TN 5 (09-97)

A. PROCEDURE

1. Servicing FO

Enter period(s) for which wage information is requested; quarterly for years prior to 1978 and yearly for years after 1977 (section 1.e.).

2. PSSO

Forward letter to the State Adjutant General and return it to the servicing FO upon completion.

B. EXHIBIT

PSSO

(Address)

The Adjutant General, (State)

• (Address)

   

Sir:

In connection with a Social Security matter, we need information to establish for the individual named below wages paid for active duty or active duty for training for the period(s) shown.

We appreciate your cooperation in providing the information in RS 01404.320B.2.

1. Identifying Information

(a) Name:              (b)Social Security Number:      

(c) Service Serial Number(s):      

(d) Organization to which assigned:     

(e) Alleged period(s) of active duty    

(f) Alleged location of active duty:    

2. Information Requested:

(a) Period(s) of active duty (if same as above, write “same” ):    

(b) Amount of wages for period(s) shown below:

If the amount of wage is not available, please provide:

(c) Indidivual's rank or pay grade during (this)(each) period and the date of rank:     

(d) Number of years of service completed for pay purposes (longevity) for (this)

(each)period):