START

CORRECT

CANCEL

STOP

CHANGE

RECERTIFICATION

REPORT

5. DUTY LOCATION (Include Station, Name, City, State, and Zip Code) 6. 

I certify ALL information regarding this authorization is correct. I will immediately notify the FAO/HRO of any changes in the information above, due to divorce, 

marriage, death, living in government quarters etc, which could affect by BAQ or VHA entitlement. 

IMPORTANT: Making a false statement or claim against the US Government is punishable by courts-martial. The penalty for willfully making a false claim or a false 

statement in connection with claims is a maximum fine of $10,000 or imprisonment for 5 years, or both. 

PRIVACY ACT STATEMENT

AUTHORITY:

PRINCIPLE PURPOSE:

ROUTINE USE:

DISCLOSURE IS VOLUNTARY: 

AUTHORIZATION TO START, STOP, OR CHANGE 

BASIC ALLOWANCE FOR QUARTERS (BAQ),

AND/OR VARIABLE HOUSING ALLOWANCE (VHA)

For use of this form, see AR 37-104-4; the proponent agency is ASA(FM)

37 USC 403; Public Law 96-343; EO 9397.

To start, adjust or terminate military member's entitlement 

to basic allowance for quarters (BAQ) and/or variable 

housing allowance (VHA).

13. DATE 15. DATE 

Rental/Residential Address: Landlord's Name and Address: 

(3) 

MARITAL/DEPENDENCY STATUS

(2) 

(4) 

(2) 

a. b. c. 

(1) 

(2)

(3) 

(3)

(4) 

(Member in grade E7 and 

above)

(2) (3) (1) (2) 

(4) 

(1) 

(5) 

(6) 

c. 

a.

d. 

b. INADEQUATE 

 (see blocks (1), (2) & (4))

QUARTERS ASSIGNMENT/AVAILABILITY

e. DEPENDENT CHILD 

(see blocks (4), (5) & (6))

b. c. 

d. 

a.

DATE/ACTION 

(YYYYMMDD)

9.

SOCIAL SECURITY NUMBER GRADE 

4. 

WITHOUT DEPENDENTS 

If you check "OTHER" above, prepare DD Form 137 to establish dependency. 

MEMBER'S SIGNATURE 

EXPENSES, IF AUTHORIZED, I AM REQUESTING VHA BASED ON

If child support received from another military member, complete (1), (2) & (3). 

CERTIFICATION OF DEPENDENT SUPPORT

BAQ TYPE

WITH DEPENDENTS PARTIAL 

TRANSIENT 

(see block (3))

ADEQUATE 

(see block (1))

NOT AVAILABLE 

QUARTERS 

NO. 

FAIR RENTAL 

VALUE $ 

CERTIFYING OFFICER'S SIGNATURE 

Sharer/Lease Information 

Effective Date: Expiration Date: Landlord's Phone No. 

My permanent duty station: My dependent's location: Both my permanent duty station and dependent's location. 

DOB OF CHILDREN

Member Dependent

TOTALS 

Monthly Expenses: 

Insurance 

Other 

NAME OF DEPENDENT/SHARER RELATIONSHIP

Spouse/Former 

Spouse SSN 

Child in

Custody of:

SINGLE 

LEGALLY SEPARATED 

Member Spouse Former Spouse Other 

Spouse/Former 

Spouse Duty Station 

Date of Marriage, 

Divorce/Separation 

7.

8.

10.

COMMANDER 

DETERMINATION 

(Attached)

MEMBER ELECTION 

12. 

11. 

Address Information 

2. 

TYPE OF ACTION 

3. 

FROM:

16. 

(1) (1)

14.

DA FORM 5960, SEP 1990 REPLACES DA FORM 3298, JUL 80 AND DA FORM 5545, JUL 86 WHICH ARE OBSOLETE APD AEM v2.06ES

1. NAME (Last, First, MI)

(see blocks (1), (2) & (3))

DEPENDENTS/SHARERS (Continue on back if required)

Number of Sharers (show name(s) and address in block 10.)

Mortgage (PITI) or Rent 

COMPLETE CURRENT ADDRESS (Include ZIP Code)

DIVORCED (see

blocks (1), (2) & (3))

(see blocks (1), (2) & (3))

To adjust member's military pay record, information may 

be disclosed to Army components, such as USAFAC, 

major commands, and other Army installations; to other 

DOD components; other federal agencies such as IRS, 

Social Security Administration and VA, GAO, members of 

Congress; State and local government; US and State 

courts, and various law enforcement agencies. Social 

Security Number (SSN) is used for positive identification.

Nondisclosure may result in nonpayment of BAQ and/or 

VHA. Disclosure of your SSN is voluntary. However, this 

form will not be processed without your SSN because 

the Army identifies you for pay purposes by your SSN.

I certify that I can provide, or willing to provide, adequate support for the above named dependents. I am aware that failure to support the above named 

dependents may result in stopping BAQ and recouping BAQ for any prior periods/nonsupport.

IAW service regulations. I certify that the dependency status of my primary dependents, on whose behalf I am receiving BAQ, has not changed so as to affect 

my entitlement thereto for the period.

 TO: 

MARRIED
START

CORRECT

CANCEL

STOP

CHANGE

RECERTIFICATION

REPORT

5. DUTY LOCATION (Include Station, Name, City, State, and Zip Code) 6. 

I certify ALL information regarding this authorization is correct. I will immediately notify the FAO/HRO of any changes in the information above, due to divorce, 

marriage, death, living in government quarters etc, which could affect by BAQ or VHA entitlement. 

IMPORTANT: Making a false statement or claim against the US Government is punishable by courts-martial. The penalty for willfully making a false claim or a false 

statement in connection with claims is a maximum fine of $10,000 or imprisonment for 5 years, or both. 

PRIVACY ACT STATEMENT

AUTHORITY:

PRINCIPLE PURPOSE:

ROUTINE USE:

DISCLOSURE IS VOLUNTARY: 

AUTHORIZATION TO START, STOP, OR CHANGE 

BASIC ALLOWANCE FOR QUARTERS (BAQ), AND/OR VARIABLE HOUSING ALLOWANCE (VHA)

For use of this form, see AR 37-104-4; the proponent agency is ASA (FM)

37 USC 403; Public Law 96-343; EO 9397.

To start, adjust or terminate military member's entitlement 

to basic allowance for quarters (BAQ) and/or 

variable housing allowance (VHA).

13. DATE 15. DATE 

Rental/Residential Address: Landlord's Name and Address: 

(3) 

MARITAL/DEPENDENCY STATUS

(2) 

(4) 

(2) 

a. b. c. 

(1) 

(2)

(3) 

(3)

(4) 

(Member in grade E7 and 

above)

(2) (3) (1) (2) 

(4) 

(1) 

(5) 

(6) 

c. 

a.

d. 

b. INADEQUATE 

 (see blocks (1), (2) & (4))

QUARTERS ASSIGNMENT/AVAILABILITY

e. DEPENDENT CHILD 

(see blocks (4), (5) & (6))

b. c. 

d. 

a.

DATE/ACTION 

(YYYYMMDD)

9.

SOCIAL SECURITY NUMBER GRADE 

4. 

WITHOUT DEPENDENTS 

If you check "OTHER" above, prepare DD Form 137 to establish dependency. 

MEMBER'S SIGNATURE 

EXPENSES, IF AUTHORIZED, I AM REQUESTING VHA BASED ON

If child support received from another military member, complete (1), (2) & (3). 

CERTIFICATION OF DEPENDENT SUPPORT

BAQ TYPE

WITH DEPENDENTS PARTIAL 

TRANSIENT 

(see block (3))

ADEQUATE 

(see block (1))

NOT AVAILABLE 

QUARTERS 

NO. 

FAIR RENTAL 

VALUE $ 

CERTIFYING OFFICER'S SIGNATURE 

Sharer/Lease Information 

Effective Date: Expiration Date: Landlord's Phone No. 

My permanent duty station: My dependent's location: Both my permanent duty station and dependent's location. 

DOB OF CHILDREN

Member Dependent

TOTALS 

Monthly Expenses: 

Insurance 

Other 

NAME OF DEPENDENT/SHARER RELATIONSHIP

Spouse/Former 

Spouse SSN 

Child in

Custody of:

SINGLE 

LEGALLY SEPARATED 

Member Spouse Former Spouse Other 

Spouse/Former 

Spouse Duty Station 

Date of Marriage, 

Divorce/Separation 

7.

8.

10.

COMMANDER 

DETERMINATION 

(Attached)

MEMBER ELECTION 

12. 

11. 

Address Information 

2. 

TYPE OF ACTION 

3. 

FROM:

16. 

(1) (1)

14.

DA FORM 5960, SEP 1990 REPLACES DA FORM 3298, JUL 80 AND DA FORM 5545, JUL 86 WHICH ARE OBSOLETE

1. NAME (Last, First, MI)

(see blocks (1), (2) & (3))

DEPENDENTS/SHARERS (Continue on back if required)

Number of Sharers (show name(s) and address in block 10.)

Mortgage (PITI) or Rent 

COMPLETE CURRENT ADDRESS (Include ZIP Code)

DIVORCED (see

blocks (1), (2) & (3))

(see blocks (1), (2) & (3))

To adjust member's military pay record, information may 

be disclosed to Army components, such as USAFAC, 

major commands, and other Army installations; to other 

DOD components; other federal agencies such as IRS, 

Social Security Administration and VA, GAO, members 

of Congress; State and local government; US and State 

courts, and various law enforcement agencies. Social 

Security Number (SSN) is used for positive identification.

Nondisclosure may result in nonpayment of BAQ and/or 

VHA. Disclosure of your SSN is voluntary. However, this 

form will not be processed without your SSN because 

the Army identifies you for pay purposes by your SSN.

I certify that I provide, or am will to provide adequate support for the above named dependents. I am aware that failure to support the above named 

dependents may result in stopping BAQ and recouping BAQ for any prior periods/nonsupport.

IAW service regulations, I certify that the dependency status of my primary dependents, on whose behalf I am receiving BAQ, has not changed so as to affect 

my entitlement thereto for the period

 TO: 

MARRIED

APD AEM v2.06ES
START

CORRECT

CANCEL

STOP

CHANGE

RECERTIFICATION

REPORT

5. DUTY LOCATION (Include Station, Name, City, State, and Zip Code) 6. 

I certify ALL information regarding this authorization is correct. I will immediately notify the FAO/HRO of any changes in the information above, due to divorce, 

marriage, death, living in government quarters etc, which could affect by BAQ or VHA entitlement. 

IMPORTANT: Making a false statement or claim against the US Government is punishable by courts-martial. The penalty for willfully making a false claim or a false 

statement in connection with claims is a maximum fine of $10,000 or imprisonment for 5 years, or both. 

PRIVACY ACT STATEMENT

AUTHORITY:

PRINCIPLE PURPOSE:

ROUTINE USE:

DISCLOSURE IS VOLUNTARY: 

AUTHORIZATION TO START, STOP, OR CHANGE 

BASIC ALLOWANCE FOR QUARTERS (BAQ), AND/OR VARIABLE HOUSING ALLOWANCE (VHA)

For use of this form, see AR 37-104-4; the proponent agency is ASA (FM)

37 USC 403; Public Law 96-343; EO 9397.

To start, adjust or terminate military member's entitlement 

to basic allowance for quarters (BAQ) and/or 

variable housing allowance (VHA).

13. DATE 15. DATE 

Rental/Residential Address: Landlord's Name and Address: 

(3) 

MARITAL/DEPENDENCY STATUS

(2) 

(4) 

(2) 

a. b. c. 

(1) 

(2)

(3) 

(3)

(4) 

(Member in grade E7 and 

above)

(2) (3) (1) (2) 

(4) 

(1) 

(5) 

(6) 

c. 

a.

d. 

b. INADEQUATE 

 (see blocks (1), (2) & (4))

QUARTERS ASSIGNMENT/AVAILABILITY

e. DEPENDENT CHILD 

(see blocks (4), (5) & (6))

b. c. 

d. 

a.

DATE/ACTION 

(YYYYMMDD)

9.

SOCIAL SECURITY NUMBER GRADE 

4. 

WITHOUT DEPENDENTS 

If you check "OTHER" above, prepare DD Form 137 to establish dependency. 

MEMBER'S SIGNATURE 

EXPENSES, IF AUTHORIZED, I AM REQUESTING VHA BASED ON

If child support received from another military member, complete (1), (2) & (3). 

CERTIFICATION OF DEPENDENT SUPPORT

BAQ TYPE

WITH DEPENDENTS PARTIAL 

TRANSIENT 

(see block (3))

ADEQUATE 

(see block (1))

NOT AVAILABLE 

QUARTERS 

NO. 

FAIR RENTAL 

VALUE $ 

CERTIFYING OFFICER'S SIGNATURE 

Sharer/Lease Information 

Effective Date: Expiration Date: Landlord's Phone No. 

My permanent duty station: My dependent's location: Both my permanent duty station and dependent's location. 

DOB OF CHILDREN

Member Dependent

TOTALS 

Monthly Expenses: 

Insurance 

Other 

NAME OF DEPENDENT/SHARER RELATIONSHIP

Spouse/Former 

Spouse SSN 

Child in

Custody of:

SINGLE 

LEGALLY SEPARATED 

Member Spouse Former Spouse Other 

Spouse/Former 

Spouse Duty Station 

Date of Marriage, 

Divorce/Separation 

7.

8.

10.

COMMANDER 

DETERMINATION 

(Attached)

MEMBER ELECTION 

12. 

11. 

Address Information 

2. 

TYPE OF ACTION 

3. 

FROM:

16. 

(1) (1)

14.

DA FORM 5960, SEP 1990 REPLACES DA FORM 3298, JUL 80 AND DA FORM 5545, JUL 86 WHICH ARE OBSOLETE

1. NAME (Last, First, MI)

(see blocks (1), (2) & (3))

DEPENDENTS/SHARERS (Continue on back if required)

Number of Sharers (show name(s) and address in block 10.)

Mortgage (PITI) or Rent 

COMPLETE CURRENT ADDRESS (Include ZIP Code)

DIVORCED (see

blocks (1), (2) & (3))

(see blocks (1), (2) & (3))

To adjust member's military pay record, information may 

be disclosed to Army components, such as USAFAC, 

major commands, and other Army installations; to other 

DOD components; other federal agencies such as IRS, 

Social Security Administration and VA, GAO, members 

of Congress; State and local government; US and State 

courts, and various law enforcement agencies. Social 

Security Number (SSN) is used for positive identification.

Nondisclosure may result in nonpayment of BAQ and/or 

VHA. Disclosure of your SSN is voluntary. However, this 

form will not be processed without your SSN because 

the Army identifies you for pay purposes by your SSN.

I certify that I provide, or am will to provide adequate support for the above named dependents. I am aware that failure to support the above named 

dependents may result in stopping BAQ and recouping BAQ for any prior periods/nonsupport.

IAW service regulations, I certify that the dependency status of my primary dependents, on whose behalf I am receiving BAQ, has not changed so as to affect 

my entitlement thereto for the period

 TO: 

MARRIED

APD AEM v2.06ES