Dd Form 2648 - 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

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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; E.O. 9397, as amended (SSN).

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, USC 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): None.

DISCLOSURE: Disclosure of SSN is mandatory. Disclosure of other information in Section II 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)

1. NAME

2. SSN

3. GRADE

4. DATE OF BIRTH

c. Middle

(YYYYMMDD)

a. Last Name

b. First Name

Initial

5. SERVICE

5.a. COMPONENT

6. DUTY STATION

7. ANTICIPATED DATE OF SEPARATION

(X one)

(YYYYMMDD)

a. MILITARY INSTALLATION/CITY

ARMY

AGR

MARINE CORPS

I AM

7.a.

(X one)

NAVY

b. STATE

c. ZIP CODE

Separating

AIR FORCE

RPA

Retiring

Involuntarily

COAST GUARD

FTS

Separating Voluntarily

8. DATE CHECKLIST

8.a. Place an X in this box ONLY if you have 89 days or less remaining on active duty before separation or retirement.

PREPARED

(Please read the following instructions: If separating or retiring and you have 89 days or less remaining on active duty before your

(YYYYMMDD)

separation or retirement, why was your preseparation counseling not conducted earlier? Please go to Section VI - REMARKS and

check the response that best describes why preseparation counseling was not conducted earlier.)

9. Is your spouse/family member/legal guardian/designee present during preseparation counseling?

YES

N/A

(X one)

9.a. Are you willing to be contacted after separation or retirement regarding the value of the

YES

transition assistance programs and services you received?

(X one)

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.

Page 1 of 5 Pages

DD FORM 2648 TEST, JAN 2011

PREVIOUS EDITION IS OBSOLETE.

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