Claim Certification and Voucher for Death Gratuity Payment

OMB 0730-0017

OMB 0730-0017

This form is used to document and approve death gratuity payments. The Service Casualty Office completes part of the form and provides the form to the Service Member's beneficiaries to complete and sign their portion of the form. The form is sent to DFAS for payment.

The latest form for Claim Certification and Voucher for Death Gratuity Payment expires 2021-02-28 and can be found here.


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