Address change form privacy act statement




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ADDRESS CHANGE FORM

PRIVACY ACT STATEMENT
Personal information is solicited on this form. As required by the Privacy Act of 1974, we advise:

1. AUTHORITY: 37 U.S.C. 101 et seq. 5 U.S.C., Chapter 55; 10 U.S.C., Chapters 67.71, and 871; Title 39, U.S.C. 406 and Title 10, U.S.C. 8013; E.O. 9397, Nov 1943

2. PRINCIPAL PURPOSES: To permit address changes for the Joint Uniform Military Pay System (JUMPS), the Retired Pay Systems, the Reserve component pay

systems, and the civilian pay systems. To maintain a record of current address for pay related matters and bonds.

3. ROUTINE USES: Information may be disclosed to the General Accounting Office to provide financial information; Federal, State, and local courts for tax and welfare

purposes; U.S. treasury to provide information on bonds purchased; and to the Department of Justice in some cases for criminal prosecution, civil litigation, or investigative purposes.

4. DISCLOSURE: Voluntary; however, failure to provide the requested information as well as the SSN may result in a delay in receipt of funds, Leave and Earnings Statement, Net Pay Advices, and miscellaneous pay-related documents.



Complete section 1 to change your mailing or organizational address for pay related items. Complete Section 2 to change the mailing address for some or all of your payroll deduction U.S. Savings Bonds. Civilian employees do not use Section 2 for bonds.

SECTION 1

NAME


Social Security #



CHECK ONE:

AD  RET  CIV 

GUARD/RES 

AIR FORCE  ARMY 



NEW MAILING ADDRESS

NUMBER, STREET, PO BOX



CITY, STATE, ZIP, APO/FPO



NEW ORGANIZATIONAL ADDRESS

UNIT/OFFICE SYMBOL

     


DUTY PHONE

     


BOX NO

     


RNLTD

     


DEPARTURE DATE

     


EST ARR DATE

     


GRADE

     


LOCAL ADDRESS

     


HOME PHONE

     


FORWARDING ADDRESS

     


SECTION 2

ADDRESS CHANGE FOR PAYROLL DEDUCTION BONDS




NEW

 (CHECK HERE IF THE SAME MAILING ADDRESS AS IN SECTION 1 AND COMPLETE FIRST BLOCK BELOW)






NEW

 (CHECK HERE IF THE SAME MAILING ADDRESS AS IN SECTION 1 AND COMPLETE FIRST BLOCK BELOW)


B

O



NAME TO WHOM MAILED

     

B

O


NAME TO WHOM MAILED

     


N

D

#1



NUMBER, STREET, PO BOX

     


N

D

#2



NUMBER, STREET, PO BOX

     





CITY, STATE, ZIP, APO/FPO

     





CITY, STATE, ZIP, APO/FPO

     





NEW

 (CHECK HERE IF THE SAME MAILING ADDRESS AS IN SECTION 1 AND COMPLETE FIRST BLOCK BELOW)






NEW

 (CHECK HERE IF THE SAME MAILING ADDRESS AS IN SECTION 1 AND COMPLETE FIRST BLOCK BELOW)


B

O



NAME TO WHOM MAILED

     

B

O


NAME TO WHOM MAILED

     


N

D

#3



NUMBER, STREET, PO BOX

     


N

D

#4



NUMBER, STREET, PO BOX

     





CITY, STATE, ZIP, APO/FPO

     





CITY, STATE, ZIP, APO/FPO

     


SIGNATURE OF MEMBER/EMPLOYEE



DATE


AF Form 1745, NOV 90 (Word 6.0)

PREVIOUS EDITION WILL BE USED







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