CTMD Form 4-7 "Report of Financial Liability" - Connecticut

What Is CTMD Form 4-7?

This is a legal form that was released by the Connecticut Military Department - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2021;
  • The latest edition provided by the Connecticut Military Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CTMD Form 4-7 by clicking the link below or browse more documents and templates provided by the Connecticut Military Department.

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CTMD Form 4-7
(New 4/2021)
CONNECTICUT MILITARY DEPARTMENT
INSTRUCTIONS FOR REPORT OF FINANCIAL LIABILITY
PURPOSE: To officially report the facts and circumstances supporting the assessment of financial
charges for the loss, damage, or destruction of state-controlled property.
AUTHORITY: Paragraph 6 of CTMD General Order 2018-3.
INSTRUCTIONS:
UNIT/SECTION INFORMATION: Provide the name and location of your organization into
which the property was assigned.
ITEM INFORMATION: Provide a brief description of the state-owned property as well as the
name of the manufacturer, model, serial number and state tag number. Provide the date the item
was acquired by the organization
INVESTIGATING OFFICER: A Report of Unaccounted Property (CTMD Form 4-5) must be
completed if the Hand Receipt Holder is available to provide their actions taken to protect, locate and
recover the item(s). In the event the Hand Receipt Holder is unavailable, the investigating officer
must provide substantiating comments regarding the circumstances as to why they are unavailable.
If negligence or abuse is evident or suspected, the investigating officer must provide comments
substantiating the claim.
Example 1: “Individual failed to properly secure item despite being instructed to do so by chain
of command”
Example 2: “Individual has refused to turn in assigned uniforms/equipment as required”
In the comments section, the Investigating Officer must provide details of their investigation and
provide recommendations for corrective action, to include their assessment of the Hand Receipt
Holder’s liability.
APPOINTING AUTHORITY: The Appointing Authority is the first person in the chain of
command who has command authority over the Hand Receipt Holder. For example, the
Commandant of the unit for members of the Governor’s Foot & Horse Guard. The Appointing
Authority will approve or disapprove the Investigating Officer’s recommendations and provide
appropriate comments or rationale for that decision.
APPROVING AUTHORITY: The Approving Authority is the direct supervisor of the Appointing
Authority. For example, if the Commandant is the Appointing Authority, the Assistant Adjutant
General is the Approving Authority. The Approving Authority will approve or disapprove the
Investigating Officer’s recommendations and provide appropriate comments or rationale for that
decision. If approved, a Financial Liability Officer will be appointed on appointment orders by the
Approving Authority.
FINANCIAL LIABILITY OFFICER: The Financial Liability Officer will provide their comments and
recommendations and will provide a dollar amount of the loss based on the item’s initial cost, its
replacement cost and reasonable depreciation or appreciation of the item. The Financial Liability
Officer will also determine who is financially liable for the loss, if any and the percentage of that financial
liability.
Page 1 of 5
CTMD Form 4-7
(New 4/2021)
CONNECTICUT MILITARY DEPARTMENT
INSTRUCTIONS FOR REPORT OF FINANCIAL LIABILITY
PURPOSE: To officially report the facts and circumstances supporting the assessment of financial
charges for the loss, damage, or destruction of state-controlled property.
AUTHORITY: Paragraph 6 of CTMD General Order 2018-3.
INSTRUCTIONS:
UNIT/SECTION INFORMATION: Provide the name and location of your organization into
which the property was assigned.
ITEM INFORMATION: Provide a brief description of the state-owned property as well as the
name of the manufacturer, model, serial number and state tag number. Provide the date the item
was acquired by the organization
INVESTIGATING OFFICER: A Report of Unaccounted Property (CTMD Form 4-5) must be
completed if the Hand Receipt Holder is available to provide their actions taken to protect, locate and
recover the item(s). In the event the Hand Receipt Holder is unavailable, the investigating officer
must provide substantiating comments regarding the circumstances as to why they are unavailable.
If negligence or abuse is evident or suspected, the investigating officer must provide comments
substantiating the claim.
Example 1: “Individual failed to properly secure item despite being instructed to do so by chain
of command”
Example 2: “Individual has refused to turn in assigned uniforms/equipment as required”
In the comments section, the Investigating Officer must provide details of their investigation and
provide recommendations for corrective action, to include their assessment of the Hand Receipt
Holder’s liability.
APPOINTING AUTHORITY: The Appointing Authority is the first person in the chain of
command who has command authority over the Hand Receipt Holder. For example, the
Commandant of the unit for members of the Governor’s Foot & Horse Guard. The Appointing
Authority will approve or disapprove the Investigating Officer’s recommendations and provide
appropriate comments or rationale for that decision.
APPROVING AUTHORITY: The Approving Authority is the direct supervisor of the Appointing
Authority. For example, if the Commandant is the Appointing Authority, the Assistant Adjutant
General is the Approving Authority. The Approving Authority will approve or disapprove the
Investigating Officer’s recommendations and provide appropriate comments or rationale for that
decision. If approved, a Financial Liability Officer will be appointed on appointment orders by the
Approving Authority.
FINANCIAL LIABILITY OFFICER: The Financial Liability Officer will provide their comments and
recommendations and will provide a dollar amount of the loss based on the item’s initial cost, its
replacement cost and reasonable depreciation or appreciation of the item. The Financial Liability
Officer will also determine who is financially liable for the loss, if any and the percentage of that financial
liability.
Page 1 of 5
CTMD Form 4-7
(New 4/2021)
CONNECTICUT MILITARY DEPARTMENT
INSTRUCTIONS FOR REPORT OF FINANCIAL LIABILITY
INDIVIDUAL CHARGED: The Individual Charged must be afforded the opportunity to rebut the
findings and recommendations made by all parties. In the event the Individual Charged is unavailable,
three attempts must be made to contact the individual. All attempts can be performed on the same
day.
1. By Phone – Note the date and the number called.
2. By E-Mail – Provide the date of the e-mail and the e-mail address it was sent to. Print
out a copy of the sent e-mail and attach to this document.
3. By Certified Mail – Provide a copy of the certified mail receipt that includes the tracking
number and attach to this document.
FINAL DISPOSITION BY FINANCIAL LIABILITY OFFICER: Based upon any new information
or evidence provided by the Individual Charged, the Financial Liability Officer will make any
adjustments, if any.
CTMD FISCAL BUSINESS OFFICE: Once the recommendation is approved and complete, the
Financial Liability Officer will forward this form and all substantiating documentation to the CTMD Fiscal
Business Office to process invoicing and receiving payment from the Individual Charged.
SEND THIS FORM & SUPPORTING DOCUMENTATION TO:
Connecticut Military Department
Fiscal Business Office
360 Broad Street Room #219
Hartford, Connecticut, 06105-3706
(860) 548-3247 (fax)
Page 2 of 5
RESET FORM
CTMD Form 4-7
(New 4/2021)
CONNECTICUT MILITARY DEPARTMENT
REPORT OF FINANCIAL LIABILITY
UNIT/SECTION INFORMATION:
Organization:
Location:
ITEM INFORMATION:
Item Description
Date Loss Discovered
Manufacturer
Model
Serial Number
State TAG Number
Date Acquired
INVESTIGATING OFFICER
Was a Report of Unaccounted Property Completed
Negligence or abuse evident or suspected:
Yes
No (provide comments)
Yes
No
Comments/Recommendations:
Printed Name
Signature
Date
APPOINTING AUTHORITY:
Recommendation
Comments/Rationale
Approve
Disapprove
Printed Name/Rank
Signature
Date
APPROVING AUTHORITY:
Recommendation
Comments/Rationale
Approve
Disapprove
Printed Name
Signature
Date
Page 3 of 5
CTMD Form 4-7
(New 4/2021)
CONNECTICUT MILITARY DEPARTMENT
REPORT OF FINANCIAL LIABILITY
FINANCIAL LIABILITY OFFICER:
Findings and Recommendations
Dollar Amount of Loss
Recommended Financial Liability
Percentage of Responsibility
Printed Name
Signature
Date
INDIVIDUAL CHARGED:
I have examined the findings and recommendations of the financial liability officer and
Submit the attached statement of objection
Do not intend to make such a statement
I have been informed of my right to legal advice. My signature is not an admission of liability
Printed Name
Signature
Date
Individual refused/failed to respond
Date and phone number called
Date and e-mail sent (attach e-mail)
Date certified mail sent (attach USPS certified mail receipt)
Page 4 of 5
CTMD Form 4-7
(New 4/2021)
CONNECTICUT MILITARY DEPARTMENT
REPORT OF FINANCIAL LIABILITY
FINAL DISPOSITION BY FINANCIAL LIABILITY OFFICER:
No change
Change in Dollar Amount Loss to:
Change in Recommended Financial Liability to:
Change in Percentage of Responsibility to:
Printed Name
Signature
Date
CTMD FISCAL BUSINESS OFFICE
Date Invoice Sent
Invoice Number
Invoice Amount
Printed Name
Signature
Date
Date Payment Received
Financial Institution
Check Number
Page 5 of 5
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