Follow the steps to successfully complete the application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Item 1, provide your personal information. Fill in your full name (last, first, middle initial), social security number, pay grade, military rank, and mailing address, ensuring accuracy.
3. Indicate the period for which you believe arrears are due in Item 2. Enter the start date in the 'From' field and the end date in the 'To' field using the format YYMMDD.
4. In Item 3, check the appropriate box to indicate which branch of the armed forces you have served: Army, Navy, Air Force, Marine Corps, or Coast Guard.
5. Provide the last date you enlisted or entered active duty in Item 4 using the format YYMMDD.
6. In Item 5, enter the last date you were discharged or released from active duty, also in YYMMDD format.
7. Specify the place of discharge (city and state) in Item 6.
8. In Item 7, provide a detailed explanation of the facts and circumstances supporting your claim. If additional space is needed, continue on the reverse side.
9. If you are still on active duty, Item 8 must be completed by your disbursing or finance officer, providing their name, unit/command name, signature, date signed (YYMMDD), and disbursing officer symbol number.
10. Attach all available documentary evidence in support of your claim.
11. Review all entries for accuracy. Once complete, save changes, download, print, or share the form as needed.

Start your application now by completing the necessary documents online.