Dd Form 2901 - Child Abuse Or Domestic Violence Related Fatality Notification Page 4
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4INSTRUCTIONS FOR COMPLETING
CHILD ABUSE OR DOMESTIC VIOLENCE RELATED FATALITY NOTIFICATION
(Continued)
SECTION II - SUSPECT INFORMATION.
SECTION III - VICTIM INFORMATION.
Complete items 16 through 24 for each fatality occurring because
Complete items 9 through 15 for each individual
of the reported incident. If there is more than one victim, submit
suspected of committing a homicide in the reported
an additional page 1 with completed items 16 through 24 for each
incident. If there is more than one suspect, submit an
additional victim in the same incident.
additional page 1 with completed items 9 through 15
16. Victim No. __ of __. Assign a number for each victim for
for each additional suspect in the same incident.
whom information is submitted, and enter the total number of
victims. For example, if a spouse is killed by domestic violence,
9. Suspect No. __ of __. Assign a number for each
enter "Victim No. 1 of 1". If two individuals were fatalities, for
suspect for whom information is submitted, and enter
instance when a spouse is killed and then the suspected killer
commits suicide, enter "Victim No. 1 of 2" for the spouse, submit
the total number of suspects. For example, if an
an additional page 1, and enter on it "Victim No. 2 of 2" for the
individual is suspected of killing his spouse, enter
suicide victim.
"Suspect No. 1 of 1". If two individuals are suspected
of homicide, enter "Suspect No. 1 of 2" on page 1,
17. Age. Enter the age of the victim on his or her last birthday.
submit an additional page 1, and enter on it "Suspect
18. Gender. Mark (X) the gender of the victim.
No. 2 of 2".
19. Relationship to DoD. Mark (X) whether the victim was a
10. Age. Enter the age of the suspect on his or her
member of a Military Department on active duty, a current
last birthday.
dependent of a member of a Military Department on active duty, a
civilian employee of DoD, or had no affiliation with DoD. For
purposes of fatality notification, a victim who was in the Reserve
11. Gender. Mark (X) the gender of the suspect.
Component but not on active duty or who was a retired member of
the Armed Forces shall be considered to have had no affiliation
12. Relationship to DoD. Mark (X) whether the
with DoD unless the victim was a current dependent of a member
of a Military Department on active duty or a civilian employee of
suspect is a member of a Military Department on
DoD. If the victim was an active duty Service member, enter his/
active duty, a current dependent of a member of a
her pay grade.
Military Department on active duty, a civilian employee
of DoD, or had no affiliation with DoD. For purposes
20. Service. Mark (X) the victim's Service. If the Service member
of fatality notification, a suspect who is in the Reserve
was also assigned to a Defense Agency or DoD Field Activity, X
the Service and on the line labeled "Other", enter "Defense
Component but not on active duty or who is a retired
Agency" or "DoD Field Activity". If this question is not applicable
member of the Armed Forces shall be deemed to
to the victim, X "Not Applicable".
have had no affiliation with DoD unless the suspect is
a current dependent of a member of a Military
21. Relationship to Suspect. Mark (X) the relationship to the
suspect.
Department on active duty or a civilian employee of
DoD. If the suspect is an active duty Service member,
22. Suspected Cause of Death. Mark (X) the suspected cause of
enter his/her pay grade.
the victim's death if known at the time the "Initial Notification" form
is submitted. If "Other", enter the suspected cause of death. If the
13. Service. Mark (X) the suspect's Service. If the
cause of death is unknown when submitting the "Initial
Notification" form to the DUSD(MC&FP), X "Unknown". (If
Service member is also assigned to a Defense
possible, the medical examiner should be consulted when
Agency or DoD Field Activity, X the Service and on
indicating the suspected cause of death.)
the line labeled "Other", enter "Defense Agency" or
"DoD Field Activity". If this question is not applicable
23. Date of Death. Enter the date on which the victim died if
known at the time the "Initial Notification" form is submitted to the
to the suspect, X "Not Applicable".
DUSD(MC&FP), using the format YYYYMMDD.
14. Was the suspect previously reported to command
24. Was victim previously known to the Family Advocacy
for alleged family violence? Mark (X) whether the
Program? Mark (X) whether the victim was known to the Family
suspect had been reported to command for alleged
Advocacy Program prior to the incident ultimately causing the
fatality. If this is unknown when filling out the form, X "Unknown".
family violence prior to the incident ultimately causing
the fatality.
PAGE 2 - BRIEF NARRATIVE.
15. Is the suspect currently in military restraint or
25. Brief Narrative of the Incident. Enter a description of the
incident that ultimately caused the fatality/fatalities. If the space
civilian custody? Mark (X) whether the suspect has
provided for the narrative is not adequate, the complete
been apprehended (taken into custody) or placed
description may be submitted on an additional piece of 8-1/2 x 11
under pre-trial restraint, or has been arrested or is
white paper. Only one item 25 needs to be completed, even if
being held in custody by civilian law enforcement as of
there is more than one suspect or more than one fatality.
the date the "Initial Notification" form is being
submitted to the DUSD(MC&FP).
DD FORM 2901 INSTRUCTIONS (BACK), MAY 2012
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