DA Form 5435-1 Statement of Understanding - the Selected Reserve Montgomery Gi Bill Kicker Program (10 Usc 16131)

DA Form 5435-1 - also known as the "Statement Of Understanding - The Selected Reserve Montgomery Gi Bill Kicker Program (10 Usc 16131)" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 5435-1 - was last revised on February 1, 2016. Download an up-to-date fillable PDF version of the DA 5435-1 down below or look it up on the Army Publishing Directorate website.

ADVERTISEMENT
STATEMENT OF UNDERSTANDING - THE SELECTED RESERVE MONTGOMERY GI BILL
KICKER PROGRAM (10 USC 16131)
For use of this form, see AR 621-202; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, USC 3013, Secretary of the Army: AR 621-202, Education, Army Educational Incentives and Entitlements
AUTHORITY:
and Student Loan Repayments Program Records: and E.O. 9397, as amended.
To explain obligation and eligibility requirements for entitlement under the Selected Reserve (SELRES)
PRINCIPAL PURPOSE:
Montgomery GI Bill (10 USC 16131) and to ensure that your understanding of these conditions is a matter of
record. To determine Servicemember's qualification for selective reenlistment bonuses.
ROUTINE USES:
In addition to those disclosures generally permitted under 5 USC 552 of the Privacy Act of 1974, these records
contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 USC 552(a)(7),
(b)(3), (e)(3)(c), and (e)(4)(d). DoD "Blanket Routine Uses" set forth at the beginning of the Army's compilation of
systems of records notices also apply to this system. The Department of Veterans Affairs provides payroll
information for members who participated in making contributions to the Veterans Education Assistance Program
(VEAP), and the Montgomery GI Bill (MGIB) Program.
Disclosure of your SSN is voluntary, however, if not provided, could result in misplacement of records.
DISCLOSURE:
SECTION l - APPLICABILITY
This statement of Understanding will be completed by all eligible persons enlisting in the SELRES of the Army (ARNG or USAR) for the
incentive under the Montgomery GI Bill-Selected Reserve (MGIB-SR) Kicker Program.
SECTION ll - INSTRUCTIONS
The service representative is responsible for reading and explaining the MGIB-SR Kicker requirements outlined on this form. Following the
reading, explanation, and affixing of proper signatures, a copy of this form will be stapled to each copy of the DD Form 1966, for ARNG and for
USAR personnel.
SECTION lll - ACKNOWLEDGMENT
, for entitlement to the MGIB-SR Kicker, I hereby acknowledge that I meet
In connection with my enlistment/reenlistment in the
)
(ARNG or USAR
the following eligibility criteria (The applicant will initial the applicable paragraphs):
ENLISTED SOLDIERS:
1.
I am enlisting/reenlisting in the ARNG/USAR with assignment to a unit of the SELRES for a minimum of 6 years.
Incentive entitlement is based on-
a. Assignment to a high-priority unit authorized by HQDA for the MGIB-SR Kicker.
(Enter complete unit identification and UIC)
b. Assignment to a unit (not high-priority) authorized by HQDA for the MGIB-SR Kicker in a MOS that is authorized by
HQDA for the MGIB-SR Kicker.
(Enter MOS and complete unit identification and UIC)
2.
I am a secondary school diploma graduate, or I am currently attending high school and expect to graduate before I enter
the second phase of initial active duty for training (IADT) under the split-training option.
3.
a. I have scored 31 or higher on the Armed Forces Qualification Test (AFQT).
b. I have scored 50 or higher on the AFQT for membership in the ARNGUS.
4.
I have completed IADT or I will complete the second phase of IADT prior to becoming eligible for the MGIB-SR Kicker
incentive.
5.
I meet the eligibility requirements to receive basic MGIB or MGIB-SR benefits or I will be eligible upon completion of IADT.
COMMISSIONED OFFICERS/CANDIDATES:
6.
I am a lieutenant eligible for MGIB or MGIB-SR basic benefits and do not have a baccalaureate degree. I have signed a
DA Form 5447 (Officer Service Agreement) to serve in the
(USAR/ARNGUS) for 6 years.
7.
I am a lieutenant and will become eligible for MGIB or MGIB-SR basic benefits after I complete the Officer Basic Course. I
will become eligible for the MGIB-SR Kicker incentives at the same time. I have signed a DA Form 5447 to serve in the
(USAR/ARNGUS) for 6 years.
8.
I am eligible for the MGIB or MGIB-SR basic benefits and completed the Federal Officer Candidate School (OCS) Program
on or after 1 October 1999. I have signed a DA Form 5447 to serve in the
(USAR/ARNGUS) for 6 years.
9.
I am eligible for the MGIB or MGIB-SR basic benefits and qualify to participate in a State OCS Program currently in
phase II or III (completed the first annual training period) and have agreed to reenlist/extend my current enlistment to serve not less than
6 years in the
(USAR/ARNGUS).
NAME
SSN
DA FORM 5435-1, FEB 2016
Page 1 of 4
APD LC v1.00ES
STATEMENT OF UNDERSTANDING - THE SELECTED RESERVE MONTGOMERY GI BILL
KICKER PROGRAM (10 USC 16131)
For use of this form, see AR 621-202; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, USC 3013, Secretary of the Army: AR 621-202, Education, Army Educational Incentives and Entitlements
AUTHORITY:
and Student Loan Repayments Program Records: and E.O. 9397, as amended.
To explain obligation and eligibility requirements for entitlement under the Selected Reserve (SELRES)
PRINCIPAL PURPOSE:
Montgomery GI Bill (10 USC 16131) and to ensure that your understanding of these conditions is a matter of
record. To determine Servicemember's qualification for selective reenlistment bonuses.
ROUTINE USES:
In addition to those disclosures generally permitted under 5 USC 552 of the Privacy Act of 1974, these records
contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 USC 552(a)(7),
(b)(3), (e)(3)(c), and (e)(4)(d). DoD "Blanket Routine Uses" set forth at the beginning of the Army's compilation of
systems of records notices also apply to this system. The Department of Veterans Affairs provides payroll
information for members who participated in making contributions to the Veterans Education Assistance Program
(VEAP), and the Montgomery GI Bill (MGIB) Program.
Disclosure of your SSN is voluntary, however, if not provided, could result in misplacement of records.
DISCLOSURE:
SECTION l - APPLICABILITY
This statement of Understanding will be completed by all eligible persons enlisting in the SELRES of the Army (ARNG or USAR) for the
incentive under the Montgomery GI Bill-Selected Reserve (MGIB-SR) Kicker Program.
SECTION ll - INSTRUCTIONS
The service representative is responsible for reading and explaining the MGIB-SR Kicker requirements outlined on this form. Following the
reading, explanation, and affixing of proper signatures, a copy of this form will be stapled to each copy of the DD Form 1966, for ARNG and for
USAR personnel.
SECTION lll - ACKNOWLEDGMENT
, for entitlement to the MGIB-SR Kicker, I hereby acknowledge that I meet
In connection with my enlistment/reenlistment in the
)
(ARNG or USAR
the following eligibility criteria (The applicant will initial the applicable paragraphs):
ENLISTED SOLDIERS:
1.
I am enlisting/reenlisting in the ARNG/USAR with assignment to a unit of the SELRES for a minimum of 6 years.
Incentive entitlement is based on-
a. Assignment to a high-priority unit authorized by HQDA for the MGIB-SR Kicker.
(Enter complete unit identification and UIC)
b. Assignment to a unit (not high-priority) authorized by HQDA for the MGIB-SR Kicker in a MOS that is authorized by
HQDA for the MGIB-SR Kicker.
(Enter MOS and complete unit identification and UIC)
2.
I am a secondary school diploma graduate, or I am currently attending high school and expect to graduate before I enter
the second phase of initial active duty for training (IADT) under the split-training option.
3.
a. I have scored 31 or higher on the Armed Forces Qualification Test (AFQT).
b. I have scored 50 or higher on the AFQT for membership in the ARNGUS.
4.
I have completed IADT or I will complete the second phase of IADT prior to becoming eligible for the MGIB-SR Kicker
incentive.
5.
I meet the eligibility requirements to receive basic MGIB or MGIB-SR benefits or I will be eligible upon completion of IADT.
COMMISSIONED OFFICERS/CANDIDATES:
6.
I am a lieutenant eligible for MGIB or MGIB-SR basic benefits and do not have a baccalaureate degree. I have signed a
DA Form 5447 (Officer Service Agreement) to serve in the
(USAR/ARNGUS) for 6 years.
7.
I am a lieutenant and will become eligible for MGIB or MGIB-SR basic benefits after I complete the Officer Basic Course. I
will become eligible for the MGIB-SR Kicker incentives at the same time. I have signed a DA Form 5447 to serve in the
(USAR/ARNGUS) for 6 years.
8.
I am eligible for the MGIB or MGIB-SR basic benefits and completed the Federal Officer Candidate School (OCS) Program
on or after 1 October 1999. I have signed a DA Form 5447 to serve in the
(USAR/ARNGUS) for 6 years.
9.
I am eligible for the MGIB or MGIB-SR basic benefits and qualify to participate in a State OCS Program currently in
phase II or III (completed the first annual training period) and have agreed to reenlist/extend my current enlistment to serve not less than
6 years in the
(USAR/ARNGUS).
NAME
SSN
DA FORM 5435-1, FEB 2016
Page 1 of 4
APD LC v1.00ES
SECTION III - ACKNOWLEDGMENT (Continued)
10.
I am eligible for the MGIB or MGIB-SR basic benefits and contracted as an ROTC Simultaneous Membership Program
(SMP cadet as a MS II, III or IV) and have agreed to reenlist/extend my current enlistment to serve not less than 6 years in the
(USAR/ARNGUS).
WARRANT OFFICERS:
11.
I am eligible for the MGIB or MGIB-SR basic benefits and completed the Warrant Officer Basic Course on or after 1
October 1999. I have signed DA Form 5447 to serve in the
(USAR/ARNGUS) for 6 years.
SECTION IV - OBLIGATION
1.
I am enlisting to serve 6 years in a SELRES unit in an authorized HQDA unit or MOS, unless excused for the convenience
of the Government to include normal career progression.
2.
I have signed DA Form 5447 to serve in the
USAR/ARNGUS for 6 years.
3.
I agree to serve satisfactorily in the SELRES for which contracted.
SECTION V - ENTITLEMENT
1.
Initial agreement pertains to both enlisted and officer agreements. I am entitled to the MGIB-SR Kicker Program in the
amount of $
per month (for full-time enrollment), for 36 academic months. This amount will be adjusted by the DVA for less
than full-time pursuit of qualifying educational program. As a lieutenant, I do not have a baccalaureate degree.
2.
As an enlisted Soldier, I further understand that I cannot receive any portion of the MGIB-SR Kicker until I have received
my secondary school diploma, completed initial active duty for training, and have been awarded my DMOS.
3.
I understand the procedures for payment of the MGIB-SR Kicker will be initiated by myself through the unit commander
or direct representative.
4.
As an officer currently not entitled to MGIB-SR basic benefits. I understand that upon completion of the Officer Basic
Course and gaining eligibility for the MGIB-SR basic benefits, I will also be eligible for the Kicker incentive in the amount of $
per month.
per month. Since my commissioner
5.
As a prior enlisted Soldier I was receiving the Kicker in the amount of $
as an officer/warrant officer, completing Phase I in the State OCS Program or enrolling as a ROTC SMP (MS II, III or IV) cadet, I am eligible for the
increased Kicker in the amount of $
per month.
6.
If I voluntarily or involuntarily transfer within or between units of the ARNGUS or USAR, including the IRR, due to unit
transition, per AR 601-210 or other applicable regulation, or upon completion of my 6 years Kicker obligation, I will continue to receive the Kicker
incentive until my basic MGIB or MGIB-SR benefits are exhausted.
7.
I understand all incentive payments are subject to Federal and State income tax withholdings.
SECTION VI - SUSPENSION
I understand that under certain conditions I can be suspended on a one-time basis for a specified period from the incentive program rather than being
terminated. Suspensions are limited to the following conditions:
1.
Temporary overseas residence, missionary obligation, or overseas employment obligation for 3 years or less. Also
transfer to the Inactive National Guard or Individual Ready Reserve for personal reasons for up to 1 year. Reinstatement to a partial or full
resumption of incentive eligibility, when authorized, requires extending my term of service equal to a period that, in combination with time already
served will equal 6 years.
2.
I must remain Duty Military Occupational Specialty Qualified (DMOSQ) unless changed through unit transition, reclassifi-
cation of a position to non-critical, transfers to another position at the convenience of the government or promotion within the specialty or skill
career progression path that provided MGIB-SR Kicker eligibility. If I voluntarily request reassignment to a new position for any other reason,
my MGIB-SR Kicker benefits will be suspended. When non-DMOSQ occurs due to reason above, I must become DMOSQ within 24 months
to continue receipt of Kicker incentives. The only exceptions are those Servicemembers enrolling for officer or warrant officer candidacy
programs, result in suspension of Kicker benefits.
3.
If I enter a period of service where favorable personnel actions on my behalf are suspended, entitlement to subsequent
MGIB-SR Kicker payments will also be suspended. If otherwise eligible, I will be entitled to receive MGIB-SR Kicker payments (section V)
when the suspension has been favorably lifted. Reinstatement to a partial or full resumption of incentive eligibility requires that I extend my
term of service for the period of unfavorable personnel actions in combination with service already served to equal six years. This excludes
suspension of favorable personnel actions for Army Physical Fitness Test (APFT) failure or failure to meet body fat standards. Repeat APFT
failure or failure to meet body fat standard within a one year period will result in suspension of Kicker benefits.
4.
MGIB-SR Kicker benefits suspended after the 6-year obligation is served will be restored upon reaffiliation in the SELRES
in any position or unit of any component as long as I am entitled to MGIB-SR basic benefits.
5.
If I fail to participate satisfactorily, my Kicker incentives will be suspended until I have been declared a satisfactory
participant.
6.
If I transfer to the USAR Control Group (ROTC) for the purpose of accepting an active duty scholarship as provided under
Title 10, USC, Section 2107, my Kicker incentives will be suspended.
7.
As an OCS or SMP cadet, if I fail to complete the program or fail to accept the oath of office, my Kicker incentives will be
suspended. If I was previously eligible to a lower Kicker amount as an enlisted Soldier, I will regain eligibility to the lower Kicker amount upon returning
to the enlisted position for the position for which I initially contracted.
SSN
NAME
Page 2 of 4
DA FORM 5435-1, FEB 2016
APD LC v1.00ES
SECTION VII - TERMINATION
The MGIB-SR Kicker incentives will be terminated should any of the following conditions occur before the fulfillment of my enlistment
agreement and obligation:
1. If I become an unsatisfactory participant per AR 135-91, the termination of the incentive will be effective on the date of my suspension
(termination will result in recoupment action).
2. If I fail to return within the authorized period of nonavailability, my Kicker incentives will terminate with recoupment action.
3. If I fail to extend my SELRES contracted term of service to compensate for a period of authorized nonavailability, my Kicker benefits
will terminate with recoupment action.
4. If I complete less than 6 years in a SELRES unit under the terms of the initial contract; recoupment action will be initiated.
5. My MGIB-SR Kicker benefits will terminate without recoupment when discharged, transferred, or reassigned from the SELRES as a
result of the following reasons:
a. Enters the second phase of alternate (split) training without proof of qualification as a secondary school diploma graduate.
b. If I fail to meet qualifications for membership in the SELRES under law or regulations, to include medical fitness standards.
c. If I become a military technician and qualify for an unreduced annuity under the Civil Service Retirement and Disability System or the
Federal Employees Retirement System.
d. If I become eligible for separation pay.
e. If I refuse to accept another position in the SELRES
(USAR/ARNGUS) that was offered and within a reasonable
commuting distance of the Soldier's residence, or if the position is outside a reasonable commuting distance, but was located at or in
close proximity to the unit I had been affiliated with and the position did not require a reduction in grade.
f. If I voluntarily enter on extended active duty in the Active Army, or if I enlist or accept an appointment in a Regular component or
another Reserve component for continued service in the SELRES.
g. If I fail to become DMOSQ within 24 months following an involuntary reassignment to an authorized MOS other than that for which
I contracted. When retraining is required as a result of involuntary unit transition and the training is not achieved within the time limit authorized,
the Kicker benefits will terminate without recoupment.
h. If I enter the Active Guard Reserve program in a non-critical MOS.
i. Upon completion of the authorized maximum number of 36 academic months of MGIB-SR basic benefits.
j. Upon reaching the 10-year delimiting date, except as provided for by the DVA.
k. If I accept an appointment as a commissioned officer or warrant officer with consecutive assignment to the SELRES.
l. If I transfer to Army ROTC Control Group for the purposes of accepting an Army ROTC scholarship under 10 USC 2107.
6. As an officer candidate, if I fail to complete the program or fail to administer the oath of office and am not entitled to Kicker incentives
as an enlisted Soldier, I will be terminated from Kicker incentives.
7. If I transfer between the USAR and the ARNGUS, the following rules will apply:
a.
As a USAR Soldier eligible for MGIB-SR Kicker benefits who transfers to the ARNGUS-
(1) I will continue to receive Kicker benefits according to the DVA policy when a TPU has been affected by unit transition.
(2) Upon completion of my 6 years obligation, I will continue to receive Kicker benefits as long as I have not received the maximum
36 academic months of benefits and I have basic MGIB-SR benefits remaining.
(3) For any reason other than (1) or (2) above, my Kicker benefits will terminate (with recoupment) unless the Chief, National Guard
Bureau authorizes continued receipt of Kicker benefits based on my enlistment into the ARNGUS.
b.
As an ARNGUS Soldier entitled to the MGIB-SR Kicker benefits who transfers to a USAR SELRES unit for any
reason other than a (1) or a (2) above, my Kicker benefits will terminate (with recoupment) unless the Chief, Army Reserve authorizes
continued receipt of Kicker benefits based on my enlistment into the USAR.
8. Two consecutive APFT or body fat standard failures will result in termination of Kicker incentives.
SECTION VIII - RECOUPMENT
1. If my eligibility to the MGIB-SR Kicker is terminated for a reason listed in paragraph 1 through 4 of section VII above, I may be subject
to recoupment action. The recoupment amount will be calculated as follows:
a. The number of months served satisfactorily during the term of my enlistment will be multiplied by the proportionate monthly dollar
amount (total bonus authorized divided by 72 months).
b. The product of the above will be subtracted from the total amount of bonus paid to me to date, including initial and subsequent
payments.
c. If the above calculation indicates overpayment to me, I will be required to refund that amount to the U.S. Government. If the
calculation indicates I have earned more than I have been paid,I will be paid a final payment in the amount due to me.
d. Any refund made by me will not affect my period of obligation to serve in the ARNGUS or USAR.
NAME
SSN
DA FORM 5435-1, FEB 2016
Page 3 of 4
APD LC v1.00ES
SECTION VIII - RECOUPMENT (Continued)
2. If I am in receipt of the MGIB-SR Kicker incentives and lose my eligibility, I will be subjected to recoupment plus interest. If I cannot
receive a waiver of recoupment through my service representative (Chief, National Guard Bureau for the ARNGUS or Chief, Army Reserve
for the USAR), I am obligated to repay benefits received through the recoupment process.
3. All debts to the U.S. Government will be submitted for collection from SELRES members declared unsatisfactory participants when a waiver
is not authorized. Delinquent repayment will result in the collection of interest on the remaining balance.
SECTION IX - STATEMENT OF UNDERSTANDING
I have read and understand each of the statements above and have had my questions satisfactorily answered. I understand the statements
above are intended to constitute all promises and agreements, whatsoever, concerning my entitlement for MGIB-SR Kicker benefits. Any
other representation, or commitments, made to me in connection with my enlistment for the MGIB-SR Kicker has been entered below in my
own handwriting, or they are hereby waived. (If none, indicate by writing the word "NONE" below.)
APPLICANT'S NAME AND RANK
SSN
DATE (YYYYMMDD)
SIGNATURE
SECTION IX - CERTIFICATION BY SERVICE REPRESENTATIVE
I certify that I have witnessed the reading and signing of the above agreement and the signature appearing above is that of the applicant. I have
verified the applicant meets the eligibility requirements of AR 601-210 and AR 621-202, and the applicant's unit of assignment (section III,
para 1a) or MOS (section III, para 1b) is currently eligible, per HQDA annual policy guidance, for the MGIB-SR Kicker. No other promises
were made to the applicant as a condition of entitlement to the MGIB-SR Kicker under the SELRES Incentive Program. I have provided the
applicant with a copy of this form.
SERVICE REPRESENTATIVE'S NAME, RANK AND TITLE
DATE (YYYYMMDD)
SIGNATURE
Page 4 of 4
DA FORM 5435-1, FEB 2016
APD LC v1.00ES

Download DA Form 5435-1 Statement of Understanding - the Selected Reserve Montgomery Gi Bill Kicker Program (10 Usc 16131)

754 times
Rate
4.6(4.6 / 5) 73 votes
ADVERTISEMENT
Page of 4