Form DD2789 WAIVER/REMISSION OF INDEBTEDNESS APPLICATION

CUI (when filled in)

Prescribed by: DOD 1700.14-R

OMB No.0730-0009
OMB expires: 20240831

WAIVER/REMISSION OF INDEBTEDNESS APPLICATION

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.
WAIVER

1. TYPE OF CLAIM (X one)

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

SECTION I - CIVILIAN/MILITARY/RETIREE/ANNUITANT INFORMATION
3. RANK/GRADE
4. SOCIAL SECURITY NUMBER

5. AGENCY/SERVICE (X one)
ARMY

6. STATUS (X applicable block and provide date (YYYYMMDD) for separation (DOS), retirement (DOR), or
service computation date (SCD), as appropriate.)

AGENCY (Specify)

ACTIVE

NAVY

GUARD/RESERVE DOS:

AIR FORCE

RETIRED

MARINE CORPS
7. CURRENT COMPLETE MAILING ADDRESS
(Street, City, State, ZIP Code)

DOS:

DOR:

SEPARATED

DOS:

DOD CIVILIAN

SCD:

ANNUITANT

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.)

16c. HR POC PHONE

16b. HR POINT OF CONTACT (Civilian employees)

17. PLEASE PROVIDE COPIES OF ALL PAY RECORDS (LES/RAS/AAS, etc.) INCLUDING 3 PAY PERIODS BEFORE AND AFTER THE DEBT PERIOD (if
applicable).
17a. I ATTEST I HAVE ATTACHED ALL COPIES OF AVAILABLE PAY RECORDS FROM

(date) to

(date).

17b. ALL RECORDS PROVIDED COVER THE ENTIRE DEBT PERIOD AS STATED ABOVE:

YES

NO

18. HAVE YOU FILED FOR A CORRECTION OF MILITARY RECORDS? (If Yes above, provide copy of Board decision.
Waiver and Board actions cannot be submitted concurrently)

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)

DD FORM 2789, FEB 2024
PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

Controlled by: DFAS
CUI Category: PRVCY
LDC: FEDCON
POC: 1 (888) 332-7411

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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 22b. SIGNATURE (Electronic or Handwritten/Typed not
accepted)
print)

22c. 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)
YES NO (5) DATE THE DEBT WAS
DISCOVERED (YYYYMMDD)

d. (X and complete as applicable)
(1) HAS THE DEBT BEEN VALIDATED?

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

(6) NAVY ONLY: AMOUNT
UNCOLLECTED AS OF DATE OF
THE COMMANDER'S SIGNATURE:

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

$

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

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

c. WAS PAID

b. DATE(S) (YYYYMMDD)

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?
NO

YES (Explain)

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

30. DESIGNATED FINANCIAL AGENT
a. SIGNATURE (Electronic or Handwritten) (Typed not
accepted)

31a. COMPLETE UNIT MAILING ADDRESS

PARTIAL $

DENY

b. TITLE

c. DATE SIGNED (YYYYMMDD)

31b. POINT OF CONTACT NAME
31c. TELEPHONE

31e. ADSN/DSSN/UIC

DD FORM 2789, FEB 2024
PREVIOUS EDITION IS OBSOLETE.

31d. DSN

31f. E-MAIL ADDRESS

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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:

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.

1.

Type of claim (Remission/Waiver)
(Required)

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
https://www.esd.whs.mil/Portals/54/Documents/DD/forms/dd/
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).

DD FORM 2789, FEB 2024
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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.

Agency/Service (Required)

Civilian: Check “Agency” and specify what Agency at the time of
debt.
Military: Mark branch of Service.
Retirees: Mark branch of Service.
Annuitants: Mark “Agency” and specify “Annuitant”.

5.

Status at the time of debt (Required)
Please “X” the applicable box and provide
date (YYYYMMDD) for separation (DOS),
retirement (DOR), or service computation
date (SCD), as appropriate.

Active: Fill in “DOS”.
Guard/Reserve: Fill in “DOS".
Retired: Fill in “DOR”.
Separated: Fill in “DOS”.
DOD Civilian: Fill in “SCD”.
Annuitant: Only need to “X” the box, no date needed.

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.

16a.

Attach copies of all pertinent documents
(Required)

Attach any supporting documentation from parts #12
through #14.

6.

7.

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16b.

HR Point Of Contact (POC) (Civilian
employees only) (Required)

16c.

HR POC phone

17.

Please provide copies of all pay records
(LES/RAS/AAS) including 3 pay periods
before and after the debt period (if
applicable). (Required)

17a.

I attest I have attached all copies of
available pay records from ___ (date) to
___ (date). (Required)

17b.

All records provided cover the entire
debt period as stated above:
(Required)

Check "Yes" or "No" confirming records provided cover the
entire debt period. Records could include: emails, memos,
orders, etc.

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.

Write HR contact and Telephone number.

Documents required to match time period of the Debt Letter.

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.)

21.

Recommendation

22a.

Commander’s or Supervisor’s Name

22b.

Commander’s or Supervisor’s Electronic
or Handwritten Signature

22c.

Date Signed

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..

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.

23b.

Type(s) of Payments

List type of payments included in debt.

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23c.

Date(s) of Payment(s)

List the dates of payments received.

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.

DD FORM 2789, FEB 2024
PREVIOUS EDITION IS OBSOLETE.

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