DD Form 2698 Application for Transitional Compensation

CUI (when filled in)
OMB No. 0704-0578
OMB Expires:
XX/XX/XXXX

APPLICATION FOR TRANSITIONAL COMPENSATION

The public reporting burden for this collection of information, 0704-0578, is estimated to average XX hours/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 the burden estimate or burden reduction suggestions to the
Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@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.

PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 1059, Dependents of members separated for dependent abuse: transitional compensation; commissary and exchange benefits; DoD Instruction 1342.24,
Transitional Compensation for Abused Dependents; and E.O. 9397 (SSN), as amended.
PURPOSE: To validate eligibility, coordinate and process requests, and ensure proper payment of transitional compensation.
ROUTINE USES: Disclosure of records are generally permitted under 5 U.S.C. 522a(b) of the Privacy Act of 1974, as amended. Pursuant to 5 U.S.C. 522a(b)(3), records may be
disclosed as a routine use to the Internal Revenue Service for normal wage and tax withholding, and to receive approved requests from the military services to make payments of
transitional compensation to military member's spouses, former spouses, and other dependents that are determined to be victims of abuse. A complete list of routine uses may be found
in the applicable System of Records Notice; T7347b, Defense Military Retiree and Annuity Pay System Records at: http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORNArticle-View/Article/570196/t7347b/
DISCLOSURE: Voluntary; however, failure to provide the information may result in delay or denial of compensation.

PRESCRIBING AUTHORITY: DoDI 1342.24, Transitional Compensation for Abused Dependents
SECTION I - PAYEE INFORMATION
(If more than one eligible dependent, use Section III - Remarks on page 3 to enter applicable information for each payee.)
1. TYPE OF REQUEST (Select one)
Regular Transitional Compensation Request

Exceptional Eligibility Request

2. PAYEE NAME (Last, First, Middle Initial)

Add Eligible Newborn Child Beneficiary Information

3. SOCIAL SECURITY NUMBER

4. DATE OF BIRTH
(YYYYMMDD)

5. SEX (Select one)

6. ADDRESS
b. CITY

a. STREET (Include apartment no.)

c. STATE (Select one)

d. ZIP CODE

NEEDS DD67

7. RELATIONSHIP TO (FORMER) MEMBER (Select one)
SPOUSE (Date of Marriage (YYYYMMDD)

)

FORMER SPOUSE (Date of Divorce/Annulment (YYYYMMDD)

)

CHILD (includes stepchild and adopted child)

8. INCAPACITATION (All boxes must be completed. Select “N/A” if not applicable. Select “YES” or “NO” for payees with a mental or physical incapacity)
YES

NO

N/A

a. IS PAYEE INCAPABLE OF SELF-SUPPORT BECAUSE OF A MENTAL OR PHYSICAL INCAPACITY?
b. IS INCAPACITY PERMANENT?
c. DID INCAPACITY OCCUR BEFORE AGE 18?
d. DID INCAPACITY OCCUR BETWEEN AGES 18 AND 23?
e. IS PAYEE UNMARRIED?
f. DID PAYEE RESIDE WITH (FORMER) MEMBER OR ELIGIBLE SPOUSE AT THE TIME OF THE DEPENDENT-ABUSE
OFFENSE?
g. IS PAYEE NOW, OR WAS PAYEE AT THE TIME THE PUNITIVE OR OTHER ADVERSE ACTION WAS EXECUTED,
DEPENDENT ON THE (FORMER) MEMBER FOR OVER ONE-HALF OF PAYEE SUPPORT?
9. MINOR PAYEE (All boxes must be completed. Select “N/A” if not applicable. Select “YES” or “NO” if payee is a minor. Payee should complete the section
based on the status on the date the (former) member was convicted of the dependent-abuse offense (via court-martial conviction, U.S. district court
conviction, or State court conviction) or the separation action was initiated.)
YES

NO

N/A
a. IS PAYEE UNDER 18 YEARS OF AGE? (If yes, skip to 9.c.)
b. IS PAYEE BETWEEN AGES 18 AND 23? (If no, skip to 9.c.)
i. Is payee enrolled in full-time course of study in institution of higher learning approved by Secretary of Defense?
ii. Is payee now, or was payee at the time the punitive or other adverse action was executed, dependent on the
(former) member for over one half of payee's support?
c. IS PAYEE UNMARRIED?
d. DID PAYEE RESIDE WITH (FORMER) MEMBER OR ELIGIBLE SPOUSE AT THE TIME OF THE DEPENDENT ABUSE?

DD FORM 2698, DRAFT 20240521
PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

Controlled by: USD(P&R) MPP- Military Compensation Policy
Page
CUI Category: Privacy
Distribution/Dissemination Control: FEDCON
POC: Assistant Director for Transitional Compensation - (703) 693.9075

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10. COURT-APPOINTED GUARDIAN (Complete only if payee has a court-appointed guardian, as defined by DoDI 1342.24)
a. NAME (Last, First, Middle Initial) b. STREET ADDRESS (Include apartment/suite no.) c. CITY

d. STATE

e. ZIP CODE

11. CUSTODY OF DEPENDENT CHILDREN (If payee is spouse or former spouse, enter names of dependent children from Section II, block 11 who are in
payee's custody. If all, enter "ALL".)

12. PAYEE CERTIFICATION. I certify, under penalty of law, that the information above is true and correct to the best of my knowledge. I understand that I may
not receive payment under both Section 1059 and Section 1408(h) of Title 10, U.S.C. and, if eligible for both, I must elect which to receive. By completing this
form, I am electing to receive payment under Section 1059, Title 10, U.S.C. I further certify that:
a. For spouses/former spouses:

b. For eligible dependents 18 to 23 and court-appointed guardians:

(1) I am not cohabitating with the (former) member.

(1) The payee is not cohabitating with the (former) member or an ineligible
spouse/former spouse.

(2) I have not remarried.

(2) The payee is not married.

(3) I have custody of the dependent children listed in block 11.

(3) The payee resided with the (former) member or eligible spouse at the time of
the dependent abuse offense resulting in conviction/administrative separation.

(4) I was married to the (former) member in Section II, block 2 at the time of
the dependent abuse offense resulting in conviction/administrative
separation.

(4) I will notify DFAS within 30 days of any changes in payee's status, such as
the payee marrying or cohabitating with the (former) member or ineligible
spouse/former spouse.

(5) I will notify DFAS within 30 days of any changes in status, such as
remarrying or cohabitating with the former spouse.
c. SIGNATURE (Applicant acknowledges that acceptance of payments if the
offender rejoins household is punishable under the law.)

d. DATE SIGNED (YYYYMMDD)

NEEDS DD67
SECTION II - MEMBER IDENTIFICATION

1. BRANCH OF SERVICE (Select one)

2. MEMBER NAME (Last, First, Middle Initial)

7. OBLIGATED SERVICE DATES

AIR FORCE

ARMY

3. PAY GRADE (Prior to
conviction or separation)

MARINE CORPS

NAVY

4. SOCIAL SECURITY NUMBER

SPACE FORCE

5. DATE OF BIRTH
(YYYYMMDD)

6. SEX (Select one)

b. EXPIRATION OF ACTIVE OBLIGATED SERVICE
(Enlisted only)

a. ACTIVE DUTY SERVICE ENTRY DATE

8. PAYMENT DATES

a. START

b. STOP

9. DATE OF APPROVAL OF THE COURT-MARTIAL
SENTENCE/U.S. DISTRICT COURT SENTENCE/
STATE COURT SENTENCE/ADMINISTRATIVE
SEPARATION

c. BASIS FOR START DATE

10. CERTIFYING OFFICIAL’S STATEMENT OF CERTIFICATION. I
certify -ORdo not certify the offense resulting in court-martial conviction, U.S.
district court conviction, State court conviction, or involved in administrative separation is a dependent-abuse offense in accordance with DoD regulations. If
married and the dependent-abuse victim is a dependent child or children, the spouse was not a participant in the abuse offense.
d. TELEPHONE (Include
a. NAME/SIGNATURE
b. TITLE
c. DATE SIGNED
area code)
e. STREET ADDRESS (Include apartment or suite no.)

f. CITY

g. STATE

h. ZIP CODE

11. DEPENDENT CHILDREN AT THE TIME OF THE ABUSE (Continue in Section III Remarks, if necessary)
a. NAME (Last, First, Middle Initial)

DD FORM 2698, DRAFT 20240521
PREVIOUS EDITION IS OBSOLETE.

b. SOCIAL SECURITY NUMBER

CUI (when filled in)

c. DATE OF BIRTH (YYYYMMDD)

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Yes

No

Projected date of delivery (Provide medical proof of pregnancy)

12. Were you pregnant at the time of dependent abuse? (Select one)
SECTION III - REMARKS
(Use this area to continue items as necessary. Reference each entry by Section and block number.)

NEEDS DD67
SECTION IV - APPROPRIATION DATA
1. DFAS-CL IS AUTHORIZED TO CITE FOLLOWING APPROPRIATIONS FOR PAYMENT:

2. FUND CITE APPROVING OFFICIAL TITLE

a. TELEPHONE (include area b. STREET ADDRESS (Include apartment or suite number)
code)

c. CITY

e. ZIP CODE

d. STATE

DD FORM 2698, DRAFT 20240521
PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

f. NAME/SIGNATURE

g. DATE SIGNED
(YYYYMMDD)

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