DA Form 3715 Us Army Nonappropriated Funds - Disposition of Retirement Benefits

DA Form 3715 - also known as the "Us Army Nonappropriated Funds - Disposition Of Retirement Benefits" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 3715 - was last revised on January 1, 2002. Download an up-to-date fillable PDF version of the DA 3715 down below or look it up on the Army Publishing Directorate website.

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US ARMY NONAPPROPRIATED FUNDS - DISPOSITION OF RETIREMENT BENEFITS
For use of this form, see AR 215-3; the proponent agency is DCS, G1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Internal Revenue Service Code, Section 401(a).
AUTHORITY:
The information you provide is for the purpose of preparing a refund of contribution or to process a retirement annuity.
PRINCIPAL PURPOSE:
For terminating employees, the information is used to prepare a refund or a deferred annuity as requested. For retiring
ROUTINE USES:
employees, the information is used to process a monthly annuity payment thereafter. For survivors, the information is
used to process survivor benefits.
Disclosure of your social security number and primary insurance amount is voluntary. Disclosure of other personal
DISCLOSURE:
information is voluntary, however, failure to provide this information within one year of termination of employment
will result in automatic refund of contributions and denial of annuity.
SECTION I - GENERAL INFORMATION
1. EMPLOYEE'S NAME (Last, first, MI)
2. SOCIAL SECURITY NUMBER 3. DATE OF BIRTH (YYYYMMDD)
4a. COMPLETE MAILING ADDRESS
4b. E-MAIL ADDRESS
5a. AREA CODE/TELEPHONE NUMBER
5b. FAX TELEPHONE NUMBER
6. SERVICE COMPUTATION DATE (YYYYMMDD)
7. DATE OF SEPARATION AND REASON (YYYYMMDD)
8. ACCUMULATED SICK LEAVE HOURS
9. EMPLOYING NAF:
10. STANDARD NAF NUMBER
11. MARITAL STATUS
12. NAME OF LEGAL SPOUSE (Last, First, MI)
NOT MARRIED
MARRIED
13. SOCIAL SECURITY NUMBER OF LEGAL SPOUSE
14. DATE OF BIRTH OF LEGAL SPOUSE
15. DATE OF MARRIAGE (YYYYMMDD)
(YYYYMMDD)
The date of marriage has been verified by satisfactory evidence and the benefit authorized. A certified copy of the Death Certificate and Statement of
Survivor's Social Security Entitlements are attached.
Annuity Benefits resulting from the death of the employee are payable in accordance with the Army NAF Retirement Plan.
SECTION II - RETIREMENT FUND OPTIONS
16. CHECK ONE:
In accordance with AR 215-3
(
)
I request a refund of my contributions and accumulated interest in full satisfaction of all annuity payable.
(
I request my contributions remain in deposit for a maximum of 5 years.
)
(
)
I request an immediate Annuity (Normal or Early Retirement)
(
)
I request a Deferred Annuity payable at age 62.
(
)
I request Disability Retirement.
(
)
I request Disability Retirement due to work related injury.
(
)
I request Survivor Benefits.
SECTION III - EMPLOYEE'S OR SURVIVOR SIGNATURE
17. SIGNATURE OF EMPLOYEE/SURVIVOR
18. DATE (YYYYMMDD)
SECTION IV - VERIFICATION AND CPU MAILING ADDRESS AND SIGNATURE
19. The above information has been verified from the employee's personnel records and DA Form 3473 coded 04 is attached.
a. CPU SIGNATURE
b. DATE (YYYYMMDD)
c. MAILING ADDRESS
d. E-MAIL ADDRESS
DO NOT USE - FOR OFFICIAL USE ONLY
20. DATE RECEIVED (YYYYMMDD)
21. DATE PROCESSED (YYYYMMDD)
22. PROCESSED BY
DA FORM 3715, JAN 2002
EDITION OF NOV 85 IS OBSOLETE.
APD LC v1.01ES
US ARMY NONAPPROPRIATED FUNDS - DISPOSITION OF RETIREMENT BENEFITS
For use of this form, see AR 215-3; the proponent agency is DCS, G1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Internal Revenue Service Code, Section 401(a).
AUTHORITY:
The information you provide is for the purpose of preparing a refund of contribution or to process a retirement annuity.
PRINCIPAL PURPOSE:
For terminating employees, the information is used to prepare a refund or a deferred annuity as requested. For retiring
ROUTINE USES:
employees, the information is used to process a monthly annuity payment thereafter. For survivors, the information is
used to process survivor benefits.
Disclosure of your social security number and primary insurance amount is voluntary. Disclosure of other personal
DISCLOSURE:
information is voluntary, however, failure to provide this information within one year of termination of employment
will result in automatic refund of contributions and denial of annuity.
SECTION I - GENERAL INFORMATION
1. EMPLOYEE'S NAME (Last, first, MI)
2. SOCIAL SECURITY NUMBER 3. DATE OF BIRTH (YYYYMMDD)
4a. COMPLETE MAILING ADDRESS
4b. E-MAIL ADDRESS
5a. AREA CODE/TELEPHONE NUMBER
5b. FAX TELEPHONE NUMBER
6. SERVICE COMPUTATION DATE (YYYYMMDD)
7. DATE OF SEPARATION AND REASON (YYYYMMDD)
8. ACCUMULATED SICK LEAVE HOURS
9. EMPLOYING NAF:
10. STANDARD NAF NUMBER
11. MARITAL STATUS
12. NAME OF LEGAL SPOUSE (Last, First, MI)
NOT MARRIED
MARRIED
13. SOCIAL SECURITY NUMBER OF LEGAL SPOUSE
14. DATE OF BIRTH OF LEGAL SPOUSE
15. DATE OF MARRIAGE (YYYYMMDD)
(YYYYMMDD)
The date of marriage has been verified by satisfactory evidence and the benefit authorized. A certified copy of the Death Certificate and Statement of
Survivor's Social Security Entitlements are attached.
Annuity Benefits resulting from the death of the employee are payable in accordance with the Army NAF Retirement Plan.
SECTION II - RETIREMENT FUND OPTIONS
16. CHECK ONE:
In accordance with AR 215-3
(
)
I request a refund of my contributions and accumulated interest in full satisfaction of all annuity payable.
(
I request my contributions remain in deposit for a maximum of 5 years.
)
(
)
I request an immediate Annuity (Normal or Early Retirement)
(
)
I request a Deferred Annuity payable at age 62.
(
)
I request Disability Retirement.
(
)
I request Disability Retirement due to work related injury.
(
)
I request Survivor Benefits.
SECTION III - EMPLOYEE'S OR SURVIVOR SIGNATURE
17. SIGNATURE OF EMPLOYEE/SURVIVOR
18. DATE (YYYYMMDD)
SECTION IV - VERIFICATION AND CPU MAILING ADDRESS AND SIGNATURE
19. The above information has been verified from the employee's personnel records and DA Form 3473 coded 04 is attached.
a. CPU SIGNATURE
b. DATE (YYYYMMDD)
c. MAILING ADDRESS
d. E-MAIL ADDRESS
DO NOT USE - FOR OFFICIAL USE ONLY
20. DATE RECEIVED (YYYYMMDD)
21. DATE PROCESSED (YYYYMMDD)
22. PROCESSED BY
DA FORM 3715, JAN 2002
EDITION OF NOV 85 IS OBSOLETE.
APD LC v1.01ES

Download DA Form 3715 Us Army Nonappropriated Funds - Disposition of Retirement Benefits

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