GSA5039

Living Quarters Eligibility Questionnaire

Agency
GSA
Revision
Rev. 10/2023
Fillable fields
40
Pages
2
Official source
GSA form page
Checked
October 20, 2026
Fill GSA5039 online
Page 1 of form GSA5039

GSA Form 5039: Living Quarters Eligibility Questionnaire

GSA Form 5039, Living Quarters Eligibility Questionnaire, is a two-page General Services Administration (GSA) form printed as GSA 5039 10/2023, with OMB Control Number 3090-0331 and an expiration date of 10/31/2026. GSA hosts it in its forms library, and GSA's page lists HRM 9301.1 as its authority or regulation.

The form says living quarters allowance (LQA) is provided to reimburse employees for suitable, adequate living quarters at posts where the U.S. Government does not provide quarters, and that it is a discretionary housing allowance, not an entitlement. The questionnaire asks for contact details, uniformed service history, overseas residence and employer history, and a checklist of documents.

The form says job candidates currently living in the Continental United States (CONUS), Alaska, Hawaii, or U.S. territories or possessions do not have to complete it. GSA estimates 1 hour to read the instructions, gather the facts and answer the questions. You can fill it out free in your browser on this page and download the result without an account.

Top of page 1 of GSA Form 5039: Living Quarters Eligibility Questionnaire, as printed by GSA

What's on GSA Form 5039

Instructions

What LQA reimburses, a pointer to DSSR 130 for the full list of covered costs, and which candidates complete which sections.

Section A: all job candidates

First and last name, middle initial, email address, postal mailing address, permanent address, work address, and federal agency or military component.

Section B: uniformed services job candidates

Place of entry into active service, home of record, station at discharge and separation date, each keyed to a DD-214 item, plus yes or no questions on PCS orders and later employers.

Section C: civilian job candidates

Arrival at the foreign post, the return transport agreement, a spouse or partner receiving a housing allowance, the actual place of residence in the U.S., and questions on overseas residence and employers citing DSSR 031.11 and 031.12.

Section D: checklist of required documents

Six documents to check and attach: PCS orders CONUS to OCONUS, all subsequent PCS orders, DD-214 and/or separation location memo, retirement or separation orders, a transportation agreement back to the U.S. such as DD-1617, and DD-2367.

Certification and statements

Printed name, signature and date, then the Privacy Act and Paperwork Reduction Act statements.

How to complete GSA Form 5039

  1. 1

    Check whether the form applies

    The instructions say candidates living in CONUS, Alaska, Hawaii, or U.S. territories or possessions do not complete it.

  2. 2

    Complete Section A

    Enter your name, email, addresses and federal agency or military component.

  3. 3

    Complete Section B or C as it applies

    Uniformed services candidates use the DD-214 item numbers printed under each Section B box. Section C asks for dates as dd/mm/yyyy.

  4. 4

    Gather the documents in Section D

    The form says to retrieve the listed documents, attach them to the form and check which ones are available.

  5. 5

    Sign the certification

    The certification says false information may lead to being determined ineligible for LQA and indebted to the U.S. Government, and that not answering all questions may lead to denial of LQA eligibility.

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Use, time and privacy

Where it goes

The form gives no submission address. The Privacy Act statement says the GSA Office of Human Resources Management and the employee's new supervisor use the information.

Where it is stored

The form says the information is stored in OPM's Electronic Personnel Folder (eOPF) under System of Record Notice OPM/GOVT-1 and is not releasable to the general public.

Time to complete

GSA estimates 1 hour to read the instructions, gather the facts and answer the questions.

Comments on the time estimate

The form says to send only comments about the time estimate to U.S. General Services Administration, Regulatory Secretariat Division (MVCB), 1800 F Street, NW, Washington, DC 20405.

Missing information

The form says failure to provide the information may lead to the erroneous payment of compensation and benefits, or the non-payment of eligible compensation and benefits.

Related forms

Who fills out GSA Form 5039?

  • All job candidates: Section A

    The form says all applicants complete Section A, with name, email address, mailing, permanent and work addresses, and federal agency or military component.

  • Uniformed services candidates: Section B

    Members of the Uniformed Service complete Section B and attach a copy of their most recent DD-214, Report of Transfer or Discharge.

  • Civilian employees living overseas: Section C

    The form says current civilian employees living overseas complete Section C.

  • Candidates who skip the form

    The form says job candidates currently living in CONUS, Alaska, Hawaii, or U.S. territories or possessions do not have to complete it.

  • Who uses the answers

    The Privacy Act statement says the information will only be used by the GSA Office of Human Resources Management and the employee's new supervisor.

The instructions say which job candidates complete which sections.

Official sources and the blank

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Questions about Form GSA5039

Who issues GSA Form 5039?

It is a General Services Administration form, printed as GSA 5039 10/2023 with OMB Control Number 3090-0331 and an expiration date of 10/31/2026. GSA's page lists HRM 9301.1 as its authority or regulation.

What is LQA, according to the form?

The form says living quarters allowance reimburses employees for suitable, adequate living quarters at posts where the U.S. Government does not provide quarters, and may be used to pay for rent, utilities, taxes and related fees. It points to DSSR 130 for the full list.

Is LQA an entitlement?

The form says LQA is a discretionary housing allowance granted to candidates recruited in the United States or outside the U.S. under certain circumstances, and that it is not an entitlement.

Who does not have to complete GSA Form 5039?

The form says job candidates currently living in the Continental United States (CONUS), Alaska, Hawaii, or U.S. territories or possessions do not have to complete it.

What documents does the form list?

Section D lists PCS orders CONUS to OCONUS, all subsequent PCS orders, DD-214 and/or a separation location memo, retirement or separation orders, a transportation agreement back to the U.S. such as DD-1617, and DD-2367.

How long does GSA Form 5039 take?

GSA estimates it will take 1 hour to read the instructions, gather the facts and answer the questions.