Fill out DA Form 1103 (Application for Army Emergency Relief)-
Required Supporting Documentation
Required supporting documentation varies from case to case. Requirements noted in the following paragraphs are a minimum standard. Other supporting documents may be required. If, for example, assistance is requested for basic needs (e.g. rent, food, utilities, low-cost POV repair), and the soldier is in full receipt of pay, the applicant will be required to explain why the basic expenses weren't paid, and provide receipts detailing how the money was spent instead.
- Active duty soldiers needing assistance can pick up the DA Form 1103 at their unit, complete the form, and obtain the commander’s signature. You may also download and print DA 1103, if you have Adobe Acrobat Reader or you can download the Adobe Acrobat Reader. Applicants may also pick up forms at the AER office.
- All applicants need to bring their military ID card and substantiating documents (car repair estimate, rental agreement, etc.).
NOTE: The First Sergeant or unit commander must endorse fill out and sign Part IV of DA From 1103 on all applications for emergency assistance.
- Complete information must be provided. Include complete explanation of reason for inability to meet financial needs.
- All applications must be accompanied by the service member’s latest Leave and Earnings Statement.
- Completed applications should be brought to the Army Emergency Relief Office at the Family Support Center in building 14, or faxed to (508) 233-4910, For telephone information call (233) 508-4798.
RENT TO PREVENT EVICTION:
A written eviction notice from landlord.
PAST DUE MORTGAGE PAYMENTS:
A written threat to foreclose.
TO PREVENT UTILITY CUT-OFF:
Written utilities cut-off notice(s).
FOOD TO PREVENT PRIVATION:
Written certification by the Commander/1SG that the soldier has no food or money.
NON-RECEIPT OF PAY:
Assistance may be provided to cover bare necessities if the soldier did not receive all the pay and/or allowances to which he/she is entitled. This does NOT include deductions for fines, garnishments, pay advances, casual pays, etc.
EMERGENCY, CRITICAL MEDICAL/DENTAL EXPENSES:
EMERGENCY REPAIR OF ESSENTIAL POV:
- AER will consider only those expenses not covered by medical/dental insurance.
- Applications must include written statement(s) from the doctor(s) involved verifying that: the procedure must be carried out immediately and that payment is demanded in advance of treatment.
- Applicant may be required to seek other sources of treatment which do not demand payment in advance.
CRITICAL, EMERGENCY TRAVEL: Must be accompanied by:
- proof of ownership.
- proof of insurance.
- If cost exceeds $500, service member must present 3 estimates .
- Approved emergency leave.
- Red Cross verification of the death/illness.
- If the case involves a mother, father, brother, sister, child, spouse, or grandparents/uncle/aunt in loco parentis, the soldier can ask the Red Cross to request verification from a Red Cross near the victim.
- If the case involves grandparents, aunts, or uncles not in loco parentis, then the soldier should have family near the victim contact their local Red Cross office. Red Cross can receive verification on grandparents, aunts, uncles, but cannot request it.
- Deceased was a member of the soldier or spouse’s immediate family.
- Written, itemized statement of costs from the funeral director (AER can assist only with reasonable, essential expenses).
- AER will request that other immediate family members share expenses.
- AER will request service member seek additional charitable contributions to offset this expense.
- Funeral homes provide no-interest payment plans for non-internment expenses.
- AER will cover the cost of the room and food only.
- Aid is a one-time, one-night at a time, although special circumstances will be considered.
- If paperwork is not filled out in advance of the service, the soldier must go to AER the first working day following the service, to process paperwork for the loan.
AER can only assist if Red Cross has not, or if Red Cross was unable to provide enough assistance to cover all essential expenses. (For example, AER may be able to help the applicant with initial housekeeping expenses if his/her present residence is no long habitable, but we cannot provide funds to replace furnishings.)
FOR SPOUSES WHOSE SPONSORS ARE DEPLOYED:
- Spouse should bring application form and his/her valid ID card to AER Office.
- AER Officer will verify service member is not being considered for discharge, and ensure the soldier knows of the emergency and agrees to the loan.
- A Power of Attorney is used only as a last resort.
- AER Officer will notify service member’s Commander and/or 1st Sgt.
- The AER loan officer will contact the soldier and unit commander before recommending approval or disapproval.