X one) (If Spouse is Active Duty or JROTC
Instructor, complete Items 8 and 9.)
NON-MILITARY ACTIVE DUTY MEMBER
OTHER FEDERAL SERVICE INSTRUCTOR (Junior ROTC Program)
9. IF SPOUSE IS ACTIVE DUTY OR INSTRUCTOR
a. DoD ID NUMBER b. BRANCH OF SERVICE c. DUTY LOCATION
YES NO
10a. RESIDING IN GOVERNMENT/EMPLOYER PROVIDED QUARTERS (X one) b. IF YES, DO EITHER YOU OR YOUR SPOUSE PAY RENT?
YES NO
YES NO
11. IF NOT MARRIED, DO YOU HAVE DEPENDENTS?
(X one)
RESIDING WITH INSTRUCTOR (Go to Item 14)
NOT RESIDING WITH INSTRUCTOR (Complete Item 13)
12. DEPENDENT STATUS (X one)
13. DEPENDENT(S) ADDRESS (If not residing with instructor)
a. STREET (Include apartment or suite number) b. CITY c. STATE d. ZIP CODE
DD FORM 2754, DEC 2017
Adobe Professional 7.0
PREVIOUS EDITION IS OBSOLETE.
3. DoD ID NUMBER
COAST
GUARD
e. DAYTIME TELEPHONE NO.
(Include Area Code)
(2) FAX NUMBER (Include Area Code) (1) TELEPHONE NUMBER (Include Area
Code)
(2) FAX NUMBER (Include Area Code)
