Fillable Printable Authorization to Start, Stop or Change an Allotment

Authorization to Start, Stop or Change an Allotment

AUTHORIZATION TO START, STOP OR CHANGE AN ALLOTMENT

PRIVACY ACT STATEMENT

AUTHORITY: 37 U.S.C., E.O. 9397.

PRINCIPAL PURPOSE: To permit starts, changes, or stops to allotments. To maintain a record of allotments and ensure starts, changes, and

stops are in keeping with member’s desires.

ROUTINE USES: Information may be released to computer service centers and other accounting services when such centers and services act as

authorized agents of organizations specified by the member to receive allotments. Disclosure may be made to the Federal Reserve System when

payment of allotment is made through the electronic fund transfer system to financial organizations. Records may also be disclosed to Congress;

allottees, Secret Service; General Accounting Office, Federal, State and local courts; U.S. Treasury; and to the Department of Justice, in some

cases for prosecution, civil litigation, or for investigative purposes.

DISCLOSURE: Voluntary; however, failure to provide the requested information as well as the SSN may result in the member not being able to

start, change, or stop allotments.

TO BE COMPLETED BY ALLOTTER

2. NAME OF ALLOTTER

(Last, First , Middle Initial)

(Print or type)

3. SSN4. PAY GRADE

5. ADDRESS OF ALLOTTER

(Street or Box Number, City, State,

ZIP Code)

7. EFFECTIVE

DATE

(YYYYMM)

8. MONTHLY AMOUNT

OF ALLOTMENT

9. NAME OF ALLOTTEE

(First, Middle Initial, Last)

12. CREDIT LINE

(If applicable)

10. ALLOTMENT ACTION

(X one)

STARTSTOPCHANGE

13. ALLOTMENT CLASS AUTHORIZED

(X one)

- OTHER

(Specify)

14. ALLOTTEE’S MAILING ADDRESS

(Street or Box Number,

City, State, ZIP Code)

15. IF FOREIGN ADDRESS COMPLETE AS FOLLOWS

(Province,

Country)

16. REMARKS

18. ACCOUNT NUMBER/POLICY NUMBER

19. TOTAL CLASS L AMOUNT

20. TOTAL CLASS T AMOUNT

21. SIGNATURE OF ALLOTTER22. DATE

(YYYYMMDD)

NOTE 1. Must be different address than allotter. Each dependent allotment must have a different credit line. Only one support allotment per

dependent is allowed.

NOTE 2. This is a voluntary allotment and can be to any payee you desire.

DD FORM 2558, NOV 1996 (EG)

Designed using Perform Pro, WHS/DIOR, Nov 96

1. BRANCH OF SERVICE

(X one)

AIR FORCE

ARMY

MARINE CORPS

NAVY

6. DAYTIME TELEPHONE

NUMBER

(Include Area

Code)

11. TERM IN MONTHS

C - CHARITY/CFC

D - DISCRETIONARY ALLOTMENTS

(Includes dependent support, payment

to financial institution, insurance, repayment of home loan, rent, etc.

(Notes 1 and 2))

F - CHARITY - EMERGENCY/ASSISTANCE FUND CONTRIBUTION

L - REPAYMENT OF LOAN TO SERVICE ORGANIZATION

(Red Cross, Relief

Society, etc. - Navy and Marine Corps only)

N - NSLI OR USGLI INSURANCE PREMIUM

T - PAYMENT OF DEBTS TO U.S., DELINQUENT STATE OR LOCAL INCOME/

EMPLOYMENT TAXES

17. COMPANY CODE/FINANCIAL INSTITUTION/ROUTING

TRANSIT NUMBER

STATEMENT OF UNDERSTANDING

I understand that this allotment is legal and that by voluntarily completing this form, I am responsible for:

- Ensuring that the information is correct;

- Reviewing my Leave and Earnings Statement to ensure the allotment stops, starts, or changes as directed including amount and payee;

- Collecting overpayments from the receiver (payee) of the allotment, if I do not change or stop the allotment after a loan is repaid;

- Contacting the receiver (payee) of the allotment, at my expense, to obtain monthly statements for my personal records.

I also understand that any problems once the allotment is delivered to the receiver (payee) are beyond the control of the Defense Finance and

Accounting Service (DFAS) and that DFAS is only responsible for ensuring proper delivery of any voluntary allotment for the per iod directed. I

further understand that pursuant to conditions listed in the DoD 7000.14-R, Volume 7A, changes can be made by DFAS to an allottee’s name,

address, or account number.

PREVIOUS EDITION IS OBSOLETE.