Prescribed by: DoD 1700.14-R 

PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

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Controlled by: DFAS 

CUI Category: PRVCY 

LDC: FEDCON 

POC: 1 (888) 332-7411

DD FORM 2789, JUNE 2019 Page 1 of 6

WAIVER/REMISSION OF INDEBTEDNESS APPLICATION OMB No.0730-0009 

OMB expires: 20240831

If more space is needed, continue on separate sheet(s). Identify each item by number. For further guidance with completing this form, please visit: www.dfas.mil/

waiversandremissions.html

The public reporting burden for this collection of information is estimated to average 2 hours 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the 

burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@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 DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION.

- Active duty military, Guard/Reserve, retired or annuitant pay recipients, civilian employees, return completed form to the address listed on the debt notification letter for completion of the back side. 

- Separated Military or former civilian employees, please see instructions website regarding where to send your claim. 

- Current Active Duty Military, Guard, Reserve, Retired or Annuitant Pay Recipients, Civilian Employees: Complete Fields 1-19 For completion of the second page of the form. RETURN 

- THE FORM TO: DFAS-IN DEPT 3300 (WAIVER/REMISSION), 8899 East 56TH Street, Indianapolis, IN 46249-3300 Unless instructed to send to a different address on debt notification letter. 

- Separated Military or Former Civilian Employees complete fields 1-19. Send form to DFAS-IN DEPT. 3300 (WAIVER/REMISSION), 8899 East 56TH Street, Indianapolis, IN 46249-3300

Read Privacy Act Statement and Instructions beginning on Page 3 before completing form.

1. TYPE OF CLAIM (X one) WAIVER REMISSION (Not applicable for civilians) (If Army, please use DA Forms 3508 and 2823.)

 Authority for granting waiver: Active/Retired Military - 10 U.S.C. 2774; National Guard - 32 U.S.C. 716; Civilian - 5 U.S.C. 5584; Annuitant - 10 U.S.C. 

 1442/1453. Remission: Army - 10 U.S.C. 4837; Navy - 10 U.S.C. 6161; Air Force - 10 U.S.C. 9837.

SECTION I - CIVILIAN/MILITARY/RETIREE/ANNUITANT INFORMATION

2. NAME (Last, First, Middle Initial) 3. RANK/GRADE 4. SOCIAL SECURITY NUMBER

5. AGENCY/SERVICE (X one)

ARMY

NAVY

AIR FORCE

MARINE CORPS

OTHER (Specify)

6. STATUS (X applicable block and provide date (YYYYMMDD) for end of enlistment period (EOE), retirement 

 (DOR), separation (DOS), or service computation date (SCD), as appropriate.)

EOE:

EOE:

DOR:

ACTIVE

GUARD/RESERVE

RETIRED

SEPARATED

DOD CIVILIAN

ANNUITANT

DOS:

SCD:

7. CURRENT COMPLETE MAILING ADDRESS 

 (Street, City, State, ZIP Code)

8. PLACE OF ASSIGNMENT OR EMPLOYMENT 9. TELEPHONE(Include DSN or area code)

a. WORK 

b. HOME

c. E-MAIL ADDRESS

10. TYPE OF DEBT OR ERRONEOUS PAYMENT 11. GROSS DEBT AMOUNT

12. STATE THE DATE AND HOW YOU FIRST BECAME AWARE OF DEBT OR ERRONEOUS PAYMENT. (Attach notification, if available.)

13. IF YOU WERE AWARE OF DEBT OR ERRONEOUS PAYMENT, EXPLAIN THE ACTIONS YOU TOOK TO CORRECT SITUATION.

14. REASON FOR REQUESTING WAIVER/REMISSION AND WHY YOU BELIEVE IT SHOULD BE APPROVED 

 (Financial hardship applies ONLY to REMISSION and if claimed, a financial statement must be attached to include all supporting documentation.)

15. FOR ANNUITANTS, PROVIDE NAME, SSN AND DATE DECEASED OF MILITARY MEMBER/SPONSOR.

16a. ATTACH COPIES OF ALL PERTINENT DOCUMENTS (Such as Request for BAH, Statement of Service, Separation Worksheet, DD Form 214,Travel 

 Voucher, Notification of Personnel Action). (If not available, please explain.)

16b. HR POINT OF CONTACT (Civilian employees) 16c. HR POC PHONE 

17a. IF MILITARY OR CIVILIAN, DID YOU RECEIVE LEAVE AND EARNINGS STATEMENT(S)? YES NO

17b. IF MILITARY OR CIVILIAN, DID YOU REQUEST THEM ON MYPAY? YES NO

17c. IF RETIREE OR ANNUITANT, DID YOU RECEIVE AN ACCOUNT STATEMENT? YES NO

17d. IF RETIREE OR ANNUITANT, DID YOU REVIEW THEM? YES NO

(If answer to a. or c. is Yes, attach a copy of statement covering before, during, and after period. If No, explain why.)

18. HAVE YOU FILED FOR A CORRECTION OF MILITARY RECORDS? YES NO

19. I certify the above statements are true and correct to the best of my knowledge. The information presented may be referred to the appropriate 

 investigating office for verification. I understand the penalty for a false claim is a maximum fine of $10,000 or a maximum imprisonment of 5 years, 

 or both.

a. SIGNATURE (Electronic or Handwritten/Typed not accepted) b. JOB TITLE/CAREER FIELD c. DATE SIGNED (YYYYMMDD)
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DD FORM 2789, JUNE 2019 Page 2 of 6

20. COMMANDER'S ENDORSEMENT (Required for Space Force, Air Force and Navy active duty and reserves. Optional for all others.)

21. RECOMMENDATION APPROVE PARTIAL $ DENY RECOMMEND COLLECTION RATE $

22a. COMMANDER'S OR SUPERVISOR'S NAME 

 (Please print)

22b. SIGNATURE (Electronic or Handwritten/Typed not 

accepted)

c. DATE SIGNED (YYYYMMDD)

SECTION II - REPORT OF INVESTIGATION 

To be completed and signed by appropriate payroll/travel office. (Not applicable for retirees, annuitants, or out-of-service military members.)

23. INFORMATION ON DEBT OR ERRONEOUS PAYMENT(S)

a. GROSS DEBT AMOUNT b. TYPE(S) OF PAYMENT(S) c. DATE(S) OF PAYMENT(S) 

 (YYYYMMDD)

d. (X and complete as applicable) YES NO

(1) HAS THE DEBT BEEN VALIDATED?

(2) HAS THE DEBT BEEN POSTED TO THE DEBTOR'S RECORDS?

(3) REMISSION: HAS THE COLLECTION ACTION BEEN SUSPENDED?

(4) WAIVER: HAS FINANCE OFFICE SUSPENDED COLLECTION IAW DoD 1700.14-R?

(5) DATE THE DEBT WAS 

 DISCOVERED (YYYYMMDD)

(6) NAVY ONLY: AMOUNT 

 UNCOLLECTED AS OF DATE OF 

 THE COMMANDER'S SIGNATURE: 

$

24. A DEBT COMPUTATION MUST ACCOMPANY THIS APPLICATION. It must include dates of erroneous payments, what was paid (broken down by month 

 by entitlements), what should have been paid, and the difference. The total debt must equal the debt posted to the debtor's record. Indicate any entitlements 

 or credits used to offset the debt. This application will be returned without action if the computation is not included. See instructions website for 

 examples.

a. ENTITLEMENT b. DATE(S) (YYYYMMDD) c. WAS PAID d. SHOULD HAVE BEEN PAID e. DIFFERENCE

25. DETAILED STATEMENT OF HOW AND WHY ERROR OCCURRED.

26. IS THERE ANY INDICATION OF FRAUD, MISREPRESENTATION, FAULT, OR LACK OF GOOD FAITH ON THE PART OF THE CLAIMANT?

YES (Explain) NO

27. STATEMENT AS TO WHETHER OR NOT THE CLAIMANT KNEW OR SHOULD HAVE BEEN AWARE OF RECEIVING AN ERRONEOUS PAYMENT. 

 (Furnish facts and circumstances to support answer, state whether claimant received documents, and provide copies, if available. Use a separate sheet of 

 paper if additional space is required.)

28. REMARKS (Attach a separate sheet of paper, if needed.)

29. RECOMMENDATION APPROVE PARTIAL $ DENY

30. DESIGNATED FINANCIAL AGENT

a. SIGNATURE (Electronic or Handwritten/Typed not 

accepted)

b. TITLE c. DATE SIGNED (YYYYMMDD)

31a. COMPLETE UNIT MAILING ADDRESS 31b. POINT OF CONTACT NAME

31c. TELEPHONE 31d. DSN 

e. ADSN/DSSN/UIC f. E-MAIL ADDRESS
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DD FORM 2789, JUNE 2019 Page 3 of 6

PRIVACY ACT STATEMENT 

AUTHORITY: Waiver authority: 10 U.S.C. 1442, "Recovery of Annuity Erroneously Paid;" 10 U.S.C. 1453, "Recovery of 

Amounts Erroneously Paid;" 10 U.S.C. 2774, "Claims for Overpayment of Pay and Allowances and of Travel and Transportation 

Allowances;" 32 U.S.C. 716, "Claims for Overpayment of Pay and Allowances, and Travel and Transportation; and E.O. 9397 

(SSN), as amended. Remissions authority: Navy 10 U.S.C. 6161; Air Force 10 U.S.C. 9837 

PRINCIPAL PURPOSES(S): To be used by civilian employees (current, former, or retired) and military members (active, 

separated or retired), and annuitants to request waiver of indebtedness collection for erroneous payments of salary or pay and 

allowances and expense reimbursement or allowances for travel, transportation, and relocation; or in the case of enlisted 

members, remission of debts. 

ROUTINE USE(S): For a complete list of routine uses, visit the applicable systems of records notices: 

T7332, Defense Debt Management System: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/ 

Article/570181/t7332/ 

T7335, Defense Civilian Pay System: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/

Article/570184/t7335/ 

T7340, Defense Joint Military Pay System – Active Component: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wideSORN-Article-View/ 

Article/570191/t7340/ 

T7344, Defense Joint Military Pay System – Reserve Component: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wideSORN-Article-View/ 

Article/570195/t7344/ 

DISCLOSURE: Voluntary; however, failure to provide this information will result in initiating administrative or salary offset 

procedures under the provision of the Debt Collection Act of 1982 (Pub. L. 97-365, as amended by Pub L. 104-134, the Debt 

Collection Improvement Act of 1996).

INSTRUCTIONS FOR COMPLETING DD FORM 2789, 

WAIVER/REMISSION OF INDEBTEDNESS APPLICATION 

Please note: If you do not agree with the validity of your debt, a waiver request cannot be processed. You must first agree that 

the debt is valid. This is not admission to or agreement that you should be responsible for the repayment of the debt. It merely 

means that you agree that you received an erroneous payment or an overpayment. Once you agree with the validity of the debt 

you may file for waiver at that time. Please visit www.dfas.mil/waiversandremissions for guidance with completing and 

submitting your waiver. 

To complete the DD Form 2789, please follow instructions below. Please note that an incomplete DD Form 2789 will 

delay the processing of the Remission/Waiver consideration. Carefully read and complete all information as requested, 

and be sure to include any required documentation with your submission. If DFAS does not receive a valid DD Form 

2789, the indebtedness will continue to be collected. For sections 10 through 16, if you need additional space for this 

information you can attach a typed and a signed document. All fields must be filled out. If some fields do not apply to 

you, please put Not Applicable (N/A). 

INSTRUCTIONS BY SECTION:

1. Type of claim (Remission/Waiver) 

 (Required)

Place an “X in appropriate box. All service members may 

apply for Remission. (Army, Navy, AF, and US M C). Waiver 

applicants please refer to http://www.dfas.mil/

waiversandremissions.html for the Remission process. 

USMC-please refer to 

http://www.dfas.mil/waiversandremissions.html

to reference address.The debt had to occur while on Active 

Duty, not National Guard Bureau, or Reserve Duty. 

AF/USMC-use DD Form 2789. Please refer to 

http://www.dtic.mil/whs/directives/infomgt/forms/eforms/

dd2789.pdf and send the DD Form 2789 to your agency. 

Army - use DA Form 3508. Please refer to http:// 

armypubs.army.mil/eforms/pdf/a3508.pdf and send the DA Form 

3508 to the Army (HRC). 
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DD FORM 2789, JUNE 2019 Page 4 of 6

INSTRUCTIONS: Page 1, Section I - Civilian /Military/Retiree/Annuitant Information 

2. Name (Required)

3. Rank/Grade (status at the time of debt) 

(Required) 

Civilians: Grade. 

Military: Rank. 

Retirees: Retired rank/rate. 

Annuitants: Not applicable. 

4. Social Security Number (Required) Debtor’s Social Security Number.

5. Agency/Service (Required) 

Civilian: Check “Other” and specify what Agency at the time of 

debt. 

Military: Mark branch of Service. 

Retirees: Mark branch of Service. 

Annuitants: Mark “Other” and specify “Annuitant”. 

6.

Status at the time of debt (Required) 

 Please “X” the applicable box and provide 

 date (YYYYMMDD) for end of enlistment 

 period (EOE), retirement (DOR), or 

 service computation date (SCD), as 

 appropriate. 

Active: Fill in “EOE”. 

Guard/Reserve: Fill in “EOE. 

Retired: Fill in “DOR”. 

Separated: Fill in “DOS”. 

DOD Civilian: Fill in “SCD”. 

Annuitant: Only need to “X” the box, no date needed.

7. Current mailing address (Required) Current mailing address

8. Place of assignment or Employment

Civilian: Employing Agency. 

Military: Employing Agency/Assignment. 

Retirees: Not applicable (Mark N/A). 

Annuitants: Not applicable (Mark N/A). 

9a. Work Telephone (Required) Work telephone number (if applicable). 

9b. Home Telephone 

(Required if no work phone) Home and/or cell telephone number. 

9c. E-Mail Address .gov or .mil e-mail preferred. 

10. Type of Debt or Pay and Allowance 

 Erroneously Paid Brief description of debt as stated in debt notification letter. 

11. Gross Debt Amount (Required) Gross debt amount provided on debt notification letter.

12.

State the date and how you first became 

aware of the erroneous payment. 

(Required) 

Date debt notification letter (or other correspondence, if 

applicable) was received. Attach copy of notification letter or 

other correspondence. 

13.

If you were aware of the debt or 

erroneous payment, explain the 

actions you took to correct the situation. 

(Required) 

Explain any actions taken to correct the debt or prevent debt 

from occurring. If needed, explanation can continue on 

additional pages. Any additional explanations and 

documentation (emails, letters, etc.) showing your attempts 

should be signed and submitted with the completed form.

14.

Reason for requesting a Remission/

Waiver and why you feel it should be 

approved. (Required) 

Explain why you think your Remission/Waiver request should be 

approved. Submit any additional documentation with the 

completed form.

15.

For Annuitants, provide name, SSN, 

and date of death of deceased Military 

member/sponsor. (Required) 

Retirees: Not Applicable (Mark N/A). 

Annuitants: State deceased spouse/sponsor’s full name, SSN, 

and date of death. 
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DD FORM 2789, JUNE 2019 Page 5 of 6

16a. Attach copies of all pertinent documents 

(Required) 

Attach any supporting documentation from parts #12 

through #14. 

16b. HR Point Of Contact (POC) (Civilian 

employees only) (Required) Write HR contact and Telephone number.

16c. HR POC phone 

17a.

If Military or Civilian, did you receive 

Leave and Earnings Statement(s)? 

(Required) 

Retirees and Annuitants: Not Applicable.

17b. If Military or Civilian, did you request 

them on on My Pay? (Required) Retirees and Annuitants: Not Applicable.

17c. If Retiree or Annuitant, did you receive a 

Retiree Account Statement? (Required) 

Retirees and Annuitants: Mark “Yes” if you received an Account 

Statement regarding the debt. Mark "No" if you did not receive 

an Account Statement regarding the debt. 

If “Yes”, attach a copy of the statement covering before, during, 

and after notification. 

17d. If Retiree or Annuitant, did you review 

them? (Required)

Retirees and Annuitants: Mark “Yes” if you reviewed the 

Account Statement. Mark “No’ if you did not review the Account 

Statement.

18. Have you filed for a Correction of Military 

Records? (Required)

Military and Retirees: Mark “Yes” if you have filed for a 

Correction to Military Record. (Please provide all documentation 

from the Board of Corrections concerning their findings). Mark 

“No” if you have not filed for a Correction to Military Record. 

Annuitants can request a change through Annuity Pay 

Office.

19a. Signature (Electronic or Handwritten) 

Required

Sign form if you certify that your statements on this form are 

true and correct to the best of your knowledge. An unsigned 

form is considered invalid, cannot be processed, and will be 

returned.

19b. Job Title/Career Field Civilian and Military: Career Field Retirees: Mark “Retired” 

Annuitants: Mark “Annuitant”.

19c. Date signed (Required) Mark date form was completed and signed. An undated form is 

considered invalid, cannot be processed, and will be returned.

Page 2: Parts 20 through 31. Section I - Active duty/Reserves/Federal Civilian Employees

20.

Commander’s Endorsement (Required for 

Navy active duty and reserves. Optional 

for all others.)

Please have your commanding officer provide a statement 

expressing his or her opinion of the Waiver/Remission request. 

This is required for Space Force, Air Force, and Navy active 

duty and reserve members. Federal civilian employees and 

service members (including guard and reserves) of the Army, 

and USMC are not required to provide a supervisor or 

commander endorsement, but have the option to do so..

21. Recommendation 

22a. Commander’s or Supervisor’s Name 

22b. Commander’s or Supervisor’s Electronic 

or Handwritten Signature 

22c. Date Signed 

Section II - Report of Investigation. To be completed and signed by Military payroll/travel office/civilian payroll, 

or finance office. (not applicable for retirees, annuitants, or out of service military members). 

23a. Gross Debt Amount Amount of Gross Debt.
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DD FORM 2789, JUNE 2019 Page 6 of 6

23b. Type(s) of Payments List type of payments included in debt.

23c. Date(s) of Payment(s) List the dates of payments received.

23d1. 23d1. Has the debt been validated? Check yes or no.

23d2. Has the debt been posted to the debtor’s 

records? Check yes or no.

23d3. Remission: Has the collection action 

been suspended? Check yes or no.

23d4.

Waiver: Has finance office suspended 

collection in accordance with DoD 

1700.14-R? 

Check yes or no.

24a. Entitlement Provide type(s) of entitlement included in debt broken down 

monthly. 

24b. Dates Provide exact dates of the indebtedness. The debt must be 

broken down by month. 

24c. Was Paid Provide the amount member was paid, broken down by month. 

24d. Should have been paid Provide the amount the member should have been paid, broken 

down by month.

24e. Difference

Provide the difference amount between what the member was 

paid, and should have been paid. The difference amount must 

be broken down by month. 

25. Detailed statement of how and why error 

occurred.

Provide detailed explanation for how and why the error 

occurred. 

26.

Is there any indication of fraud, 

misrepresentation, fault, or lack of good 

faith on the part of the claimant?

Check yes or no, if yes, please provide a detailed explanation. 

27.

Statement as to whether or not the 

claimant knew or should have been aware 

of receiving an erroneous payment. 

Provide a detailed statement which indicates whether the 

claimant knew or should have known he or she was receiving 

erroneous payments. 

28. Remarks Provide any additional statements, facts, or remarks. 

29. Recommendation Provide recommendation for waiver request. Please indicate 

approve, partial, or deny. 

30a. Designated Financial Agent Electronic or 

Handwritten Signature Provide hand written signature of designated financial agent. 

30b. Title Provide title of signature of designated financial agent.

30c. Date Signed Provide date of signature of designated financial agent.

31a. Complete Unit Mailing Address Provide complete mailing address of Unit.

31b. Point of Contact Name Provide point of contact for questions regarding the Waiver/

Remission request. 

31c. Telephone Provide telephone number for the point of contact. 

31d. DSN Provide DSN for point of contact. 

31e. ADSN/DSSN/UIC Provide applicable ADSN, DSSN, UIC. 

31f. E-Mail Address Provide e-mail address for point of contact.