Form DD Form 2827 DD Form 2827 Application for Trusteeship

OMB No. 0730-0013
OMB approval expires
Jan 31, 2007

APPLICATION FOR TRUSTEESHIP

The public reporting burden for this collection of information is estimated to average 30 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 this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0730-0013). 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.

RETURN COMPLETED APPLICATION TO:

Defense Finance and Accounting Service
Continuing Government Activity (CGA)
P.O. Box 998021, Room 2323
Cleveland, OH 44199-8021

PRIVACY ACT STATEMENT
AUTHORITY: 37 U.S.C. Section 602; Department of Defense Financial Management Regulation 7000.14-R, Vol. 7-A, Chapter 33, and Vol. 7B,
Chapter 16; and E.O. 9397.
PRINCIPAL PURPOSE: To apply for appointment of trusteeship for a mentally incompetent member of the uniformed services who may be either on
active duty or retired.
ROUTINE USE(S): The information on this form may be disclosed as generally permitted under 5 U.S.C. Section 552a(b) of the Privacy Act, as
amended. It may also be disclosed outside of the Department of Defense to the Internal Revenue Service for tax purposes, Department of Veterans
Affairs, and Social Security Administration, regarding pay entitlements, American Red Cross for locator service; and military aid societies for family
assistance. In addition, other Federal, State, or local government agencies, which have identified a need to know, may obtain this information for the
purpose(s) identified in the DoD Blanket Routine Uses as published in the Federal Register.
DISCLOSURE: Disclosure is voluntary; however, if the information is not provided, an appointment of a trustee cannot be made.

SECTION I - INFORMATION ABOUT THE SERVICE MEMBER
1. NAME (Last, First, Middle Initial)

2. SOCIAL SECURITY NUMBER

3. BRANCH OF SERVICE

4. RANK

5. CURRENT ADDRESS (Street, Apartment Number, City, State, and ZIP Code)

7. STATUS OF MEMBER (X one)
HOSPITALIZED/
NURSING HOME

6. TELEPHONE (Include Area
Code)

(If member is not at home, give name and address of facility)

HOME
OTHER (Specify)

SECTION II - APPLICATION FOR TRUSTEESHIP
8. I,

, request that I be designated Trustee to receive and administer

payments of active duty or retired pay on behalf of the above cited member who is unable to manage his/her own financial affairs. I certify that I am
21 years of age, or older, and that I have reasonable cause in maintaining funds for the welfare and benefit of the cited member.
My relationship to the cited member is:
LAWFUL SPOUSE
CHILD
OTHER (Specify)
HEAD OF INSTITUTION OF CONFINEMENT

PARENT

ADOPTED CHILD

9. MEMBER'S IMMEDIATE FAMILY (Attach continuation sheet if necessary)
a. NAME (Last, First, Middle Initial)

b. DATE OF BIRTH
(YYYYMMDD)

c. ADDRESS (Street, City, State, ZIP Code)

d. RELATIONSHIP

10. CONDITIONS
Regulations established pursuant to appointing a Trustee to receive pay on behalf of mentally incompetent members who are incapable of handling
their own financial affairs, provided a guardian or other legal representative has not been appointed by a court of competent jurisdiction, require the
Trustee named to:
a. Provide a suitable bond, paid from amounts due the member, when payments can reasonably be expected to exceed $1,000.
b. Post a new bond equal to the Trustee bank account balance, plus the projected accrual for 12 months following the date of such balance, if
requested to do so by the Director of the appropriate Defense Finance and Accounting Service Center.
c. Deposit all funds in a special bank account and draw checks in the name of the Trustee or persons to whom payments are made.
THE TRUSTEE WILL NOT DRAW CHECKS TO "CASH" OR PAYABLE TO THE MEMBER.
d. Serve the best interests of the member without fee of any kind. Trustee may not obligate funds for attorney fees or similar charges.
e. Obtain prior approval before expending funds on other than ordinary items needed for member's maintenance, care and comfort.
f. Submit financial reports on a recurring basis, as may be directed, using the form furnished. Support all expenditures with cancelled checks or
receipts and bank statements showing balances.
Trusteeship is subject to termination upon death of the member; death or disability of Trustee; appointment of a committee, guardian or fiduciary by
a competent court; failure of Trustee to render reports; improper use of DoD funds; medical determination of member's return to competency; or
discretion of the Director of the appropriate DFAS Center.
11. APPLICANT'S SIGNATURE

12. ADDRESS (Street, City, State, ZIP Code)

13. TELEPHONE (Include
Area Code)

14. DATE
(YYYYMMDD)

SECTION III - DESIGNATION OF TRUSTEE (Do not write in this area.)
is hereby appointed as Trustee to receive and disburse funds on
behalf of the mentally incompetent member of the United States military named above. This designation is contingent on compliance with the
instruction given by DFAS-CL/DE personnel.
15. DESIGNATOR NAME (Last, First, Middle
Initial)

DD FORM 2827, JUN 2006

16. TITLE

18. DATE
(YYYYMMDD)

17. SIGNATURE

PREVIOUS EDITION IS OBSOLETE.

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