Dd Form 2648 – Fill Out and Use This PDF

PRESEPARATION COUNSELING CHECKLIST

FOR ACTIVE COMPONENT (AC), ACTIVE GUARD RESERVE (AGR), ACTIVE RESERVE (AR), FULL TIME SUPPORT (FTS), AND RESERVE PROGRAM ADMINISTRATOR (RPA) SERVICE MEMBERS

(Please read Privacy Act Statement and Instructions in Section III before completing this form.)

SECTION I - PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. 1142, Preseparation Counseling; transmittal of medical records to Department of Veterans Affairs, and E.O. 9397 (SSN) as amended.

PRINCIPAL PURPOSE(S): To record preseparation services and benefits requested by and provided to Service members; to identify preseparation counseling areas of interest as a basis for development of an Individual Transition Plan (ITP). The signed preseparation counseling checklist will be maintained in the Service member’s official personnel file. Title 10 U.S.C. 1142 requires that not later than 90 days before the date of separation, for anticipated losses, preseparation counseling for Service members be made available. For unanticipated losses, preseparation counseling shall be made available as soon as possible.

ROUTINE USE(S): Disclosure of records are generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended. Applicable Blanket Routine Use(s) are: Law Enforcement Routine Use, Congressional Inquiries, Disclosure to the Department of Justice for Litigation Routine Use, Disclosure of Information to the National Archives and Records Administration Routine Use, and Data Breach Remediation Purposes Routine Use. To the Department of Veterans Affairs and other federal agencies for the purpose of providing transition assistance and available benefits to the eligible Service member. The DoD Blanket Routine Uses set forth at the beginning of the Office of the Secretary of Defense (OSD) compilation of systems of records notices may apply to this system. The complete list of DoD Blanket Routine Uses can be found online at http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx

The applicable system of records notice is: DMDC 01, Defense Manpower Data Center Data Base. The SORNs may be found at

http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/570563/dmdc-01.aspx

DISCLOSURE: Disclosure is voluntary however it may not be possible to initiate preseparation counseling and other transition assistance services or develop an Individual Transition Plan (ITP) for a Service member if the information is not provided.

SECTION II - PERSONAL INFORMATION (To be filled out by all applicants)

SECTION III - INSTRUCTIONS

All transitioning Service members shall read these instructions before completing Sections IV, V, and VI of this form. After being counseled, Service member shall sign and date the form in items 28.a. and 28.b.

This form will be used for Active Component (AC), Active Guard Reserve (AGR), Active Reserve (AR), Full Time Support (FTS), and Reserve Program Administrator (RPA) Service members.

(1)Items checked "YES" indicate that you require additional information or referral to a subject matter expert on the installation or to an appropriate person in another agency or organization outside of DoD or attendance at a scheduled employment or VA session (Section IV).

(2)Shaded areas on the form mean: (a) the information is not applicable (example: item 11.b. is shaded under "Spouse" because DD Form 2586, "Verification of Military Experience and Education - VMET", does not apply to spouses); or (b) the item is referring to a Web site address and URLs require no further explanation. URLs are provided so Service members can research information at their leisure on a given topic or subject.

(3)Department of Labor TAP Employment Workshop: In accordance with DoDI 1332.35, AC, AGR, AR, FTS, and RPA separating and retiring Service members who check "YES" in item 11.a. on DD Form 2648, "Preseparation Counseling Checklist", shall be released to complete the Department of Labor (DOL) Transition Assistance Program (TAP) Employment Workshop in its entirety. Service members will be exempt from normal duty the full 24 hour period of each DOL workshop day and the 12 hours immediately preceding and following the DOL workshop. In the event that a DOL Workshop is unavailable, the Service member will attend a military equivalent employment workshop conducted by the Military Services.

(4)Veterans Benefits Briefing: In accordance with DoDI 1332.35, all separating and retiring Service members who check "YES" in item 19 shall be released to complete the Veterans Benefits Briefing sponsored and offered by the Department of Veterans Affairs (VA) in its entirety. Service members will be exempt from normal duty the full 24 hour period of each VA Benefits Briefing day and the 12 hours immediately preceding and following the VA Benefits Briefing.

(5)Disabled Transition Assistance Program (DTAP): In accordance with DoDI 1332.35, all separating and retiring Service members who check "YES" in item 20 (with special emphasis on Wounded, Ill, or Injured) who have or think they have a service-connected disability, are awaiting a medical discharge, or have incurred an injury or illness while on active duty, or aggravated a pre-existing condition, and those referred to a Physical Evaluation Board or placed in a medical hold status by their Service, shall be released to complete the DTAP briefing sponsored by VA. Spouses/Family Member/Legal Guardian/Designee are encouraged to attend the DTAP briefing. Service members will be exempt from normal duty the full 24 hour period of each VA DTAP Briefing day and the 12 hours immediately preceding and following the VA DTAP Briefing.

18.RESERVE AFFILIATION

19.Do you want to attend the Veterans Benefits Briefing? (See section III, Instructions, item 4.)

20.DISABLED VETERANS BENEFITS

a.Do you want to attend the Disabled Transition Assistance Program (DTAP) Briefing? See Section III - Instructions, item 5 and VA Vocational Rehabilitation and Employment Service at www.vba.va.gov/bln/vre

b.VA Disability Benefits www.vba.va.gov/VBA/benefits/factsheets

c. Benefits Delivery at Discharge and Quick Start www.vba.va.gov/predischarge

21.STATE VETERANS BENEFITS

22.2-YEAR COMMISSARY AND EXCHANGE PRIVILEGES (Eligible Involuntary Separatees)

23.LEGAL ASSISTANCE

24.POST GOVERNMENT (MILITARY) SERVICE EMPLOYMENT RESTRICTION COUNSELING

Information on post government (military) employment counseling (restrictions on employment, imposed by statute and regulation) shall be conducted by Services as appropriate. Transition/Command Career Counselors shall refer separating and retiring Service members to an installation legal office (Staff Judge Advocate or Counselor's Office) to ensure they receive a post government (military) employment restrictions briefing or counseling from an ethics official.

25.INDIVIDUAL TRANSITION PLAN (ITP)

a.As a separating Service member, after receiving Preseparation Counseling information and completing this checklist, you and your spouse/ family member/legal guardian/designee (if applicable) are entitled to receive assistance in developing an Individual Transition Plan (ITP) based on the areas of interest you have identified on this checklist. The Preseparation Counseling Checklist addresses a variety of transition services and benefits to which you may be entitled. Each individual is strongly encouraged to take advantage of the opportunity to develop an ITP. The purpose of the ITP is to identify educational, training, and employment objectives and to develop a plan to help you achieve these objectives. It is the Military Department's responsibility to offer Service members the opportunity and assistance they need to develop an ITP. It is the Service member's responsibility to develop an ITP based on his/her specific objectives and the objectives of his or her spouse, if appropriate.

b. To assist your transition counselor, choose the answer that best describes your post-military goal(s): (X all that apply)

SECTION V - LANGUAGE SKILLS/REGIONAL EXPERTISE

Counselors will ensure all transitioning Service members, Active, Guard and Reserve with language skills and/or regional expertise complete Item 26.

26.The Department of Defense and other Federal agencies have placed a high level of importance on critical foreign language skills and regional expertise to meet emerging requirements during times of need, crisis, and/or national emergency. The Department of Defense and other Federal agencies may want to contact you in the future to determine if you would be willing to volunteer your services or to offer you potential employment that would take advantage of your language proficiency and/or regional expertise.

SECTION VI - REMARKS (Attach additional pages if necessary)

Complete the following ONLY if you placed an X in Item 8.a. (See page 1, Section II, item 8.a.)

27. MY COUNSELING WAS CONDUCTED 89 DAYS OR LESS BEFORE MY SEPARATION OR RETIREMENT BECAUSE OF: (X one)

28.SERVICE MEMBER ACKNOWLEDGEMENT

By signing and dating this form, you, the Service member, are acknowledging that you received Preseparation Counseling on the date below (item 28.b.), and that you understand the transition benefits and services available to assist you in your transition as required by Title 10, U.S.C., Chapter 58, Section 1142.