Da form 7574-2026

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The document is an Incapacitation Pay Monthly Claim Form used by Reserve Component Soldiers to apply for incapacitation pay due to injury, illness, or disease. It outlines the necessary information required from the soldier, their employer's verification, and the commander's approval. The form ensures that all claims are accurately reported and verified to determine eligibility for compensation under U.S. military regulations.

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Click ‘Get Form’ to open it in the editor.
Begin with Section I - Claim Statement. Fill in your last name, first name, middle initial, and SSN. Ensure all information is printed clearly.
Continue by entering your rank, duty MOS/AOC, unit of assignment, and unit phone number. Specify the month and year of your claim as well as the date of injury/illness.
Indicate the exact dates of incapacitation by filling in the 'From' and 'To' fields. Be precise to avoid delays.
In Section II - Employer's Verification, provide details about your employer and confirm your employment status during the incapacitation period.
Complete Section III - Commander's Verification by having your commander sign off on your claim to validate its accuracy.

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