ANNEX K TO DD FORM 4 OR DA FORM 4836 (SUPPLEMENTAL) MONTGOMERY GI-BILL SELECTED RESERVE (MGIB-SR) KICKER ADDENDUM ARMY NATIONAL GUARD (ARNG) of the UNITED STATES For use of this form see NGR 135-7 The proponent agency is ARNG-HRM PRIVACY ACT STATEMENT AUTHORITY: Title 10, United States Code (USC), Chapter 1606; Sections 16131 through 16136 and Title 10 USC, Section 3013; Executive Order 9397; and 10 USC Section 3013, Secretary of the Army E. O. 9397 (SSN); and Army Regulations (AR) 600-8-104, Military Personnel Information Management/Records PURPOSE(S): Information will be used to establish eligibility by members of the Selected Reserve (SR) for MGIB-SR Kicker Educational Assistance benefits. ROUTINE USES: To the Department of Veterans Affairs (DVA), to substantiate eligibility for an increase in Educational Assistance under the MGIB-SR. DISCLOSURE: Voluntary, however, failure to provide the requested information may delay processing of your application and you may not be eligible for the ARNG MGIB-SR Kicker. COMPUTER MATCHING: Release is restricted to ARNG incentive personnel who need the information to assist in activities related to Selective Reserve Incentive Program (SRIP). The information provided may be used in computer matching programs within the Department of Defense (DoD) and the Department of Veterans Affairs (DVA) or with any other Federal Agency for verification to determine your eligibility and/or compliance with the benefit program requirements being applied for herein and to effect recovery of any improper payments made toward delinquent debts owed by a beneficiary or former beneficiary. ---------------------------------------------SECTION I APPLICABILITY------------------------------------------------------ This addendum is applicable to ARNG Soldiers who have a current MGIB-SR Kicker contract (NGB Form 5435, Annex K to Department of Defense (DD) Form 4 or Department of Army (DA) 4836 who enroll in a State Officer Candidate School (OCS) Program, Phase II or III, Warrant Officer Candidate School (WOCS) Program or in the Simultaneous Membership Program (SMP) as a Military Science (MS) II, III, IV or V. It is also applicable to ARNG Soldiers who have a current MGIB-SR Kicker contract that have accepted a commission in the ARNG and have signed this addendum within 90 days of accepting their Officer/Warrant Officer commission. A copy will be furnished to the Soldier. ---------------------------------------------------SECTION II INSTRUCTIONS----------------------------------------------- The ARNG representative will read and explain the MGIB-SR Kicker requirements outlined on this addendum and attach a copy of this form (initialed, signed, and dated) to the enlistment contract as applicable. --------------------------------SECTION III ACKNOWLEDGEMENT / ELIGIBILITY----------------------------------- 1. In connection with my commission or entrance into an Officer/Warrant Officer program, I hereby acknowledge that I meet the following eligibility criteria: a. I have previously contracted and am still eligible for a MGIB-SR Kicker. b. I am being commissioned or have enrolled into an ARNG Commissioning Program. I understand that my MGIB-SR Kicker will increase to the new rate of $350. NGB FORM 5435-1 Page 1 of 5 2 JUNE 2014
c. I understand that in order to continue receiving the MGIB-SR Kicker at the new rate of $350, I must complete the commissioning program and accept a commission in the ARNG. d. I understand that I am eligible to continue receiving the MGIB-SR Kicker at the $350 rate after I receive my commission provided I sign a DA Form 5447-R Officer Service Agreement (OSA) and agree to serve in the ARNG for the time remaining on my original MGIB-SR Kicker obligation. e. I have received an Honorable Discharge from ALL previous service periods if applicable. (Uncharacterized Discharge for IADT is authorized) f. I am not being commissioned in the SR for the purpose of qualifying for an Active Guard Reserve (AGR) position or a Military Technician (Mil Tech) position where membership in a RC is a condition of employment (one-time temporary assignment as a Mil-Tech under 180 days in a continuous 12-month period is authorized). 2. I understand that if I fail to complete the commissioning program, fail to accept a commission in the ARNG, fail to complete Basic Officer Leadership Course (BOLC) or fail to complete my original MGIB-SR Kicker obligation, I will be subject to suspension, termination and/or recoupment of my MGIB-SR Kicker according to the conditions contained in the SRIP Policy in effect at date of contract signature. 3. I understand that if I fail to commission, I may be returned back to my original MGIB-SR Kicker rate. If I am still within my original 6 year Kicker obligation, I MUST return to the Duty Military Occupational Specialty Qualified (DMOSQ) Military Occupational Specialty (MOS) as required by my original MGIB-SR Kicker contract. 4. I understand this MGIB-SR Kicker Supplemental addendum must be signed on the same date as the execution date of my DA Form 5447-R to include the Administrative Official and Service Representative in order for this addendum to be valid. (Applies ONLY to those completing this addendum within 90 days of commissioning) 5. I understand that this MGIB-SR Kicker Supplemental addendum must use the original authorized ARNG Incentive System Control Number (CN) from the original Kicker Contract. Any MGIB-SR Kicker Supplemental addendum that is manually completed outside of an authorized ARNG Incentive System is not valid. An altered addendum voids this contract. ---------------------------------------------------SECTION IV OBLIGATION------------------------------------------------- 1. I agree to remain in the ARNG as a satisfactory participant for the remainder of my original six-year Kicker Contractual Obligation. 2. I understand that failure to complete my original six-year obligation entitling me to the MGIB-SR Kicker may result in suspension, termination, or recoupment of any MGIB-SR Kicker payments I have received. ------------------------------------------------SECTION V- ENTITLEMENT-------------------------------------------------- 1. I will be entitled to the MGIB-SR Kicker for each month of basic MGIB-SR and or MGIB-AD benefits I have remaining for a maximum of 36 months of full-time enrollment. The DVA will adjust the amount and number of months for less than full-time pursuit of qualifying educational programs. 2. I understand that I cannot receive payment of my MGIB-SR Kicker until I have received my secondary school diploma or authorized equivalent and have completed IADT or its equivalent and I have been awarded an MOS. 3. I will remain eligible for the MGIB-SR Kicker as long as I am a drilling member and continue to meet the eligibility criteria of this MGIB-SR Kicker contract or until my total entitlements are exhausted. 4. If I am mobilized, I may have my MGIB-SR Kicker eligibility extended beyond my current Expiration of Term in Service (ETS) date by the DVA for the same period of each mobilization plus four months. NGB FORM 5435-1 Page 2 of 5 2 JUNE 2014
5. If I am medically discharged from the ARNG due to a disability incurred through no misconduct of my own, I will remain eligible for MIGB-SR Kicker benefits for 14 years from my original MGIB-SR Kicker date of eligibility. --------------------------------------SECTION VI- SUSPENSION / REINSTATEMENT----------------------------------- 1. I understand that the following actions will suspend my MGIB-SR Kicker eligibility: a. Transfer into the IRR or ING or ETS/Discharge from the ARNG (Includes discharge to enter Active Duty (AD)). I understand I am only authorized one period of non-availability (one-time break in service) during my military career. A Break in Service cannot exceed 12 months for personal, or 36 months for Missionary reasons. b. Accept an AGR position. (Does not count as a one-time break in service) c. Accept a full-time Permanent or Indefinite Mil Tech or a Temporary Technician position that exceeds 180 days within a continuous 12 month period. (Does not count as a one-time break in service) d. Receive an ROTC Dedicated Army National Guard Scholarship. (Does not count as a one-time break in service) e. Become an Unsatisfactory Participant as per AR 135-91. (Awaiting Determination) 2. No payment may be processed by DVA during the time of suspension. 3. I understand that reinstatement of the MGIB-SR Kicker incentive is not guaranteed. To have my MGIB-SR Kicker reinstated and be eligible to resume receiving payments, I must: a. Return from the authorized period of non-availability (Break in Service) to an active drilling status in my contracted MOS within 12 months for personal or 36 months for Missionary reasons. If the break in service occurs during the original MGIB-SR Kicker six-year contractual obligation, then within 90 days of my return I MUST extend my enlistment for the period of the absence AND rejoin the SR in my contracted MOS before this incentive will be reinstated. b. Return from AGR to an active drilling status. If any period of AGR status occurs during the original MGIB-SR Kicker six-year contractual obligation, then within 90 days of my return I MUST extend my enlistment for that period in my contracted MOS before this incentive will be reinstated. c. Return from MIL Tech to an active drilling status. If any period of MIL Tech status occurs during the original MGIB Kicker six-year contractual obligation, I must remain a drilling member in my contracted MOS during that period. No extension is required. d. Complete my ROTC Dedicated Army National Guard Scholarship. Reinstatement will be effective upon confirmation of completion of scholarship. No extension is required. e. Receive a Commander s determination that I was NOT an Unsatisfactory Participant per AR 135-91. No extension is required. -------------------------------------------SECTION VII - CONTINUED RECEIPT--------------------------------------------- 1. I understand that I will be eligible for continued receipt of the MGIB-SR Kicker under the following conditions: a. I am performing Active Duty Operational Support (ADOS) and/or Full Time National Guard Duty for Operational Support (FTNGDOS) and continue to meet the eligibility criteria for the MGIB-SR Kicker. b. If I am mobilized for deployment, I will be eligible to retain the MGIB-SR Kicker regardless of duty position, Area of Concentration (AOC)/Military Occupational Speciality (MOS) I am cross-leveled into during mobilization. I will be able to continue to receive any remaining MGIB-SR Kicker payments while mobilized. NGB FORM 5435-1 Page 3 of 5 2 JUNE 2014
---------------------------------------SECTION VIII TERMINATION/RECOUPMENT------------------------------------ 1. I understand that the following actions will terminate my MGIB-SR Kicker eligibility: a. Failure to complete the six-year MGIB-SR Kicker contractual obligation.. b. Determined an Unsatisfactory Participant after the appeal process. c. Incur a second break in service. d. Fail to re-affiliate before the end of the authorized period of non-availability (12 months for personal or 36 months for Missionary reasons).. e. Voluntarily change my contracted MOS (including change due to IST) unless MOS change is due to unit reorganization, transformation, relocation, reassignment or I am deployed/mobilized. f. Fail to extend my enlistment for the authorized period of non-availability within 90 days of return to drilling status if the non-availability occurred during the original MGIB-SR Kicker six-year contractual obligation. 2. Termination with Recoupment is required if the termination conditions above occur before completing the original MGIB-SR Kicker six-year contractual obligation This does not apply to Soldiers who are medically discharged (not a result of misconduct) during the contractual obligation. 3. If recoupment is required, the recoupment will be according to the formula prescribed in instructions published by the DoD and DVA. I may be required to refund either part or all of the educational assistance received plus accrued interest. --------------------------------------------SECTION IX BENEFITS EXPLANATION-------------------------------------- 1. The DVA administers monthly payments for the MGIB-SR Kicker program. I may receive MGIB-SR Kicker payments in conjunction with any GI Bill program, but only as long as I have MGIB basic benefits (MGIB-SR or MGIB-AD) remaining. 2. I have up to 36 months of full-time benefits under the MGIB-SR Kicker program if I am a full-time student (72 months if attending school at half-time). 3. Unless I violate the terms of this MGIB-SR Kicker contract, all MGIB-SR Kicker amounts are valid for the entire term of the contract regardless of future increases or decreases by NGB. Current categories and monthly dollar rates are shown in the chart below: MGIB-SR Kicker Officer Commissioning Rates Soldier Category Full-Time 3/4-Time 1/2-Time Commissioning Kicker (OCS, WOC, ROTC & DC) Less Than 1/2-Time $350 $262 $175 $88 -----------------------SECTION X - STATEMENT OF UNDERSTANDING / AUTHENTICATION------------------ 1. I understand that at time of my signature, the original authorized ARNG GIMS Control Number has been verified, approved and recorded on this MGIB-SR Kicker Supplemental addendum by a Service Representative. I will be held to the terms of service of this addendum. I also understand that if I am completing this addendum on or after commissioning, I must also complete a DA Form 5447-R on the same date as this addendum. An Exception to Policy (ETP) is only authorized as per SRIP Policy in effect at date of contract signature. 2. I have read this entire MGIB-SR supplemental Kicker addendum and understand all of the above statements concerning my MGIB-SR Kicker. I also understand that this addendum will be void if I do not NGB FORM 5435-1 Page 4 of 5 2 JUNE 2014
meet all of the requirements at the time of signature. If the MGIB-SR Kicker is suspended, terminated, or recouped, I understand that it does not affect the terms of my contractual agreement. No other promises have been made to me in connection with this addendum. Typed Name of Soldier Signature of Soldier Date Signed -------------------------SECTION XI CERTIFICATION BY SERVICE REPRESENTATIVE------------------------ I certify that I have witnessed the reading and signing of this addendum and the signature appearing above is that of the Soldier. I have verified that the Soldier meets the eligibility requirements of Army Regulation (AR) 135-7 and is currently eligible for the $350 MGIB-SR Kicker. No other promises, representations, or commitments have been made in connection with this MGIB-SR Kicker. I certify that I have verified the approved authorized GIMS MGIB-SR Kicker CN that is annotated on this addendum is for the Soldier accepting this incentive in the ARNG. Typed Name/Rank Administering Official Signature of Administering Official/Date Typed Name/Rank Service Representative Signature of Service Representative/Date NGB FORM 5435-1 Page 5 of 5 2 JUNE 2014