Form DD Form 137 DD Form 137 Secondary Dependency Application

CUI (when filled in)
OMB No. 0730-0014
Expires 6/30/2024

SECONDARY DEPENDENCY APPLICATION

The public reporting burden for this collection of information is estimated to average 1 hour 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 [email protected]. 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 COMPLETED FORM TO THE ABOVE ORGANIZATION.

PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301, Departmental Regulations; 37 U.S.C., Pay and Allowances of the Uniformed Services; DoD Directive 5154.29, DoD Pay and Allowances Policy
and Procedures; DoD 7000.14-R, DoD Financial Management Manual, Volume 7A, Military Pay Policy and Procedures - Active Duty and Reserve Pay; and Joint Travel
Regulations (JTR) current edition.
PURPOSE(S): The information will be used to determine the relationship and dependency of the claimed dependents and determine the member's entitlement of authorized
benefits.
ROUTINE USE(S): To the Treasury Department to provide information on check issues and electronic fund transfers. To Federal, state, and local governmental agencies in
response to an official request for information with respect to law enforcement, investigatory procedures, criminal prosecution, civil court action and regulatory order.
Additional routine uses can be found within the applicable system of records notices, T7344, Defense Joint Military Pay System-Reserve Component; T7340, Defense Joint
Military Pay System-Active Component; and M01040-3, Marine Corps Manpower Management Information System Records, located at: http://dpcld.defense.gov/Privacy/
SORNsIndex/DOD-Component-Notices/
DISCLOSURE: Voluntary: however, failure to provide this information will result in a suspension of the dependent entitlements until the member can provide the required
certification.

WARNING
Read information regarding supporting documentation to show dependency at the end of this form prior to completing.
SECTION 1: DEPENDENCY TYPE
If approved, the claimed individual may be eligible for the following entitlements: Basic Allowance for Housing (BAH) not to exceed full BAH with
dependents, Uniformed Services Identification and Privileges Card (USIP), travel allowances, morale, welfare, and recreation privileges, and
commissary and exchange. Note: A Parent / Parent-in-law / Stepparent not residing with the sponsor and In-loco parentis dependents are not entitled
to a USIP card.
a. WHAT TYPE OF DEPENDENCY ARE YOU APPLYING FOR? (See page 3 for full description of supporting documentation that must be provided
with application.)
INCAPACITATED CHILD (21 YEARS OR OVER) - Attach a medical sufficiency letter attesting to the date and extent of incapacity and financial support
documentation.
WARD (UNDER 21 YEARS OLD) - Attach an agreement, an order, or other appropriate document from a court of competent jurisdiction granting custody and
financial support documentation.
STUDENT (CHILDREN UNDER AGE 23, ENROLLED IN HIGHER LEARNING) - Attach a letter from the school registrar certifying full-time course of study and
anticipated graduation date and financial support documentation.

NEEDS DD67

PARENT / PARENT-IN-LAW / STEPPARENT - Attach financial support documentation.

IN-LOCO PARENTIS - Attach DFAS Affidavits 9124 and 9125 attesting to the relationship and financial support documentation.

SECTION 2: SPONSOR’S INFORMATION
a. NAME (Last, First, Middle Initial)

b. DOD ID NUMBER/SSN

d. BRANCH OF SERVICE

e. SERVICE STATUS
ACTIVE DUTY
DECEASED

c. RANK

RETIRED

RESERVE

NATIONAL GUARD

(date of death) (YYYYMMDD)

f. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)

g. TELEPHONE NUMBERS (Include DSN or Area Code)
HOME/CELL:

h. E-MAIL ADDRESS

i. MARITAL STATUS

WORK:

SINGLE

LEGALLY SEPARATED

WIDOWED

MARRIED

DIVORCED

SECTION 3: CLAIMED INDIVIDUAL’S INFORMATION
a. NAME (Last, First, Middle Initial)

b. DATE OF BIRTH (YYYYMMDD)

c. RELATIONSHIP TO SPONSOR

d. COMPLETE RESIDENCE ADDRESS (Street, Apartment Number, City, State, ZIP Code)

e. CLAIMED INDIVIDUAL’S MARITAL STATUS
SINGLE

SEPARATED

WIDOWED

MARRIED

DIVORCED (Attach a copy of annulment decree of final divorce decree)

f. IF CLAIMED INDIVIDUAL IS WARD, ENTER THE DATE CLAIMED INDIVIDUAL BEGAN RESIDING WITH SPONSOR (YYYYMMDD)

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Controlled by: DFAS
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CUI Category: PRVCY
Distribution/Dissemination Control: FEDCON
POC: dfas.indianapolis-in.zed.mbx.info-management-control-officer@mail.mil

CUI (when filled in)
g. DOES ANY OTHER PERSON(S) CLAIM THE INDIVIDUAL FOR BASIC ALLOWANCE FOR HOUSING, TRAVEL ALLOWANCE, OR
UNIFORMED SERVICES IDENTIFICATION AND PRIVILEGES (USIP) CARD
YES (list below)
NO (skip to SECTION 4)
DOD ID NUMBER

NAME (Last, First, Middle Initial)

BRANCH OF SERVICE

SECTION 4: CLAIMED INDIVIDUAL'S SCHOOL ATTENDANCE
If claimed individual has been enrolled in a full-time course of study in the past 12 months, furnish all of the following information and include proof of
school registration with your application. (If not, skip to SECTION 5). Note: Student may still qualify for a Uniformed Services Identification and
Privileges Card (USIP) during school break if enrolled before school break and immediately after school break.
a. NAME AND ADDRESS OF SCHOOL

c. STUDENT MAILING ADDRESS

b. DATES ATTENDED (YYYYMMDD)
FROM:

TO:

SECTION 5: IF CLAIMED INDIVIDUAL RESIDES IN A HOSPITAL OR INSTITUTION
If claimed individual is in a hospital or institution, furnish all of the following information. (If not, skip to SECTION 6)
a. ENTERED HOSPITAL/INSTITUTION (YYYYMMDD)

b. ANTICIPATED DATE OF DISCHARGE (YYYYMMDD)

c. WILL CLAIMED INDIVIDUAL RETURN TO SPONSOR'S HOME AFTER DISCHARGE?

YES

NO (Explain where claimed dependent will reside)

SECTION 6: FINANCIAL SUPPORT REQUIREMENT

NEEDS DD67

a. DID YOU CLAIM THE INDIVIDUAL NAMED IN 3A AS A DEPENDENT ON YOUR MOST RECENT TAX RETURN?

YES (Please provide a copy of your prior year’s tax return showing the claimed individual as a dependent. If you do not want, or are unable to provide a copy of your
tax returns, please complete and return Worksheet for Determining Financial Support with your DD137 to demonstrate financial support of the claimed individual.)
NO (Please complete and return the Worksheet for Determining Financial Support with your DD137 to demonstrate financial support of the claimed individual.)

SECTION 7: REMARKS (if necessary, use back)

SECTION 8: FINANCIAL DEPENDENCY
To qualify as a secondary dependent, the claimed individual must be more than one-half (50%) ‘in fact’ dependent on the sponsor. Sponsors
must provide more than one-half (50%) of the claimed individual’s support. The claimed individual’s income that is used for own support
must also be considered in determining whether the Sponsor is providing more than one-half support. You must prove financial
dependency to qualify.
Under penalties of perjury, I certify claimed individual is to my knowledge my dependent as defined by this form.
This is to certify that based on the conditions within, I (the sponsor) hereby certify the above “qualification statement” is true and correct to the best
of my knowledge, and that I meet the requirements to claim the individual named in section 3a as my dependent.
READ THE PENALTY PROVISIONS, SIGN AND DATE THE FORM
NOTE: Whoever, in any matter within the jurisdiction of any department or agency of the United States, knowingly and willfully falsifies, conceals, or
covers up by any trick, scheme, or device, a material fact, or makes any false, fictitious, or fraudulent statements or representations, or makes or uses
any false writing or document knowing the same to contain any false, fictitious, or fraudulent statement or entry, shall be fined as provided in Title 18,
or imprisoned not more than 5 years, or both (U.S. Code, title 18, section 1001). The information provided in this form may be referred to the
appropriate Military Service investigative agency.
I make the foregoing claim with full knowledge of the penalties involved for willfully making a false claim. (U.S. Code, title 18, section 287,
formerly section 80, provides a penalty as follows: Imprisonment for not more than five years and subject to a fine in the amount provided in
this title.)
SECTION 9: SIGNATURES
a. SPONSOR/CLAIMED INDIVIDUAL’S REPRESENTATIVE
I/we

(print name(s)) will immediately notify

the service concerned of any change in claimed dependent’s financial circumstances, marital status, physical custody, or change in dependency upon
the sponsor as shown in this form.
(1) SPONSOR(S) SIGNATURE

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(2) DATE (YYYYMMDD)

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SUPPORTING DOCUMENTS FOR DEPENDENTS
Financial Dependency: Please provide a copy of your prior year’s tax return showing the claimed individual as a dependent. If you do not
want, or are unable to provide a copy of your tax return, please complete and return the Worksheet for Determining Financial Support with
your DD137 to demonstrate financial support of the claimed individual.
*Eligibility start and stop dates will be determined based upon information provided and applicable laws and regulations.
If the Person is a(n):
Incapacitated Adult Child
The individual named in section 3a is
incapable of self-support because of
mental or physical incapacity incurred
before his/her 21st birthday or incurred
before attaining age 23 during a fulltime course of study in an accredited
institution as determined by DoD
policy.

And:
The individual named in section 3a is dependent
on the member sponsor for over one-half of his/
her support.

Then please send copies of the following documents:
Prior year’s tax return or the Worksheet for Determining
Financial Support
and

and
Birth certificates or other official documents of birth,
The individual named in section 3a is unmarried*. marriage certificates, letter from an authorized adoption
agency, letter from the authorized placement agency, or
*If person does not meet these criteria, they are not
applicable court document that verify relationship to the
eligible for secondary dependency status.
child if not previously enrolled in DEERS.
and
A medical sufficiency statement issued by approved
medical provider stating incapacitation.
You will need to send more than one document.

Student (age 21-22)

The individual named in section 3a is dependent
on the member sponsor for over one-half of his/
her support.

Prior year’s tax return or the Worksheet for Determining
Financial Support

The individual named in section 3a is
under age 23 years old and enrolled in
and
a full-time course of study in an
and
accredited institution as determined by
Birth certificates or other official documents of birth,
DoD policy.
The individual named in section 3a is unmarried*. marriage certificates, letter from an authorized adoption
agency, letter from the authorized placement agency, or
*If person does not meet these criteria, they are not
applicable court document that verify relationship to the
eligible for secondary dependency status.
child if not previously enrolled in DEERS.

NEEDS DD67
and

A letter from the school registrar or the National Student
Clearinghouse enrollment verification, certifying full-time
course of study at the institution.
You will need to send more than one document.

Legal Custody Ward
The individual named in section 3a
under the age of 21 and placed in the
sponsor’s care and custody under an
order or other appropriate document
from a court of competent jurisdiction.

The individual named in section 3a lived resides
with the member sponsor unless separated by
military necessity or to receive institutional care
as a result of a disability or incapacitation)

Prior year’s tax return or the Worksheet for Determining
Financial Support

and

A copy of the order or other appropriate document from a
court of competent jurisdiction in the United States (or U.S.
territory or possession) that established legal custody of
the child by the sponsor for no less than 12 consecutive
months.

The individual named in section 3a is dependent
on the member sponsor for over one-half of his/
her support.

and

and

Note: The court order can designate the length of custody
by age, time, or permanency, stipulating temporary or
The individual named in section 3a is unmarried*. permanent. If no custody time-period is listed on the court
order, the custody is generally considered permanent.
*If person does not meet these criteria, they are not
However, if the court order is titled “temporary” but
eligible for secondary
otherwise unspecified as to duration, further clarification
may be requested to ensure the legal requirements are
met.
You will need to send more than one document.
Parent

The individual named in section 3a is dependent
on the member sponsor for over one-half of his/
her support.

Prior year’s tax return or the Worksheet for Determining
Financial Support
and

and
For USIP Benefits only: The individual named in
section 3a resides (lives with) with member
sponsor.
*If person does not meet these criteria, they are not
eligible for secondary dependency status.
** A member/sponsor may claim a parent as dependent
for housing and travel allowance purposes even if
parent is not residing with the member/sponsor.

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Member’s birth certificate or other official documents of
birth, letter from an authorized adoption agency, letter from
the authorized placement agency, or applicable court
document that verify relationship to the member if not
previously enrolled in DEERS.
and
Parent’s Marriage Certificate
You will need to send more than one document.
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Parent-In-Law

The individual named in section 3a is dependent
on the member sponsor for over one-half of his/
her support.

Prior year’s tax return or the Worksheet for Determining
Financial Support
and

and
For USIP Benefits only: The individual named in
section 3a resides (lives with) with member
sponsor.
*If person does not meet these criteria, they are not
eligible for secondary dependency status.
** A member/sponsor may claim a parent as dependent
for housing and travel allowance purposes even if
parent is not residing with the member/sponsor.

Spouse’s birth certificate or other official documents of
birth, letter from an authorized adoption agency, letter from
the authorized placement agency, or applicable court
document that verify relationship to the member if not
previously enrolled in DEERS.
and
Member’s marriage certificate
and
Parent’s Marriage Certificate
You will need to send more than one document.

Stepparent (also includes spouse’s
stepparent)

The individual named in section 3a is dependent
on the member sponsor for over one-half of his/
her support.

Prior year’s tax return or the Worksheet for Determining
Financial Support
and

For USIP Benefits only: The individual named in
section 3a resides (lives) with member
sponsor.**
* If person does not meet these criteria, they are not
eligible for secondary dependency status.
** A member/sponsor may claim a parent as dependent
for housing and travel allowance purposes even if
parent is not residing with the member/sponsor.

For a Member’s Stepparent: Member’s birth certificate or
other official documents of birth, letter from an authorized
adoption agency, letter from the authorized placement
agency, or applicable court document that verify
relationship to the member if not previously enrolled in
DEERS.
or
For a Spouse’s Stepparent: Spouse’s birth certificate or
other official documents of birth, letter from an authorized
adoption agency, letter from the authorized placement
agency, or applicable court document that verify
relationship to the member;

NEEDS DD67
and

Member’s marriage certificate
and

Parent’s Marriage Certificate

You will need to send more than one document.
In-Loco Parentis
The individual named in section 3a
stood in place of a parent to the
sponsor for at least five years prior to
sponsor’s emancipation.

The individual named in section 3a is dependent
on the member sponsor for over one-half of his/
her support.

Prior year’s tax return or the Worksheet for Determining
Financial Support
and

and
DFAS Form 9124 (Affidavit by member)
The individual named in section 3a stood in the
place of a parent to the sponsor for at least five
years prior to sponsor’s emancipation*.

and
DFAS Form 9124 (Affidavit by claimed dependent)

* If person does not meet these criteria, they are not
eligible for secondary dependency status.

and

** In Loco Parentis are not eligible for USIP benefits, but Two DFAS Form 9125 (Two third-party affidavits NOT
member/sponsor may claim for purposes of BAH and
completed by relatives of the member or the claimed
other eligible travel allowances.
dependent)

You will need to send more than one document.

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Worksheet for Determining Financial Support
WARNING
Read the instructions at the end of this form in their entirety prior to completing.
PERSONAL INFORMATION
SPONSOR NAME (Last, First, Middle Initial)

DOD ID NUMBER/SSN

CLAIMED INDIVIDUAL’S NAME (Last, First, Middle Initial)

DATE (YYYYMMDD)

FUNDS BELONGING TO THE PERSON YOU SUPPORTED*
1. Enter the total funds belonging to the person you supported, including income received (taxable and nontaxable) and
amounts borrowed during the year, plus the amount in savings and other accounts at the beginning of the year. Do
not include funds provided by the state; include those amounts on line 23 instead

1.

2. Enter the amount on line 1 that was used for the person's own support

2.

3. Enter the amount on line 1 that was used for other purposes

3.

4. Enter the total amount in the person's savings and other accounts at the end of the year

4.

5. Add lines 2 through 4. (This amount should equal line 1.)

5.

EXPENSES FOR ENTIRE HOUSEHOLD* (where the person you supported lived)
6. Lodging (complete line 6a or 6b):
a. Enter the total rent/mortgage paid for the year

6a.

b. Enter the fair rental value of the home. If the person you supported owned the home, also include this amount in
line 21

6b.

NEEDS DD67

7. Enter the total food expenses

7.

8. Enter the total amount of utilities (heat, electric, water, etc., not included in line 6a or 6b)

8.

9. Enter the total amount of home repairs (not included in line 6a or 6b)

9.

10. Enter the total of other household expenses

10.

11. Add lines 6a through 10. These are the total household expenses

11.

12. Enter total number of persons who lived in the household

12.

EXPENSES FOR THE PERSON YOU SUPPORTED*
13. Divide line 11 by line 12. This is the person's share of the household expenses

13.

14. Enter person's total clothing expenses

14.

15. Enter the person's total education expenses (not covered by scholarship or grants)

15.

16. Enter the person's, medical, vision, and dental expenses not paid for or reimbursed by insurance or TRICARE

16.

17. Enter the person's total travel and recreation expenses

17.

18. Enter the total of the person's other expenses

18.

19. Add lines 13 through 18. This is the total cost of the person's support for the year

19.

DID THE PERSON PROVIDE MORE THAN HALF OF THE PERSON’S OWN SUPPORT?
20. Multiply line 19 by 50% (0.50)

20.

21. Enter the amount from line 2, plus the amount from line 6b, if the person you supported owned the home. This is the
amount the person provided for their own support

21.

22. Is line 21 more than line 20?
Yes. You do not meet the support test for this person to be your qualifying dependent. Stop Here.
No. Continue to line 23 and fill out the rest of the worksheet.

DID YOU PROVIDE MORE THAN HALF?
23. Enter the amount others provided for the person's support. Include amounts provided by state, local, and other
welfare societies or agencies. Don't include social security income or any other amounts included on line 1

23.

24. Add lines 21 and 23

24.

25. Subtract line 24 from line 19. This is the amount you provided for the person's support

25.

26. Is line 25 more than line 20?
Yes. You meet the support test for this individual to be your qualifying dependent.
No. You do not meet the support test for this individual to be your qualifying dependent.

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INSTRUCTIONS
SUPPORT TEST – How to determine if the support test is met. Determine whether you have provided more than half of a claimed individual’s total
support by comparing the amount you contributed to that individual’s support with the entire amount of support that person received from all sources.
This includes support the individual provided from the individual’s own funds. NOTE: A person's own income is not support unless the income is
actually spent for support.
Example: Your mother received $2,400 in social security benefits and $300 in interest. She paid $2,000 for lodging and $400 for recreation. She put
$300 in a savings account. Even though your mother received a total of $2,700 ($2,400 + $300), she spent only $2,400 ($2,000 + $400) for her own
support. If you spent more than $2,400 for her support and no other support was received, you have provided more than half of her support.
FUNDS BELONGING TO THE PERSON YOU SUPPORTED
1. Enter the total funds belonging to the person you supported, including income received (taxable and nontaxable) and amounts borrowed during the
year, plus the amount in savings and other accounts at the beginning of the year. Do not include funds provided by the state; include those amounts
on line 23 instead.
Income may include:
• Wages, Salaries, Tips, or Other Cash
Gratuities
• Pensions/Annuities, Settlements/
Severance Payments, or any other
Compensation Received Because of
Prior Employment
• Interest Or Dividends Earned
• Interest Withdrawn From An Individual
Retirement Account (IRA)
• GI Bill: If the person you supported is a
veteran, and the person/veteran
received amounts from the government
under GI Bill that is used for the
education are included in claimed
person’s support.

• Mandatory Distributions from IRAs, or
Other Retirement Accounts, such as
TSP or 401K
• Net Income From Rental Property,
Business, And Farming
• Cash (or cash equivalent via bank
transfers/Zelle or payment apps such
as Venmo, Paypal, CashApp, etc.),
Check, Or Money Order Contributions
To Dependent From Persons Other
Than The Sponsor
• Federal Tax Refund(s)

• Social Security Payments, Disability Or
Regular
• Supplemental Security Income (SSI)
• Veterans Affairs (VA) Payment(s)/
Benefits received by the person you
supported
• Unemployment Compensation or
Severance Pay
• Alimony Payments From A Separated
Or Divorced Spouse

2. Enter the amount on line 1 that was used for the person's own support. The term “support” includes food, shelter, clothing, medical and dental care,
education and other items that can reasonably be related to the individual’s needs. A person's income is not support unless the income is actually
spent for support.

NEEDS DD67

3. Enter the amount on line 1 that was used for other purposes.

4. Enter the total amount in the person's savings and other accounts at the end of the year.
5. Add lines 2 through 4. (This amount should equal line 1.).

EXPENSES FOR ENTIRE HOUSEHOLD - Household expenses include expenses not directly related to any one member of a household. For
example, the cost of food for the household, must be divided among the members of the household
6. Lodging: Complete 6a or 6b if you are providing lodging for the claimed individual.
6a. Enter the total rent/mortgage paid for the year in 6a. Include property/real estate taxes (if not included in mortgage) and home/renter’s insurance (if not included in
mortgage/rent payment) in this amount; or
6b. If the claimed individual resides in a dwelling owned outright enter the Fair Rental value (FRV) in 6b. Fair rental value is the amount you could reasonably expect to
receive from a stranger for the same kind of lodging and includes a reasonable allowance for the use of furniture and appliances, and for heat and other utilities that
are provided. If you provide a person with lodging, you are considered to provide support equal to the fair rental value of the room, apartment, house, or other shelter
in which the person lives.

7. Enter the total food expenses paid for the year.
Food expenses may include:
• Food/Groceries (Exception: items purchased with food stamps)
• Grocery Delivery Services (Shipt, Instacart, etc.)

• Restaurant/Take-out Expenses
• Food Delivery Service Fees

8. Enter the total amount of utilities paid for the year that are not included in rent/mortgage not included in line 6a or 6b.
Utilities expenses may include:
• Gas (Heating)
• Electricity
• Telephones (land-lines and cell phones)

• Water/Sewage
• Trash/Recycling Service
• Internet Service/Cable/Streaming Services

9. Enter the total amount of home repairs paid for the year not included in line 6a or 6b (Do not include costs of maintaining the home, such as
mortgage interest, real estate taxes, and insurance)
10. Enter the total of other expenses paid for the year.
Other expenses may include:
• HOA Fees
• Home Security System Fees
• Car Insurance Premiums
• Gas and Car Maintenance

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• Travel/Vacation Costs within the Past Year
• Shopping Subscription Services (Amazon Prime, Walmart,
Costco, Sam's Club, etc.)
• Furniture/Appliances Purchases within Past Year if used by
whole household

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11 Add lines 6 through 10.
12. Enter total number of persons (to include yourself and the individual you supported) who lived in the household full-time for the year.
EXPENSES FOR THE INDIVIDUAL YOU SUPPORTED - Personal expenses include those recurring expenses that are necessary to provide for the
individual’s health, welfare, and that can reasonably be related to the individual’s daily needs.
13. Divide line 11 by line 12. This is the person's share of the household expenses.
14. Enter person's total clothing expenses to include laundry/dry cleaning (expense associated with keeping the individual’s clothing clean) paid for the
year.
15. Enter the person's total education expenses paid for the year. Do not enter any amount covered by scholarship or grants.
School expenses may include:
• Tuition
• Books
• Special Fees (lab fees, distance education fees, internship fees,
parking, etc.)
• Room and Board for Off-Campus Lodging

• School Supplies
• Lessons Fees (sports, dance, music)
• Tutoring

16. Enter the medical, vision, and dental expenses not paid for or reimbursed by insurance paid for the year. Include personal/supplemental insurance
premiums paid for the individual’s support. This may include premiums paid for supplementary Medicare coverage or TRICARE premiums, if any.
This amount does not include the value of medical insurance benefits and does not include the value USIP card.
17. Enter the person's total travel and recreation expenses paid for the year.
Travel and recreation expenses may include:
• Vehicle Payment (The dependent’s total vehicle payments ONLY
for vehicles registered in their name. Exception: purchase of a
handicap accessible vehicle for the child) If vehicle was used by
others in household, you can include your out-of-pocket
expenses of operating the car for the person’s benefit.)
• License Plate/Registration Fees
• Drivers License Fees
• Public Transportation/Taxi Fees (may also include ride share
services)

• Tickets (Movies, Sporting Events, Concerts, Videos, Theater,
etc.)
• Recreation/Amateur Sports/Special Olympics Enrollment Fees
• Fitness or Social Clubs Enrollment Fees

NEEDS DD67

18. Enter the total of the person's other expenses paid for the year.

Other expenses may include: (Other Items Not Listed May be Considered as Support Depending on the Facts of Each Case)
• Postage
• Checking, Savings Account or Money Order Fees, etc.
• Court Ordered Bankruptcy Payments
• Childcare Expenses, including expenses paid for care of
• Personal Hygiene Items
disabled dependent.
19. Add lines 13 through 18. This is the total cost of the individual’s support for the year.
DID THE PERSON PROVIDE MORE THAN HALF OF THE PERSON’S OWN SUPPORT?
20. Multiply line 19 by 50% (0.50).

21. Enter the amount from line 2, plus the amount from line 6b, if the person you supported owned the home. This is the amount the person provided
for his/her own support.
22. Is line 21 more than line 20? If yes, you do not meet the support test for this person to be your qualifying dependent. Stop Here. If no, continue to
line 23 and fill out the rest of the worksheet.
DID YOU PROVIDE MORE THAN HALF?
23. Enter the amount others provided for the person's support. Include amounts provided by state, local, and other welfare societies or agencies. Do
not include social security income or any other amounts included on line 1.
24. Add lines 21 and 23.
25. Subtract line 24 from line 19. This is the amount you provided for the person's support.
26. Is line 25 more than line 20? If yes, you meet the support test for this individual to be your qualifying dependent. Stop Here. If no, you do not meet
the support test for this individual to be your qualifying dependent.

*The authorizing agency reserves the right to request supporting documentation of claimed amounts.

DD FORM 137, 20240627 DRAFT
PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

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