DD Form 2903-2 "Voluntary Separation Incentive Pay Agreement BI-Weekly Installment Payment"

What Is DD Form 2903-2?

This is a form that was released by the U.S. Department of Defense (DoD) on October 1, 2005. The form, often mistakenly referred to as the DA Form 2903-2, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DoD.

Form Details:

  • A 1-page document available for download in PDF;
  • The latest version available from the Executive Services Directorate;
  • Editable, printable, and free to use;

Download an up-to-date fillable DD Form 2903-2 down below in PDF format or browse hundreds of other DoD Forms compiled in our online library.

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Download DD Form 2903-2 "Voluntary Separation Incentive Pay Agreement BI-Weekly Installment Payment"

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VOLUNTARY SEPARATION INCENTIVE PAY AGREEMENT
BI-WEEKLY INSTALLMENT PAYMENT
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 9902(i), DoDD 1400.25, DoD 1400.25-M, Subchapter 1702, "Voluntary Separation Programs".
PRINCIPAL PURPOSE(S): This form serves as an agreement between a DoD employee and the Department of
Defense when Voluntary Separation Incentive Pay (VSIP) has been approved. The agreement certifies the employee
has been counseled and freely agrees to and fully understands the conditions and terms of the VSIP.
ROUTINE USE(S): None.
DISCLOSURE: Voluntary; however, failure to provide required information may result in denial of the VSIP.
1. Title 5, United States Code s 9902(i) authorizes the Secretary of Defense to establish a program to pay a Voluntary
s
Separation Incentive Payment (VSIP) or buyout to eligible employees. This is to certify that my application for the
buyout is voluntary and the effective date of my separation shall be
. I understand that my
request for the personnel action and the payment terms are irrevocable.
2. I understand that an employee who receives a buyout, and accepts employment with the Government of the United
States (including employment in nonappropriated fund instrumentalities or with an agency of the United States through a
personal services contract with the United States) within 5 years after the date of separation on which payment of the
buyout is based, shall be required to repay the entire amount of the buyout (before taxes and deductions) to the Federal
agency that paid the buyout. I also understand that a DoD employee who receives a buyout is prohibited from
registering in the DoD Priority Placement Program and may not be reemployed by the Department of Defense in any
capacity for a 12-month period.
a. NAME
b. SSN
(Last, First, Middle Initial)
3.a. TOTAL BUYOUT AMOUNT
b. PAYMENT TERM
c. INITIALS
S
Equal bi-weekly payments of $
until my
buyout is paid in full. Buyout payment must be completed
$
within 1 year.
4. This is to certify that I have been counseled by the Human Resources Office (HRO) and that I freely agree to and
fully understand the conditions and terms of the buyout.
a. EMPLOYEE SIGNATURE
b. DATE
(YYYYMMDD)
c. HRO REPRESENTATIVE SIGNATURE
b. DATE
(YYYYMMDD)
DD FORM 2903-2, OCT 2005
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VOLUNTARY SEPARATION INCENTIVE PAY AGREEMENT
BI-WEEKLY INSTALLMENT PAYMENT
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 9902(i), DoDD 1400.25, DoD 1400.25-M, Subchapter 1702, "Voluntary Separation Programs".
PRINCIPAL PURPOSE(S): This form serves as an agreement between a DoD employee and the Department of
Defense when Voluntary Separation Incentive Pay (VSIP) has been approved. The agreement certifies the employee
has been counseled and freely agrees to and fully understands the conditions and terms of the VSIP.
ROUTINE USE(S): None.
DISCLOSURE: Voluntary; however, failure to provide required information may result in denial of the VSIP.
1. Title 5, United States Code s 9902(i) authorizes the Secretary of Defense to establish a program to pay a Voluntary
s
Separation Incentive Payment (VSIP) or buyout to eligible employees. This is to certify that my application for the
buyout is voluntary and the effective date of my separation shall be
. I understand that my
request for the personnel action and the payment terms are irrevocable.
2. I understand that an employee who receives a buyout, and accepts employment with the Government of the United
States (including employment in nonappropriated fund instrumentalities or with an agency of the United States through a
personal services contract with the United States) within 5 years after the date of separation on which payment of the
buyout is based, shall be required to repay the entire amount of the buyout (before taxes and deductions) to the Federal
agency that paid the buyout. I also understand that a DoD employee who receives a buyout is prohibited from
registering in the DoD Priority Placement Program and may not be reemployed by the Department of Defense in any
capacity for a 12-month period.
a. NAME
b. SSN
(Last, First, Middle Initial)
3.a. TOTAL BUYOUT AMOUNT
b. PAYMENT TERM
c. INITIALS
S
Equal bi-weekly payments of $
until my
buyout is paid in full. Buyout payment must be completed
$
within 1 year.
4. This is to certify that I have been counseled by the Human Resources Office (HRO) and that I freely agree to and
fully understand the conditions and terms of the buyout.
a. EMPLOYEE SIGNATURE
b. DATE
(YYYYMMDD)
c. HRO REPRESENTATIVE SIGNATURE
b. DATE
(YYYYMMDD)
DD FORM 2903-2, OCT 2005
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