DA Form 1106 Recommendation to Declare Army Emergency Relief Loan Uncollectible

DA Form 1106 - also known as the "Recommendation To Declare Army Emergency Relief Loan Uncollectible" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 1106 - was last revised on September 1, 2009. Download an up-to-date fillable PDF version of the DA 1106 down below or look it up on the Army Publishing Directorate website.

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RECOMMENDATION TO DECLARE ARMY EMERGENCY RELIEF LOAN UNCOLLECTIBLE
For use of this form, see AR 930-4; the proponent agency is OACSIM
PRINT IN BLACK INK, OR TYPE ALL INFORMATION
PART I - LOAN TO BE DECLARED UNCOLLECTIBLE
2. FROM: (AER Officer)(Include ZIP Code)
3. AER SECTION NO.
1. TO:
HQ, Army Emergency Relief
200 Stovall Street
Alexandria, VA 22332-0600
4. NAME OF BORROWER (Last, First, MI)
5. GRADE
6.CLIENT IDENIFICATION NUMBER
7. CURRENT ADDRESS (Include ZIP Code)
8. SOLDIER STATUS
ACTIVE
RETIRED
SEPARATED
9. DATE OF LOAN
10. AMOUNT OF LOAN
11. AMOUNT REPAID
$
$
12. DATE OF LAST PAYMENT
13. AMOUNT TO BE DECLARED UNCOLLECTIBLE
14. DATE OF LAST COLLECTION EFFORT
$
PART II - SECTION ACTION
15a. Recommend the above loan(s) be declared uncollectible on the basis that the borrower: (Check appropriate reason and enter date.)
DIED ON
WAS DISHONORABLY DISCHARGED ON
WAS DISCHARGED UNDER OTHER THAN HONORABLE CONDITIONS ON
WAS DROPPED FROM THE ROLLS AS A DESERTER ON
15b. SIGNATURE AND TITLE OF AER OFFICER/ASSISTANT AER OFFICER
15c. DATE
PART III - LEVEL 3 APPROVAL AUTHORITY ACTION
16a. THRU: (Level 3 Approval Authority)
16b. Recommend the above loan(s) be declared uncollectible on the basis of undue hardship on the soldier because:
16c. SIGNATURE AND TITLE OF LEVEL 3 APPROVAL AUTHORITY
16d. DATE
PART IV - HQ AER ACTION
17a. Recommended action is:
APPROVED
DISAPPROVED
UNCOLLECTIBLE NO.
17b. Declared uncollectible in the amount of $
on
(Date).
18. PROCESSED BY
19. REVIEWED AND APPROVED BY
DA FORM 1106, SEP 2009
APD LC v1.00
PREVIOUS EDITIONS ARE OBSOLETE.
RECOMMENDATION TO DECLARE ARMY EMERGENCY RELIEF LOAN UNCOLLECTIBLE
For use of this form, see AR 930-4; the proponent agency is OACSIM
PRINT IN BLACK INK, OR TYPE ALL INFORMATION
PART I - LOAN TO BE DECLARED UNCOLLECTIBLE
2. FROM: (AER Officer)(Include ZIP Code)
3. AER SECTION NO.
1. TO:
HQ, Army Emergency Relief
200 Stovall Street
Alexandria, VA 22332-0600
4. NAME OF BORROWER (Last, First, MI)
5. GRADE
6.CLIENT IDENIFICATION NUMBER
7. CURRENT ADDRESS (Include ZIP Code)
8. SOLDIER STATUS
ACTIVE
RETIRED
SEPARATED
9. DATE OF LOAN
10. AMOUNT OF LOAN
11. AMOUNT REPAID
$
$
12. DATE OF LAST PAYMENT
13. AMOUNT TO BE DECLARED UNCOLLECTIBLE
14. DATE OF LAST COLLECTION EFFORT
$
PART II - SECTION ACTION
15a. Recommend the above loan(s) be declared uncollectible on the basis that the borrower: (Check appropriate reason and enter date.)
DIED ON
WAS DISHONORABLY DISCHARGED ON
WAS DISCHARGED UNDER OTHER THAN HONORABLE CONDITIONS ON
WAS DROPPED FROM THE ROLLS AS A DESERTER ON
15b. SIGNATURE AND TITLE OF AER OFFICER/ASSISTANT AER OFFICER
15c. DATE
PART III - LEVEL 3 APPROVAL AUTHORITY ACTION
16a. THRU: (Level 3 Approval Authority)
16b. Recommend the above loan(s) be declared uncollectible on the basis of undue hardship on the soldier because:
16c. SIGNATURE AND TITLE OF LEVEL 3 APPROVAL AUTHORITY
16d. DATE
PART IV - HQ AER ACTION
17a. Recommended action is:
APPROVED
DISAPPROVED
UNCOLLECTIBLE NO.
17b. Declared uncollectible in the amount of $
on
(Date).
18. PROCESSED BY
19. REVIEWED AND APPROVED BY
DA FORM 1106, SEP 2009
APD LC v1.00
PREVIOUS EDITIONS ARE OBSOLETE.

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