DD Form 1561 Statement to Substantiate Payment of Family Separation Allowance (FSA)

What Is DD Form 1561?

DD Form 1561, Statement to Substantiate Payment of Family Separation Allowance (FSA) is used by U.S. service members separated from their dependents to apply for an FSA payment. Family Separation Allowance serves as compensation for expenses that occurred because of forced separation.

The latest version of the form - sometimes incorrectly referred to as the DA Form 1561 - was released by the Department of Defense (DoD) in December 2017 with all previous editions being obsolete. An up-to-date DD Form 1561 fillable version is available for download and online filing below or can be found through the Executive Services Directorate website.

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STATEMENT TO SUBSTANTIATE PAYMENT OF FAMILY SEPARATION ALLOWANCE (FSA)
PRIVACY ACT STATEMENT
AUTHORITY: 37 U.S.C. 427,
Family separation
allowance.
PURPOSE: To substantiate payment of Family Separation Allowance (FSA); provides an audit trail for validating propriety of payments and to assist in collecting
erroneous payments; and provides a record in service member's pay account.
ROUTINE USES: To the Treasury Department to provide information on check issues and electronic funds transfers. To Federal, state, and local governmental
agencies in response to an official request for information with respect to law enforcement, investigatory procedures, criminal prosecution, civil court action and
regulatory order. Additional routine uses can be found within the applicable system of records notices, T7344, Defense Joint Military Pay System-Reserve
Component; T7340, Defense Joint Military Pay System-Active Component; and M0104-3, Marine Corps Manpower Management Information System Records,
located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary; however, if requested information is not provided, FSA will not be considered.
1. NAME OF MEMBER
2. GRADE
3. DoD ID NUMBER
4. BRANCH AND ORGANIZATION
(Last, First, Middle Initial)
PART I - MEMBER COMPLETES THIS SECTION TO SUBSTANTIATE ENTITLEMENT TO FSA
6. DATE (DDMMYY) DEPARTED RESIDENCE TO UNIT HOME
5. TYPE II (X as applicable)
STATION (Mobilized Members)
FSA-T (Temporary)
FSA-R (Restricted)
FSA-S (Ship)
7. COMPLETE CURRENT ADDRESS(ES) OF DEPENDENT(S)
8. I CERTIFY TO THE FOLLOWING FACTS (X applicable box(es))
a. I am not divorced or legally separated from my spouse.
b. My dependent child (children) was (were) not in the legal custody of another person when I received my military orders.
c. My dependent (other than my spouse; see line f. below) is not a member of the military service on active duty.
d. My sole dependent is not in an institution for a known period of over 1 year or a period expected to exceed 1 year.
e. I am claiming FSA for my parent(s) for whom I have a current and approved dependency status and am residing with, and I maintain a residence(s) for
my dependent(s). I have assumed the liability and responsibilities thereof at the address(es) shown above, where I likely reside during periods of leave
or such other times as my duty assignment may permit.
f. I am married to another military member currently serving on active duty and my spouse
was not residing with me immediately before
was
being separated by execution of my military orders.
Spouse's DoD ID number
Branch and Component:
g. My last TDY or deployment, if any,
was
was not within the last 30 days from this TDY or deployment.
9. I understand that I must notify my commanding officer immediately upon any change in dependency status and if my sole dependent or all of my dependents
move to or near this station or if my dependent(s) visit at or near this station for more than 90 continuous days (more than 30 continuous days in the case of
FSA-T (Temp) or FSA-S (Ship) while I am in receipt of FSA.
b. SIGNATURE OF MEMBER
a. DATE
(DDMMYY)
PART II - CERTIFYING OFFICER COMPLETES THE APPROPRIATE SECTION(S) BELOW
10. TYPE II - FSA-T. Member has been ordered to and has performed temporary duty (TDY) at the location(s) shown below for more than 30 continuous days.
This (these) location(s) is (are) outside a reasonable commuting distance from the member's permanent duty station (PDS pertains to active component) or
the home of residence (HOR pertains to reserve component). A distance of 50 miles, one way, is normally considered to be within a reasonable commuting
distance of a PDS or HOR. "Within a reasonable commuting distance" also may include distances of less than 50 miles and the time required to travel, under
unusual conditions, does not exceed 1-1/2 hours.
(Attach a blank page for continuation if necessary.)
a. LOCATION
b. INCLUSIVE DATES OF TDY/T
c. NO. OF DAYS
(From/To)
11. TYPE II - FSA-R. Member departed (PCS/detached) from
on
(Last permanent duty station)
(DDMMYY)
and was on leave en route
, proceed time
(Inclusive leave dates - DDMMYY)
(Inclusive dates)
and the member reported to
on
. Transportation of dependent(s)
(DDMMYY)
(PDS)
is not authorized at government expense to this station or to a place near this station.
12. TYPE II - FSA-S. Member was serving on orders, on board ship, away from homeport commencing (DDMMYY)
a. NAME OF SHIP/UNIT
b. HOMEPORT
13. Travel performed under authority of orders
, dated
14. Member claiming Type II FSA, is receiving basic allowance for housing (BAH) (or residing in government type quarters) as a member with dependents or
member married to a military member.
15. CERTIFYING OFFICER
a. TYPED NAME
b. TITLE
(Last, First, Middle Initial)
c. ORGANIZATION
16. DATE
)
d. SIGNATURE
(DDMMYY
DD FORM 1561, DEC 2-17
Page 1 of 1
PREVIOUS EDITION IS OBSOLETE.
AEM Designer
STATEMENT TO SUBSTANTIATE PAYMENT OF FAMILY SEPARATION ALLOWANCE (FSA)
PRIVACY ACT STATEMENT
AUTHORITY: 37 U.S.C. 427,
Family separation
allowance.
PURPOSE: To substantiate payment of Family Separation Allowance (FSA); provides an audit trail for validating propriety of payments and to assist in collecting
erroneous payments; and provides a record in service member's pay account.
ROUTINE USES: To the Treasury Department to provide information on check issues and electronic funds transfers. To Federal, state, and local governmental
agencies in response to an official request for information with respect to law enforcement, investigatory procedures, criminal prosecution, civil court action and
regulatory order. Additional routine uses can be found within the applicable system of records notices, T7344, Defense Joint Military Pay System-Reserve
Component; T7340, Defense Joint Military Pay System-Active Component; and M0104-3, Marine Corps Manpower Management Information System Records,
located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary; however, if requested information is not provided, FSA will not be considered.
1. NAME OF MEMBER
2. GRADE
3. DoD ID NUMBER
4. BRANCH AND ORGANIZATION
(Last, First, Middle Initial)
PART I - MEMBER COMPLETES THIS SECTION TO SUBSTANTIATE ENTITLEMENT TO FSA
6. DATE (DDMMYY) DEPARTED RESIDENCE TO UNIT HOME
5. TYPE II (X as applicable)
STATION (Mobilized Members)
FSA-T (Temporary)
FSA-R (Restricted)
FSA-S (Ship)
7. COMPLETE CURRENT ADDRESS(ES) OF DEPENDENT(S)
8. I CERTIFY TO THE FOLLOWING FACTS (X applicable box(es))
a. I am not divorced or legally separated from my spouse.
b. My dependent child (children) was (were) not in the legal custody of another person when I received my military orders.
c. My dependent (other than my spouse; see line f. below) is not a member of the military service on active duty.
d. My sole dependent is not in an institution for a known period of over 1 year or a period expected to exceed 1 year.
e. I am claiming FSA for my parent(s) for whom I have a current and approved dependency status and am residing with, and I maintain a residence(s) for
my dependent(s). I have assumed the liability and responsibilities thereof at the address(es) shown above, where I likely reside during periods of leave
or such other times as my duty assignment may permit.
f. I am married to another military member currently serving on active duty and my spouse
was not residing with me immediately before
was
being separated by execution of my military orders.
Spouse's DoD ID number
Branch and Component:
g. My last TDY or deployment, if any,
was
was not within the last 30 days from this TDY or deployment.
9. I understand that I must notify my commanding officer immediately upon any change in dependency status and if my sole dependent or all of my dependents
move to or near this station or if my dependent(s) visit at or near this station for more than 90 continuous days (more than 30 continuous days in the case of
FSA-T (Temp) or FSA-S (Ship) while I am in receipt of FSA.
b. SIGNATURE OF MEMBER
a. DATE
(DDMMYY)
PART II - CERTIFYING OFFICER COMPLETES THE APPROPRIATE SECTION(S) BELOW
10. TYPE II - FSA-T. Member has been ordered to and has performed temporary duty (TDY) at the location(s) shown below for more than 30 continuous days.
This (these) location(s) is (are) outside a reasonable commuting distance from the member's permanent duty station (PDS pertains to active component) or
the home of residence (HOR pertains to reserve component). A distance of 50 miles, one way, is normally considered to be within a reasonable commuting
distance of a PDS or HOR. "Within a reasonable commuting distance" also may include distances of less than 50 miles and the time required to travel, under
unusual conditions, does not exceed 1-1/2 hours.
(Attach a blank page for continuation if necessary.)
a. LOCATION
b. INCLUSIVE DATES OF TDY/T
c. NO. OF DAYS
(From/To)
11. TYPE II - FSA-R. Member departed (PCS/detached) from
on
(Last permanent duty station)
(DDMMYY)
and was on leave en route
, proceed time
(Inclusive leave dates - DDMMYY)
(Inclusive dates)
and the member reported to
on
. Transportation of dependent(s)
(DDMMYY)
(PDS)
is not authorized at government expense to this station or to a place near this station.
12. TYPE II - FSA-S. Member was serving on orders, on board ship, away from homeport commencing (DDMMYY)
a. NAME OF SHIP/UNIT
b. HOMEPORT
13. Travel performed under authority of orders
, dated
14. Member claiming Type II FSA, is receiving basic allowance for housing (BAH) (or residing in government type quarters) as a member with dependents or
member married to a military member.
15. CERTIFYING OFFICER
a. TYPED NAME
b. TITLE
(Last, First, Middle Initial)
c. ORGANIZATION
16. DATE
)
d. SIGNATURE
(DDMMYY
DD FORM 1561, DEC 2-17
Page 1 of 1
PREVIOUS EDITION IS OBSOLETE.
AEM Designer

Download DD Form 1561 Statement to Substantiate Payment of Family Separation Allowance (FSA)

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How to Fill Out DD Form 1561?

A military member serving an unaccompanied tour of duty and having dependent family members may apply for Family Separation Allowance of up to $250 a month. The application is possible under one of the following conditions:

  • The military member is on a duty aboard a ship, which is away from the homeport continuously for more than 30 days;
  • They are on temporary duty - including temporary additional duty - away from the permanent station continuously for more than 30 days, and their dependents are not residing at or near the TDY station;
  • Dependents do not live in the vicinity of the members' permanent duty station and their transportation is not authorized at government expense;
  • The transportation of dependents is authorized at government expense, but they cannot accompany the military member to their permanent duty station because of medical reasons;
  • The dependents are evacuated from a dangerous area and temporarily occupy government quarters in a safe area;
  • Married army couples, if both spouses serve on active duty, can both apply and receive FSA.

In addition, the FSA has special conditions regarding visits by the dependents. Depending on the FSA type, it might be ceased. FSA-R type ceases in 30 days after the three months of dependents presence, FSA-T ceases after 30 days of the visit, same as FSA-S. More information on the FSA types can be found below.

DD Form 1561 Instructions

Instructions for filling out DD Form 1561 are not included within the form itself. The filing steps are as follows:

  1. The form is divided into two parts. Part I is filled by the applicant and Part II is for the certifying officer. The applicant provides their personal information in the top line of the form.
  2. The applicant has to choose required the FSA type: either Restricted, Transportation or Ship.
    • The Restricted FSA (FSA-R) applies when the dependents' transportation is not authorized or impossible due to a medical condition.
    • The Transportation FSA (FSA-T) is used by soldiers, deployed from their temporary duty station for more than 30 days.
    • The Ship FSA (FSA-S) is for service members who are on a duty aboard a ship for more than 30 days.
  3. After the applicant has stated their departure date in Item 6, they have to fill out the certification block. The way of filling it in depends on the case.
  4. Then, after the applicant has read and accepted the information provided in Item 9, they have to date the form and sign it. The soldier then submits the form to their servicing personnel office.
  5. The certifying officer files Part II of the DD 1561 form according to the type of the FSA requested. Item 10 is for the FSA-T type. The officer has to specify the location of the soldiers' temporary duty, the dates and days spent in the stated location.
  6. Block 11 is for FSA-T. The officer has to provide the departure station and date, proceed time and the permanent duty station of the soldier.
  7. If the service member chose FSA-S, the certifying officer must complete Item 12. This block requires specifying the name of the ship and the homeport. The officer also has to specify the orders under the authority of which the soldier is performing their duty and the date of those orders.
  8. Finally, the officer types in their name, title, and organization, fills in the date of filing and signs the completed form.