Retired Air Force, Army, Marine Corps or Navy:
Change an Existing Allotment Deduction

Print and fill out this form, then mail to the below address or FAX to the Finance Center
at (800) 469-6559:

DFAS
US Military Retired Pay
8899 East 56th Street
Indianapolis, IN 46249-1300

Name (Please Print):
Social Security Number:

Please CHANGE my allotment as outlined below:

PAYEE:

Uniformed Services Benefit Association
PO Box 25956
Overland Park, KS 66225-0956

Amount of Current Allotment: (From LES Statement)
Amount of New Allotment: (Exact Amount of your USBA premium)
Effective Date:		IMMEDIATELY
Reason:		Insurance Premium
Group Policy Number:		Use SSN
Blanket Company Code:		194

Signature:
Date Signed:

Retired Air Force, Army, Marine Corps or Navy:Change an Existing Allotment Deduction