USAREC Form 601-37.16 "Request for Health Professions Accession Bonus"

What Is USAREC Form 601-37.16?

This is a legal form that was released by the United States Army Recruiting Command on July 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2018;
  • The latest available edition released by the United States Army Recruiting Command;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of USAREC Form 601-37.16 by clicking the link below or browse more documents and templates provided by the United States Army Recruiting Command.

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REQUEST FOR HEALTH PROFESSIONS ACCESSION BONUS
(For use of this form see USAREC Reg 601-37)
PRIVACY ACT STATEMENT
AUTHORITY:
Collection of this information is authorized by 37 USC, section 302; 10 USC, section 3013; and Executive Order 9397.
Information collected will be used to qualify applicants for the Health Professions Accessions Bonus.
PRINCIPAL PURPOSE:
Blanket routine use disclosures as described in AR 340-21, The Army Privacy Program, paragraph 3-2.
ROUTINE USES:
DISCLOSURE:
Voluntary; however, failure to provide the information requested may result in nonverification of the agreement and payment of the
accession bonus may be affected.
FROM:
SSN:
FOR: HQDA
1. I hereby request participation in the Accession Bonus Program for
and certify that:
(AOC)
a. I am applying for an appointment and commission as a
Corps officer on active duty and to the best of my knowledge I qualify
for appointment as a
Corps officer in the Army.
b. I am not currently an appointed commissioned
Corps officer.
c. I am licensed in my qualifying field or I will become licensed in my qualifying field in accordance with AR 135-101 prior to my entry onto active
duty (EAD).
d. I will remain in my qualifying field for the duration of the agreement period for which the bonus is paid.
e. In case I had prior commissioned service as a
Corps officer, I was discharged at least 24 months prior to the execution of this
agreement.
f. I did not receive any financial assistance from the Department of Defense to pursue a baccalaureate degree.
2. Conditions of agreement. I understand that:
a. I must remain on active duty for a period of
years beginning on my EAD.
b. (AN Corps only.) This agreement will be terminated if I cannot become a licensed registered nurse by failing the NCLEX-RN twice or fail to remain
a licensed registered nurse during my period of obligation.
c. This agreement will be terminated if I cannot become licensed or fail to remain licensed during my period of obligation.
d. Requests for resignation or release from active duty to be effective during the period of this agreement will be disapproved except where
considered to be in the best interest of the US Army or for Reserve officers who qualify under the provisions of AR 600-8-24.
e. In the event of termination under b above, the full bonus amount will be recouped by the US Government.
f. In the event of termination under c above, the unearned bonus amount will be recouped by the Government on a pro rata basis, except in the
following circumstances:
(1) Death or disability that is not the result of misconduct or willful neglect and not incurred during a period of unauthorized absence;
(2) Separation from military service by operation of laws or regulations of the Department of Defense or Department of the Army, when a waiver
for recoupment has been approved by the Secretary of the Army.
(3) In other cases, when the Assistant Secretary of Defense (Health Affairs) determines recoupment is not in the best interest of the
Government.
g. A discharge in bankruptcy under Title 11, USC, that is entered less than 5 years after the termination of this agreement does not discharge
me from a debt arising from this agreement. This paragraph applies to any case commenced under Title 11, USC, after 29 November 1989.
Corps,
3. In consideration of my entering into the foregoing agreement, and my acceptance of a commission as an officer in the
the US Army agrees to pay a $
accession bonus annually for
years to me, subject to availability of funds, upon
arrival at my first permanent active duty station by submitting initial accession orders and this contract to the installation finance office.
TYPED NAME AND SSN OF APPLICANT
SIGNATURE
DATE
TYPED NAME AND GRADE OF WITNESSING
SIGNATURE
DATE
OFFICER OR RECRUITER
V 2.00
USAREC Form 601-37.16 (update), JUL 2018
REQUEST FOR HEALTH PROFESSIONS ACCESSION BONUS
(For use of this form see USAREC Reg 601-37)
PRIVACY ACT STATEMENT
AUTHORITY:
Collection of this information is authorized by 37 USC, section 302; 10 USC, section 3013; and Executive Order 9397.
Information collected will be used to qualify applicants for the Health Professions Accessions Bonus.
PRINCIPAL PURPOSE:
Blanket routine use disclosures as described in AR 340-21, The Army Privacy Program, paragraph 3-2.
ROUTINE USES:
DISCLOSURE:
Voluntary; however, failure to provide the information requested may result in nonverification of the agreement and payment of the
accession bonus may be affected.
FROM:
SSN:
FOR: HQDA
1. I hereby request participation in the Accession Bonus Program for
and certify that:
(AOC)
a. I am applying for an appointment and commission as a
Corps officer on active duty and to the best of my knowledge I qualify
for appointment as a
Corps officer in the Army.
b. I am not currently an appointed commissioned
Corps officer.
c. I am licensed in my qualifying field or I will become licensed in my qualifying field in accordance with AR 135-101 prior to my entry onto active
duty (EAD).
d. I will remain in my qualifying field for the duration of the agreement period for which the bonus is paid.
e. In case I had prior commissioned service as a
Corps officer, I was discharged at least 24 months prior to the execution of this
agreement.
f. I did not receive any financial assistance from the Department of Defense to pursue a baccalaureate degree.
2. Conditions of agreement. I understand that:
a. I must remain on active duty for a period of
years beginning on my EAD.
b. (AN Corps only.) This agreement will be terminated if I cannot become a licensed registered nurse by failing the NCLEX-RN twice or fail to remain
a licensed registered nurse during my period of obligation.
c. This agreement will be terminated if I cannot become licensed or fail to remain licensed during my period of obligation.
d. Requests for resignation or release from active duty to be effective during the period of this agreement will be disapproved except where
considered to be in the best interest of the US Army or for Reserve officers who qualify under the provisions of AR 600-8-24.
e. In the event of termination under b above, the full bonus amount will be recouped by the US Government.
f. In the event of termination under c above, the unearned bonus amount will be recouped by the Government on a pro rata basis, except in the
following circumstances:
(1) Death or disability that is not the result of misconduct or willful neglect and not incurred during a period of unauthorized absence;
(2) Separation from military service by operation of laws or regulations of the Department of Defense or Department of the Army, when a waiver
for recoupment has been approved by the Secretary of the Army.
(3) In other cases, when the Assistant Secretary of Defense (Health Affairs) determines recoupment is not in the best interest of the
Government.
g. A discharge in bankruptcy under Title 11, USC, that is entered less than 5 years after the termination of this agreement does not discharge
me from a debt arising from this agreement. This paragraph applies to any case commenced under Title 11, USC, after 29 November 1989.
Corps,
3. In consideration of my entering into the foregoing agreement, and my acceptance of a commission as an officer in the
the US Army agrees to pay a $
accession bonus annually for
years to me, subject to availability of funds, upon
arrival at my first permanent active duty station by submitting initial accession orders and this contract to the installation finance office.
TYPED NAME AND SSN OF APPLICANT
SIGNATURE
DATE
TYPED NAME AND GRADE OF WITNESSING
SIGNATURE
DATE
OFFICER OR RECRUITER
V 2.00
USAREC Form 601-37.16 (update), JUL 2018