Fillable JUNIOR RESERVE OFFICER TRAINING CORPS (JROTC) INSTRUCTOR PAY

Fill Online, Printable, Fillable, Blank JUNIOR RESERVE OFFICER TRAINING CORPS (JROTC) INSTRUCTOR PAY Form

Use Fill to complete blank online OTHERS pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

JUNIOR RESERVE OFFICER TRAINING CORPS (JROTC) INSTRUCTOR PAY

On average this form takes 19 minutes to complete

The JUNIOR RESERVE OFFICER TRAINING CORPS (JROTC) INSTRUCTOR PAY form is 2 pages long and contains:

  • 0 signatures
  • 3 check-boxes
  • 76 other fields

Country of origin: OTHERS
File type: PDF

BROWSE OTHERS FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
JUNIOR RESERVE OFFICER TRAINING CORPS (JROTC) INSTRUCTOR
PAY CERTIFICATION WORKSHEET FOR ENTITLEMENT COMPUTATION
PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. Section 2031; 37 U.S.C. 403 and 405; DoDI 1205.13, Junior Reserve Officer Training Corps (JROTC) Program;
DoDFMR 7000.14-R, Vol. 10, Chapter 21; and E.O. 9397.
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): In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information
contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: The DoD "Blanket
Routine Uses" published at the beginning of the DoD compilation of systems of records notices apply.
DISCLOSURE: Disclosure of this information is 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. SSN 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, SEP 2007
Adobe Professional 7.0
PREVIOUS EDITION IS OBSOLETE.
3. SSN
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)
Reset
VERIFICATION OF GOVERNMENT/EMPLOYER PROVIDED QUARTERS ASSIGNED
1. Letter from housing office if assigned to active duty spouse, or
2. Certification letter from school.
DD FORM 2754 (BACK), SEP 2007
15. IF CLAIMING DEPENDENT CHILD(REN)
a. WHO HAS CUSTODY OF CHILD(REN)?
INSTRUCTOR
FORMER SPOUSE
OTHER
(1) SSN
b. IF IN CUSTODY OF FORMER SPOUSE, AND FORMER SPOUSE IS ACTIVE DUTY OR INSTRUCTOR:
(2) DUTY LOCATION
c. DATE OF BIRTH OF YOUNGEST CHILD
CLAIMED AS A DEPENDENT (YYYYMMDD)
d. IF YOU DO NOT HAVE CUSTODY, DO YOU PAY CHILD SUPPORT?
YES
NO
IF "YES", INDICATE MONTHLY AMOUNT PAID
$
SUPPORTING DOCUMENTATION REQUIRED FOR ORIGINAL CERTIFICATION OF BAH
CERTIFICATION OF DEPENDENT(S)
1. Spouse - copy of marriage certificate with seal.
2. Child(ren) - copy of birth certificate with seal.
3. Child(ren) not in instructor's custody - divorce decree, legal separation agreement, court order.
SECONDARY DEPENDENT(S)
1. Parent(s) or parent(s)-in-law - court order of guardianship.
2. Ward - Court order of guardianship.
3. Student (age 21 - 22 in school) - letter from learning instutution verifying full time enrollment.
4. Handicapped child over age 21 - medical sufficiency statement.
PART B
SECTION I - OHA (Applies to Overseas Locations Only)
16. ACCOMPANIED (X one)
YES NO
17a. SHARER (X one)
YES NO
b. IF YES, NUMBER OF SHARERS
18a. RENTER STATUS (X one)
RENT
OWN
OTHER
b. IF RENTING, PROVIDE RENTAL/LEASE DATES:
(1) FROM (YYYYMMDD)
19a. MONTHLY RENT/MORTGAGE PAYMENT b. TAXES/INSURANCE AMOUNT (If not included in monthly mortgage
payment)
c. CURRENCY TYPE
20a. UTILITIES INCLUDED IN MONTHLY
RENT (X one)
YES NO
b. IF "NO", LIST MONTHLY AMOUNT(S) BELOW:
(1) WATER
(2) TRASH REMOVAL (3) ELECTRIC (4) GAS
21. DUTY LOCATION (City and Country)
SUPPORTING DOCUMENTATION REQUIRED FOR OHA (Original Certification and Recertification)
1. Copy of rental lease, or proof of mortgage payment amount (copy of payment coupon).
2. Evidence of real estate taxes, and homeowner insurance costs, if not included in mortgage payment if renter status in 18.a. is marked "Own".
SECTION II - COLA (Applies to Overseas Locations, Alaska and Hawaii Only)
22. NUMBER OF DEPENDENTS RESIDING
WITH INSTRUCTOR
23. JTR LOCATION (To be filled out by pay technician)
I certify that the information provided is true and correct. Entitlements will not be included in the applicable pay computation without this verification
and certification of eligibility.
SIGNATURE OF INSTRUCTOR DATE SIGNED
CERTIFICATION
14. DEPENDENT RELATIONSHIP (Enter one of the following codes)
NOTE: If code selected is B, complete all of Item 15. If code C, K. S, T, or W, complete 15c. only. If code A, D, I, L, or R, do not complete Item
15.
WITHOUT DEPENDENT(S)
I - Instructor married to
instructor
R - Own right (single)
WITH DEPENDENT OTHER THAN CHILD(REN)
A - Spouse
D - Parent (including "In Loco Parentis"
which is a person who stood in place
of the natural parents)
L - Parent(s)-in-law
WITH DEPENDENT CHILD(REN)
B - Child in legal custody of
someone other than instructor
C - Child in instructor's custody
K - Ward
S - Student (age 21 - 22)
T - Handicapped child
(over age 21)
W - Instructor married
to instructor with
dependent child(ren)
(2) TO (YYYYMMDD)
Reset
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

JUNIOR RESERVE OFFICER TRAINING CORPS (JROTC) INSTRUCTOR PAY

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 10 May 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document