Dd Form 2901 - Child Abuse Or Domestic Violence Related Fatality Notification Page 3
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4INSTRUCTIONS FOR COMPLETING
CHILD ABUSE OR DOMESTIC VIOLENCE RELATED FATALITY NOTIFICATION
INFORMATION TO BE REPORTED:
SECTION I - ADMINISTRATIVE
INFORMATION.
a. Single fatality and suspect. When an individual is suspected of having
commmitted child abuse or domestic violence that resulted in a fatality,
1. Date of Report. Enter the date that the
submit completed pages 1 and 2.
"Initial Notification" form is submitted to the
b. Multiple fatalities with one suspect. Although uncommon, an individual
DUSD(MC&FP) using the format YYYYMMDD.
may be suspected of having committed both child abuse and domestic
violence that resulted in multiple fatalities. Alternatively, an individual may
2. Date of Incident. Enter the date on which
be suspected of having committed either child abuse or domestic violence
the incident ultimately causing the child abuse
that resulted in a fatality and then committed suicide. In rare instances, an
or domestic violence-related fatality occurred,
individual may be suspected of having committed child abuse on several
using the format YYYYMMDD.
children that resulted in multiple fatalities. In any of these situations,
additional copies of page 1 with completed items 16 - 24 must be submitted
to ensure that "Victim Information" is submitted for each victim, as follows:
3. Report From. Mark (X) in the block
corresponding to the Service submitting the
(1) Complete items 1 through 8, "Administrative Information", and items 9
"Initial Notification" form to the DUSD
- 15, "Suspect Information" sections on page 1;
(MC&FP). If a Defense Agency/DoD Field
(2) Complete items 16 through 24, "Victim Information" (page 1), for the
Activity is submitting the form, X the box
first fatality;
labeled "Defense Agency/DoD Field Activity".
(3) Complete additional items 16 through 24, "Victim Information", for
each additional fatality, assigning each victim a new number in item 16, and
4. Name of Installation. Enter the name of the
(4) Complete item 25, "Brief Narrative", on page 2.
installation submitting the "Initial Notification"
form.
c. One fatality with multiple suspects. In rare instances, several individuals
may be suspects. Typically, this involves both parents when there is a
5. Person Making This Report. Enter the
suspected child abuse fatality, but it can involve a conspiracy to commit
name, official position, DSN and commercial
domestic violence against a current or former spouse or intimate partner. In
voice telephone numbers, and DSN and
any of these situations, additional copies of page 1 with completed items 9 -
commercial fax telephone numbers of the
15 must be submitted to ensure that "Suspect Information" is completed for
person submitting the "Initial Notification" form.
each suspect, as follows:
(1) Complete items 1 through 8, "Administrative Information" section, on
6. Incident Type. Mark (X) whether the fatality
page 1;
was due to child abuse or domestic violence.
(2) Complete items 9 through 15, "Suspect Information" section (page 1)
If the incident involved both child abuse and
for the first suspect;
domestic violence fatalities, X both. If the
incident was a suicide related to child abuse or
(3) Complete additional items 9 through 15, "Suspect Information" (page
domestic violence, X either child abuse or
1), for each additional suspect, assigning each suspect a new number in
item 9;
domestic violence, as appropriate, and suicide.
(4) Complete items 16 through 24, "Victim Information" section, and
7. Number of Fatalities. Enter the number of
(5) Complete item 25, "Brief Narrative", on page 2.
fatalities that were suspected homicides
occurring because of the incident, regardless
d. Multiple fatalities with multiple suspects. In the rare instance when
of incident type. Enter the number of suicides
several individuals may be suspected of committing multiple domestic
if the suspect(s) allegedly committed suicide.
violence or child abuse homicides, multiple copies of page 1 must be
submitted to ensure that "Suspect Information" is submitted for each
8. Location of the Incident. Mark (X) whether
suspect and "Victim Information" is submitted for each victim, as follows:
the incident ultimately causing the fatality
(1) Complete items 1 through 8, "Administrative Information" section, on
occurred on or off the installation. X whether
page 1;
the incident ultimately causing the fatality
(2) Complete items 9 through 15, "Suspect Information" section (page 1)
occurred in the victim's home. If the incident
for the first suspect;
ultimately causing the fatality occurred in a
location other than the victim's residence,
(3) Complete items 16 through 24, "Victim Information" section (page 1),
enter the location where the incident ultimately
for the first victim;
causing the fatality occurred.
(4) For each additional suspect and victim, complete an additional page
1, assigning each additional suspect a new number in item 9 and assigning
each additional victim a new number in item 16, and
(5) Complete item 25, "Brief Narrative", on page 2.
DD FORM 2901 INSTRUCTIONS, MAY 2012
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