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DD Form 2660 "Statement of Claimant Requesting Recertified Check"

What Is DD Form 2660?

DD Form 2660, Statement of Claimant Requesting Replacement Check is a form used by intended recipients of U.S. Treasury checks to request a substitution in cases when the checks are lost, stolen, destroyed or canceled due to limited payability. The current DD Form 2660 fillable version is available for digital filing and download below or can be found through the Executive Services Directorate website.

The information provided on the form will be used by Disbursing Offices to make the final decision on a case or cancel the original check and may be disclosed to the Department of Justice for law enforcement purposes (under 5 U.S.C. Section 552a of the Privacy Act).

The DD 2660 - sometimes incorrectly referred to as the DA Form 2660 - was released by the Department of Defense (DoD) in August 2015 with all previous editions obsolete.

How to Fill Out DD Form 2660?

The statement is made up of two pages with filing guidelines provided on the back of the form. DD Form 2660 instructions are as follows:

Box 1 requires the full name of the payee or the business name of the financial organization.
Box 2 is for the individual's SSN or business EIN
Box 3 requires the payee's phone number.
Box 4 is for the payee's e-mail address.
The account number to be credited should be entered in Box 5. The box is filed only if the payee is a financial organization
Box 6 requires the address the original check was mailed to.
A correct address is specified in Box 7 if different from the one provided in Box 6.
The information in Box 8 should describe the original purpose of the check.
The approximate date of check arrival should be in Box 9.
Box 10 is for providing a reason for the check to be replaced.
Box 11 should indicate whether the check was endorsed.
The payee has to provide their signature and date of filing and sign the form in Boxes 12 and 13.
A co-payee - if there was one - needs to provide their signature and mark the date of signing in Boxes 14 and 15.
Boxes 16 and 17 are for the Disbursing Office use only.

Download DD Form 2660 "Statement of Claimant Requesting Recertified Check"

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OMB No. 0730-0002

STATEMENT OF CLAIMANT REQUESTING REPLACEMENT CHECK

OMB approval expires

Mar 31, 2017

The public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and

maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including

suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Directives Division, 4800 Mark Center Drive, Alexandria, VA

22350-3100 (0730-0002). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it

does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN IT TO THE ADDRESS OF THE AGENCY WHO PROVIDED THIS FORM.

PRIVACY ACT STATEMENT

AUTHORITY: 5 U.S.C. 301, Departmental Regulations; Department of Defense Financial Management Regulation (DoDFMR) 7000.14-R, Volume 5;

31 U.S.C. Sections 3511, 3512, and 3513; and E.O. 9397 (SSN) (as amended).

PRINCIPAL PURPOSE(S): To be used by intended recipients of U.S. Treasury checks to request a replacement for a lost, stolen, destroyed, or

mutilated check, or one canceled due to limited payability. Disbursing Offices will use the information to make the determination to issue a replacement

check based on the information provided, and for canceling the original check. The information will also verify a proper mailing address for the claimant.

Applicable SORN: T7901 (http://dpcld.defense.gov/privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/6287/t7901.aspx).

STANFINS PIA (http://www.dfas.mil/foia/privacyimpactassessments.html).

ROUTINE USE(S): In addition to those disclosures generally permitted under 5 U.S.C. Section 552a of the Privacy Act, as amended, this information may

be disclosed to the Department of Justice of U.S. Treasury for law enforcement purposes. It may also be disclosed for any of the "Blanket Routine Uses"

as published in the Federal Register at the beginning of the DoD compilation of PA system notices.

(http://dpcld.defense.gov/privacy/SORNs/component/dfas/preamble.html)

DISCLOSURE: Disclosure is voluntary; however, failure to disclose the requested data may prevent issuance of a replacement check. The Social

Security Number is requested to verify the claimant and certify what happened to the original check issued by the government.

WARNING: Title 18, Sec 287, US Code: "Whoever makes or presents to any person or officer in the civil, military, or naval service of the United States,

or to any department or agency thereof, any claim upon or against the United States, or any department or agency thereof, knowing such claim to be

false, fictitious, or fraudulent, shall be imprisoned not more than five years and shall be subject to a fine in the amount provided in this title."

2. SSN/EIN

1. PAYEE (Show business name or financial organization, if applicable)

3. TELEPHONE NUMBER (Include area code)

4. E-MAIL ADDRESS

5. ACCOUNT TO BE CREDITED IF ITEM 1 IS A FINANCIAL ORGANIZATION

6. ADDRESS TO WHICH CHECK WAS MAILED (Include 9-digit ZIP Code)

7. CORRECT MAILING ADDRESS (If different from Item 6)

9. DATE DUE (Approximate)

8. PURPOSE FOR WHICH CHECK WAS ISSUED (X as applicable)

d. OTHER

a. REGULAR PAY

b. TRAVEL PAY

c. VENDOR PAY

(Specify)

11. WAS CHECK

10. CHECK WAS: (X as applicable)

ENDORSED? (X one)

(5) CANCELED (LIMITED

(1) LOST

(3) DESTROYED

b. RECEIVED,

a. NOT RECEIVED

PAYABILITY)

BUT:

(2) STOLEN

(4) MUTILATED

a. YES

b. NO

CERTIFICATION

I certify that I (we) have in no way benefitted from the proceeds of the above check, and do hereby request a replacement check be issued to me. I

further certify that if I recover the original check, I will not negotiate it but will immediately return it to the Disbursing Office. I fully understand that

negotiation of both the original and replacement check constitutes a fraudulent act against the United States Government and as such is subject to

punishment as provided by law. I further consent to immediate recoupment from future pay and allowances due me if I negotiate both the original and

replacement checks, including interest and administrative costs.

12. SIGNATURE OF PAYEE (Or payee representative)

13. DATE

14. SIGNATURE OF CO-PAYEE (If applicable)

15. DATE

FOR DISBURSING OFFICE USE

16. CHECK DATA

a. CHECK NUMBER

b. DATE OF CHECK

c. CHECK AMOUNT

d. ISSUING DSSN

e. VOUCHER NUMBER

17. DO REMARKS

DD FORM 2660, AUG 2015

PREVIOUS EDITION IS OBSOLETE.

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