FM 1–300

J–1

Appendix J

Monthly Exception Certification

Personnel who are required to fly a monthly minimum must have their flight hours verified and

signed by the unit commander. This verification is called a monthly exception certificate. Personnel

who become incapacitated because of an aircraft accident must have a certificate of incapacitation

prepared and signed by the appropriate medical authority. Appendix J shows samples of two

certificates: a monthly exception certificate (Figure J–1) and a certificate of incapacitation (Figure

J–2). It also shows a sample of a 120–day advance notice of removal from flight status (Figure J–3).

AR 37–104–4 provides more information on the two certificates.

OFFICE SYMBOL (MARKS NUMBER)

DATE

MEMORANDUM FOR Finance and Accounting Office, ATTN: Military Pay Section

SUBJECT: Monthly Exception Certificate

1. The following individual has not qualified for flight pay for the month of September 1997:

NAME

PAYGRADE

SSN

NUNEZ, ALFONSO

E–7

XXX–XX–XXXX

2. The following individual has met the requirements to qualify for flight pay for the month

indicated:

NAME

PAY GRADE

SSN

MONTH

BOATRIGHT, WALTER P. E–6 XXX–XX–XXXX AUG 97

3. The point of contact for this action is SFC Thrush, 262–6554.

Unit Commander's Signature Block

"(include SSN)"

Figure J–1. Sample Monthly Exception Certificate

FM 1B300

JB2

OFFICE SYMBOL (MARKS NUMBER)

DATE

MEMORANDUM FOR Finance and Accounting Office, ATTN: Military Pay Section

SUBJECT: Certificate of Incapacitation

1. SGT John E. Doe, 123–45–6789, Company D, 2/229 Aviation Regiment, is physically incapacitated

and unable to perform his duties as a UH–60 Black Hawk crewchief as a result of a Class B aircraft

accident. This incapacity occurred on 18 January 1991 while SGT Doe's unit was maneuvering

against an enemy in the northern region of Saudi Arabia during Operation Desert Storm. SGT Doe

continued to be incapacitated from 18 January 1991 to 28 February 1991.

2. SGT Doe is entitled to incentive pay during the period of incapacitation as outlined in the DOD

Military Pay and Allowances Entitlements Manual.

3. The POC for this action is SFC Mike Jones, x–1234.

Medical Authority's Signature Block

Figure J–2. Sample Certificate of Incapacitation

FM 1–300

J–3

OFFICE SYMBOL (MARKS NUMBER)

DATE

MEMORANDUM FOR Individual, SSN

SUBJECT: 120–day Advanced Notice of Removal from Flight Status

1. Because of (Reason) , you wish be removed from flight status on (Effective Date) and

your flight pay will be terminated on (Date Additional Pay Terminated) . It is important that

you financially prepare for the loss of the hazardous duty incentive pay

2. The point of contact for this action is SFC Jones, 234–2356.

Unit Commander's Signature Block

Xxxxxxx, Xx

Xxxxxxxxxxxxx

OFFICE SYMBOL (Of the preparing office) 1st End Action officer/typist's

initial/phone No.

Example: SFC Simpson/jls/7272

I acknowledge the receipt of this 120–day advanced notice of my pending removal from flight status.

I further understand that I will lose the hazardous duty incentive pay associated with that flight

status.

Individual's Signature Block

Xxxxxxxxxx, Xx

Xxxxxxxxxxxx

Figure J–3. Sample 120–Day Advance Notice of Removal from Flight Status