ENCLOSURE (3) TO COMDTINST 1754.9A
REIMBURSEMENT REQUEST FOR ADOPTION EXPENSES
(See Privacy Act Statement on Page 3.)
1.
The date that adoption proceedings were initiated is:_____________. Note: Adoption
expenses are reimbursable only to members that have completed or initiated adoption
proceedings on or after December 5, 1991. Adoption proceedings are deemed to be initiated
upon the date of the initial home study report or the placement of the child in the military
member's home.
2.
The date the adoption was finalized is: _______________. Note: Reimbursement of adoption
expenses may be paid only after the adoption is final.
3.
The adoption was arranged by:
a. _________ A state or local, government agency that has responsibility under state or local law
for placement of children for adoption.
b. _________ A nonprofit, voluntary adoption agency that is authorized by state or local law to
place children for adoption.
DEPT. OF TRANSP., USCG, CG-5553A (10-92)
LOCAL REPRO