DD Form 137-3 "Dependency Statement - Parent"

What Is DD Form 137-3?

This is a form that was released by the U.S. Department of Defense (DoD) on March 1, 2018. The form, often mistakenly referred to as the DA Form 137-3, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DoD.

Form Details:

  • A 5-page document available for download in PDF;
  • The latest version available from the Executive Services Directorate;
  • Additional instructions and information can be found on page 1 of the document;
  • Editable, printable, and free to use;
  • Fill out the form in our online filing application.

Download an up-to-date fillable DD Form 137-3 down below in PDF format or browse hundreds of other DoD Forms compiled in our online library.

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CUI (when filled in)
OMB No. 0730-0014
DEPENDENCY STATEMENT - PARENT
OMB approval expires
June 30, 2024
The public reporting burden for this collection of information, 0730-0014, is estimated to average 30-60 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-
alex.esd.mbx.dd-dod-information-collections@mail.mil. 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 RETURN COMPLETED FORM TO YOUR LOCAL SERVING PERSONNEL/PAYROLL OFFICE.
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 37 U.S.C., Pay and Allowances of the Uniformed Services; DoD Directive 5154.29, DoD Pay and
Allowances Policy and Procedures; DoD 7000.14-R, DoD Financial Management Manual, Volume 7A, Military Pay Policy and Procedures - Active Duty and
Reserve Pay; and Joint Travel Regulations (JTR) current edition.
PURPOSE(S): The information will be used to determine the relationship and dependency of the claimed dependents and determine the member's entitlement of
authorized benefits.
ROUTINE USE(S): To the Treasury Department to provide information on check issues and electronic fund 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 M01040-3, Marine Corps Manpower Management Information System Records,
located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary: however, failure to provide this information will result in a suspension of the dependent entitlements until the member can provide the
required certification.
INSTRUCTIONS
The member must complete Items 1 and 2, and sign and date the form. Parent or parent(s) representative (if parent is unable to complete the form due to
health or physical disability) must complete Items 3 through 12, sign and date the form, and have the form notarized. If a representative completes the form for
the parent(s), include in the Remarks section the name of the individual, the relationship, and the reason the form was not completed by parent(s). If the member
is deceased, information furnished must reflect the 12 months prior to member's death.
NOTES: Answer all questions. If any question does not apply, write "NOT APPLICABLE" or "N/A" in that block. Use the Remarks section when required.
Incomplete answers will delay final action on the application. Verification of all income is required. Proof of member's contribution is required when applying for
Basic Allowance for Housing (BAH). Parent must be more than 50% dependent upon member.
1. ENTITLEMENTS REQUESTED (X and complete as applicable)
a. TYPE
b. FIRST APPLICATION?
c. LAST APPLICATION WAS
BAH
USIP CARD
YES
(If No, give date of last application)
APPROVED
TRAVEL ALLOWANCE
NO
(YYYYMMDD)
DISAPPROVED
2. MEMBER INFORMATION
a. NAME (Last, First, Middle Initial)
b. DoD ID NUMBER
c. RANK
d. STATUS (X and complete as applicable)
ACTIVE DUTY
NATIONAL GUARD
ARMY
NAVY
DECEASED (Date of death) (YYYMMDD)
RETIRED
RESERVE
MARINE CORPS
AIR FORCE
OTHER (Specify)
e. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)
f. COMPLETE MILITARY ADDRESS (Include assignment: squadron and base)
g. TELEPHONE NUMBERS (Include DSN or Area Code)
i. MARITAL STATUS (X one)
h. E-MAIL ADDRESS
(1) WORK
(2) HOME
SINGLE
SEPARATED
WIDOWED
MARRIED
DIVORCED
3. PARENT(S) INFORMATION
a.
b. (1) NAME (Last, First, Middle Initial)
(1) NAME (Last, First, Middle Initial)
(2) DOD ID NUMBER
(3) DATE OF BIRTH (YYYYMMDD)
(2) DOD ID NUMBER
(3) DATE OF BIRTH (YYYYMMDD)
(4) RELATIONSHIP
(4) RELATIONSHIP
DD FORM 137-3, MAR 2018
Controlled by: DFAS
Page 1 of 5
CUI (when filled in)
Category: PRVCY
PREVIOUS EDITION IS OBSOLETE.
Distribution/DISTRO: FEDCON
POC: (888) 332-7411
CUI (when filled in)
OMB No. 0730-0014
DEPENDENCY STATEMENT - PARENT
OMB approval expires
June 30, 2024
The public reporting burden for this collection of information, 0730-0014, is estimated to average 30-60 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 the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-
alex.esd.mbx.dd-dod-information-collections@mail.mil. 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 RETURN COMPLETED FORM TO YOUR LOCAL SERVING PERSONNEL/PAYROLL OFFICE.
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 37 U.S.C., Pay and Allowances of the Uniformed Services; DoD Directive 5154.29, DoD Pay and
Allowances Policy and Procedures; DoD 7000.14-R, DoD Financial Management Manual, Volume 7A, Military Pay Policy and Procedures - Active Duty and
Reserve Pay; and Joint Travel Regulations (JTR) current edition.
PURPOSE(S): The information will be used to determine the relationship and dependency of the claimed dependents and determine the member's entitlement of
authorized benefits.
ROUTINE USE(S): To the Treasury Department to provide information on check issues and electronic fund 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 M01040-3, Marine Corps Manpower Management Information System Records,
located at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary: however, failure to provide this information will result in a suspension of the dependent entitlements until the member can provide the
required certification.
INSTRUCTIONS
The member must complete Items 1 and 2, and sign and date the form. Parent or parent(s) representative (if parent is unable to complete the form due to
health or physical disability) must complete Items 3 through 12, sign and date the form, and have the form notarized. If a representative completes the form for
the parent(s), include in the Remarks section the name of the individual, the relationship, and the reason the form was not completed by parent(s). If the member
is deceased, information furnished must reflect the 12 months prior to member's death.
NOTES: Answer all questions. If any question does not apply, write "NOT APPLICABLE" or "N/A" in that block. Use the Remarks section when required.
Incomplete answers will delay final action on the application. Verification of all income is required. Proof of member's contribution is required when applying for
Basic Allowance for Housing (BAH). Parent must be more than 50% dependent upon member.
1. ENTITLEMENTS REQUESTED (X and complete as applicable)
a. TYPE
b. FIRST APPLICATION?
c. LAST APPLICATION WAS
BAH
USIP CARD
YES
(If No, give date of last application)
APPROVED
TRAVEL ALLOWANCE
NO
(YYYYMMDD)
DISAPPROVED
2. MEMBER INFORMATION
a. NAME (Last, First, Middle Initial)
b. DoD ID NUMBER
c. RANK
d. STATUS (X and complete as applicable)
ACTIVE DUTY
NATIONAL GUARD
ARMY
NAVY
DECEASED (Date of death) (YYYMMDD)
RETIRED
RESERVE
MARINE CORPS
AIR FORCE
OTHER (Specify)
e. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)
f. COMPLETE MILITARY ADDRESS (Include assignment: squadron and base)
g. TELEPHONE NUMBERS (Include DSN or Area Code)
i. MARITAL STATUS (X one)
h. E-MAIL ADDRESS
(1) WORK
(2) HOME
SINGLE
SEPARATED
WIDOWED
MARRIED
DIVORCED
3. PARENT(S) INFORMATION
a.
b. (1) NAME (Last, First, Middle Initial)
(1) NAME (Last, First, Middle Initial)
(2) DOD ID NUMBER
(3) DATE OF BIRTH (YYYYMMDD)
(2) DOD ID NUMBER
(3) DATE OF BIRTH (YYYYMMDD)
(4) RELATIONSHIP
(4) RELATIONSHIP
DD FORM 137-3, MAR 2018
Controlled by: DFAS
Page 1 of 5
CUI (when filled in)
Category: PRVCY
PREVIOUS EDITION IS OBSOLETE.
Distribution/DISTRO: FEDCON
POC: (888) 332-7411
CUI (when filled in)
3. PARENT(S) INFORMATION (Continued)
a.
b.
(5) COMPLETE ADDRESS
(5) COMPLETE ADDRESS
(Street, Apartment Number, City, State, ZIP Code)
(Street, Apartment Number, City, State, ZIP Code)
(6) TELEPHONE NUMBER (Include Area Code)
(6) TELEPHONE NUMBER (Include Area Code)
(7) PRESENT OCCUPATION OR BUSINESS
(7) PRESENT OCCUPATION OR BUSINESS
(8) NAME AND ADDRESS OF EMPLOYER (If unemployed, state reason, date
(8) NAME AND ADDRESS OF EMPLOYER (If unemployed, state reason, date
unemployment began, and date unemployment is expected to resume.)
unemployment began, and date unemployment is expected to resume.)
c. MARITAL STATUS (X one)
d. IF SPOUSE IS DECEASED OR LEGALLY SEPARATED FROM PARENT,
GIVE DATE OF DEATH, DIVORCE OR SEPARATION (YYYYMMDD)
MARRIED
DIVORCED
SINGLE
LIVING APART UNTIL LEGAL
SEPARATION
WIDOWED
e. IF PARENT AND SPOUSE LIVE APART OR SPOUSE DOES NOT SUPPORT PARENT, GIVE REASON:
f. CHILDREN (List all parent's living children regardless of age. Show the average monthly contribution to parent from each child. Continue in Remarks section if
more space is needed.)
(1) NAME
(2) DOD ID NUMBER
(3) BRANCH OF SERVICE
(4) MONTHLY CONTRIBUTION
(Last, First, Middle Initial)
(Service Members Only)
(If on Active Duty)
TO PARENT
g. DOES ANY OTHER CHILD CLAIM PARENT FOR BAH, TRAVEL ALLOWANCE, OR USIP CARD? (If Yes, give child's name, DoD ID Number, and branch of service.)
YES
NO
4. PARENT'S RESIDENCE
a. TYPE OF RESIDENCE (X and complete as applicable)
HOME OR APARTMENT OF PARENT
HOME OR APARTMENT OF FRIEND OR RELATIVE (State relationship)
HOME OR APARTMENT OF MEMBER
(Date began residing with member)
HOSPITAL OR INSTITUTION
OTHER (Explain)
b. OWNER OF RESIDENCE
(1) NAME (Last, First, Middle Initial)
(2) ADDRESS (Street, Apartment Number, City, State, ZIP Code)
c. IS RESIDENCE
d. DATE PARENT STARTED LIVING AT
e. IS CURRENT ADDRESS PARENT'S PERMANENT ADDRESS?
SUBSIDIZED HOUSING?
CURRENT ADDRESS (YYYYMMDD)
(If No, explain where else parent lives and number of months there each year.)
YES
YES
NO
NO
DD FORM 137-3, MAR 2018
Page 2 of 5
CUI (when filled in)
PREVIOUS EDITION IS OBSOLETE.
CUI (when filled in)
5. PERSONS LIVING IN HOUSEHOLD WITH PARENT
List all persons who live in the household, including claimed parent. If employed, show hours per week worked. Continue in Remarks if more
space is needed.
f. MONTHLY
d. MARRIED (X)
e. EMPLOYED
b. RELATIONSHIP
a. NAME (Last, First, Middle Initial)
c. AGE
CONTRIBUTION TO
TO PARENT
YES
NO
HOURS PER WEEK
NO (X)
PARENT
6. HOUSEHOLD EXPENSES
List the household expenses for all persons living in the home. If expense was one-time only, such as purchase of a new chair, do not show this as a monthly
expense; list it as an expense for the past 12 months. If parent resides in the member's household or in a dwelling owned by the member, use Fair Rental Value
(FRV) for dwelling. If FRV is used, give a brief explanation of how Fair Rental Value was obtained using the Remarks section. However, if parent resides in and
owns home mortgage free, enter "None" in mortgage/rent/FRV block.
FAIR RENTAL VALUE (FRV): FRV is a single monthly sum for the entire dwelling where the parent lives. This sum is an amount the owner can reasonably
expect to receive from a stranger to rent the dwelling. FRV will not include food, utilities, furniture, and home repairs, which are listed separately.
(1)
(2)
(1)
(2)
ITEM
PRESENT MONTHLY
TOTAL EXPENSE FOR
ITEM
PRESENT MONTHLY
TOTAL EXPENSE FOR
EXPENSE
PAST 12 MONTHS
EXPENSE
PAST 12 MONTHS
a. (X one)
d. FURNITURE AND
RENT
FRV
APPLIANCES
MORTGAGE (Specify
amount of tax and
insurance if applicable)
TAX
e. REPAIRS ON HOME
INSURANCE
b. FOOD
f. OTHER
(Itemize in Remarks
section)
c. UTILITIES (Heat, power,
water, and telephone)
7. PARENT'S PERSONAL EXPENSES
List personal expenses for parent, parent's spouse, and their unmarried minor children who are not fully employed and who live in the same household. Do
not list personal expenses for the member, his or her immediate family, or any other person. List all of the parent's personal expenses regardless of who is
paying for them.
(1)
(2)
(1)
(2)
ITEM
PRESENT MONTHLY
TOTAL EXPENSE FOR
ITEM
PRESENT MONTHLY
TOTAL EXPENSE FOR
EXPENSE
PAST 12 MONTHS
EXPENSE
PAST 12 MONTHS
g. PRIVATE AUTO PAYMENTS
a. CLOTHING
(If auto is registered in
parent's name)
b. LAUNDRY AND DRY
CLEANING
h. MONTHLY TRANSPORTA-
TION PAYMENTS (Include
c. MEDICAL (Do not include
gas, oil, insurance, repairs,
expenses paid by insurance,
and public transportation)
welfare, or Medicare)
i. SCHOOL EXPENSES (Itemize)
d. VALUE OF USIP CARD
(Verification of amount is
required)
e. PERSONAL INSURANCE
(Specify)
j. OTHER EXPENSES (Itemize)
f. PERSONAL TAXES (Specify)
DD FORM 137-3, MAR 2018
Page 3 of 5
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PREVIOUS EDITION IS OBSOLETE.
CUI (when filled in)
8. PARENT'S ASSETS
List all assets such as real estate (including home), personal property, farm and/or business equipment, automobiles, trucks, cash, savings of any type, stocks,
bonds, etc., whether owned separately by parent, jointly with spouse, or jointly by parent or spouse with another person. Assets must be listed even though
parent may not be using the income earned by these assets, but is allowing the interest of dividends to accrue.
a. DESCRIPTION
b. PRESENT VALUE
c. PARENT'S EQUITY
d. IS PARENT LIQUIDATING ASSETS? (For example, is parent withdrawing money from savings, or selling stocks and bonds?)
$
YES
IF YES, HOW MUCH OF PARENT'S CAPITAL IS USED MONTHLY?
EXPLAIN:
NO
9. PARENT'S INCOME
All gross income received by parent and parent's spouse, whether taxable or nontaxable, and whether received monthly, quarterly, or yearly, must be listed. If
any income received includes funds for children, be sure to show the amount received for them. List income for parents and children separately. If any income
received during the past 12 months was a lump-sum (one-time) payment, be sure to state this. Verification documents are required.
(1) PRESENT
(2) TOTAL INCOME
(1) PRESENT
(2) TOTAL INCOME
PARENT/
SOURCE
MONTHLY
FOR PAST 12
SOURCE
MONTHLY
FOR PAST 12
CHILDREN
INCOME
MONTHS
INCOME
MONTHS
a. WAGES, SALARIES, TIPS, OR
Parent
OTHER CASH GRATUITIES
i. SCHOLARSHIPS OR
b. INTEREST ON INVESTMENTS,
EDUCATIONAL GRANTS
BONDS, SAVINGS, TRUST
Child
FUNDS, ETC.
c. INSURANCE OR PUBLIC/
j. SOCIAL SECURITY
GOVERNMENT PENSION
PAYMENTS, DISABILITY
Parent
PAYMENTS, UNEMPLOYMENT OR
OR REGULAR
DISABILITY COMPENSATION
(Specify type)
(Specify type)
Child
d. NET INCOME FROM RENTAL
Parent
PROPERTY, BUSINESS AND
k. SUPPLEMENTAL
FARMING (Specify type and
SECURITY INCOME (SSI)
Child
explain in Remarks section)
l. VETERANS
e. FOREIGN PENSION PAYMENTS
Parent
ADMINISTRATION
(Specify type and if received
PAYMENTS (Specify type)
based on previous employment,
parent's need, age, military
Child
service, etc., in Remarks section)
f. CONTRIBUTIONS FROM
m. STATE OR LOCAL
PERSONS OTHER THAN
Parent
WELFARE AID,
MEMBER
INCLUDING AID TO
g. TAX REFUNDS (Specify)
DEPENDENT CHILDREN
(Include agency in
Child
Remarks section)
h. OTHER (Specify)
Parent
n. PAYMENT OR ALIMONY
FROM SEPARATED OR
DIVORCED SPOUSE
Child
o. HAS PARENT OR SPOUSE APPLIED FOR ANY TYPE OF PENSION, SOCIAL SECURITY, VA, DISABILITY, UNEMPLOYMENT, OR RETIREMENT
PAYMENTS NOT YET RECEIVED? (If Yes, explain.)
YES
NO
IF PARENT OR SPOUSE HAS REACHED THE ELIGIBILITY AGE FOR SOCIAL SECURITY BENEFITS (Unremarried widow or widower, 60 or older, retired,
62 or older), BUT DOES NOT RECEIVE THEM, FURNISH DISALLOWANCE LETTER FROM THE SOCIAL SECURITY ADMINISTRATION.
DD FORM 137-3, MAR 2018
Page 4 of 5
CUI (when filled in)
PREVIOUS EDITION IS OBSOLETE.
CUI (when filled in)
10. MEMBER'S CONTRIBUTION
a. SHOW THE TOTAL AMOUNT THE MEMBER GAVE PARENT, OR PAID IN PARENT'S BEHALF FOR EACH OF THE PAST 12 MONTHS.
(1) MONTH AND YEAR
(2) AMOUNT
(1) MONTH AND YEAR
(2) AMOUNT
(1) MONTH AND YEAR
(2) AMOUNT
ALLOTMENT
PERSONAL CHECK
MONEY ORDER
b. MEMBER PROVIDES SUPPORT BY (X one)
(Verification documentation is required for BAH claims)
OTHER
(Explain)
11. REMARKS (Use back if necessary)
READ THE PENALTY PROVISIONS, SIGN AND DATE THE FORM, AND HAVE IT NOTARIZED.
NOTE: Whoever, in any matter within the jurisdiction of any department or agency of the United States, knowingly and willfully falsifies, conceals, or covers up by
any trick, scheme, or device, a material fact, or makes any false, fictitious, or fraudulent statements or representations, or makes or uses any false writing or
document knowing the same to contain any false, fictitious, or fraudulent statement or entry, shall be fined as provided in Title 18, or imprisoned not more than 5
years, or both (U.S. Code, title 18, section 1001). The information provided in this form may be referred to the appropriate Military Service investigative agency.
I make the foregoing claim with full knowledge of the penalties involved for willfully making a false claim. (U.S. Code, title 18, section 287,
formerly section 80 provides a penalty as follows: Imprisonment for not more than five years and subject to a fine in the amount provided in this title.)
12. SIGNATURES
a. PARENT(S)
I,
(print name) and
(print name)
will immediately notify the service concerned of any changes in residency, financial circumstances, or dependency upon the member.
(2) DATE SIGNED
(4) DATE SIGNED
(1) PARENT'S SIGNATURE
(3) PARENT'S SIGNATURE
(YYYYMMDD)
(YYYYMMDD)
b. NOTARY PUBLIC
Subscribed and duly sworn (or affirmed) to before me according to law by the above named affiant(s).
This
day of
,
, at city (or town) of
, county of
,
and state (or territory) of
,
,
(Notary)
(Official Seal)
(Official Title)
c. MEMBER
(1) SIGNATURE
(2) DATE SIGNED (YYYYMMDD)
DD FORM 137-3, MAR 2018
Page 5 of 5
CUI (when filled in)
PREVIOUS EDITION IS OBSOLETE.