IA01 Technical Exhibit 6 - eForm (2648) W9124D20R0016 DEC18.pdf

DD FORM 2648, DEC2018 PREVIOUS EDITION IS OBSOLETE. Page 1 of 3

SERVICE MEMBER PRE-SEPARATION/TRANSITION COUNSELING AND CAREER READINESS STANDARDS EFORM FOR

SERVICE MEMBERS SEPARATING, RETIRING, RELEASED FROM ACTIVE DUTY (REFRAD)

SECTION I - PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. 1142, Preseparation Counseling; transmittal of medical records to Department of Veterans Affairs.

PURPOSE(S): To record pre-separation counseling services and benefits requested by and provided to Service members; to identify pre-separation counseling areas of interest as a basis for development of an Individual Transition Plan (ITP). The signed pre-separation 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, pre-separation counseling for Service members be made available. For unanticipated losses, or in the event a member of a reserve component is being demobilized under circumstances in which operational requirements make the 90-day requirement unfeasible, pre-separation counseling shall be made available as soon as possible within the remaining period.

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 for the purpose of available benefits to the Service member.

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/DOD-wide-SORN-Article-View/Article/570563/dmdc-01/ 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 – SERVICE MEMBER PERSONAL INFORMATION

1. NAME 2. DOD ID NUMBER 3. GRADE 4. DATE OF BIRTH 5. SERVICE 5a. COMPONENT

6. UNIT NAME 6a. UNIT ID CODE 6b. MILITARY INSTALLATION

7. ANTICIPATED DATE OF

SEPARATION

7a. REASON FOR SEPARATION 7b. TYPE OF SEPARATION 8. DATE FORM WAS INITIATED

9. MEMBER ALLOWS THIS FORM TO BE SENT TO FEDERAL AGENCIES FOR ADDITIONAL TRANSITION ASSISTANCE POST SEPARATION:

9a. MEMBER ALLOWS THIS FORM TO BE SENT TO FEDERAL AND OTHER AGENCIES WHO LOOK FOR CRITICAL LANGUAGE SKILLS AND/OR REGIONAL EXPERTISE THAT COULD BE VITAL DURING TIMES OF NEED, CRISIS, AND/OR NATIONAL EMERGENCIES:

9b. POST-SEPARATION EMAIL: 9c. POST-SEPARATION PHONE NUMBER:

10. MILITARY MEMBER/CAREGIVER/LEGAL GUARDIAN/DESIGNEE GOING TO BE PRESENT DURING PRE-SEPARATION COUNSELING:

SECTION III – PRE-SEPARATION / TRANSITION COUNSELING, PRE-SEPARATION / TRANSITION COUNSELING NEEDS ASSESSMENT, REVIEW, AND

VERIFICATION TO MEET CAREER READINESS STANDARDS (CRS), AND VOW COMPLIANCE

Service members shall be counseled on all items prescribed in Title 10, United States Code (U.S.C.), Chapter 58, Sections 1142(b) (1-17), Sections 1143, 1143a, 1144, 1145, 1146, 1147, 1148, 1149, 1150, 1151, and 1154, and DoD policies; involuntarily separated Service members have alternative benefits and programs that apply to them. Service member completed the following to meet Career Readiness Standards (CRS):

*Required

11. Completed Pre-Separation Counseling: *

12. Completed the Veteran Affairs (VA) Benefits Briefings I and II: *

13. Completed the Department of Labor (DOL) Employment Workshop: *

14. Registered on eBenefits *

15. Prepared a criterion-based Financial Plan for military to civilian transition *

16. Completed a criterion-based Individual Transition Plan (ITP) *

17. Completed a Continuum of Military Service Opportunity Counseling (Required Active Component Only)

18. Evaluated transferability of military skills to civilian workforce / Complete DoD Standardized Gap Analysis *

19. Documented requirements and eligibility for licensure, certification, and apprenticeship *

20. Completed an assessment tool to identify personal interests and leanings regarding career selection *

21. Completed a job application package or received a job offer letter *

22. Completed an assessment tool to identify aptitudes, interests, strengths, or skills

23. Completed a comparison of higher academic or technical training institution options

24. Completed a college, university, or career technical training application or received an acceptance letter

25. Confirmed one-on-one counseling with a higher education or career technical training institution advisor

26. I WAS COUNSELED AND RECEIVED DOCUMENTATION ON ALL ITEMS IN SECTION III, WHICH INCLUDES ALL ITEMS LISTED ON THE PRE-SEPARATION /

TRANSITION COUNSELING ADDENDUM SHEET:

27. PRE-SEPARATION / TRANSITION COUNSELING WAS COMPLETED WITH 89 DAYS OR LESS REMAINING BEFORE SEPARATION:

27a. PRE-SEPARATION / TRANSITION COUNSELING COMPLETED 89 DAYS OR LESS JUSTIFICATION:

28. SERVICE MEMBER SIGNATURE & DATE 29. TRANSITION COUNSELOR SIGNATURE & DATE

Capstone

CRS Review

Pre-Sep

Assessment

Technical Exhibit 6

DoD Form 2648 (eForm)

DD FORM 2648, DEC2018 PREVIOUS EDITION IS OBSOLETE. Page 2 of 3

SECTION IV – OTHER REQUIREMENTS

30. EVALUATED POST-TRANSITION TRANSPORTATION REQUIREMENTS AND DEVELOPED A PLAN TO MEET PERSONAL/FAMILY NEEDS:

31. EVALUATED POST-TRANSITION HOUSING REQUIREMENTS AND DEVELOPED A PLAN TO MEET PERSONAL/FAMILY NEEDS:

SECTION V – OTHER CURRICULUM ATTENDANCE

32. ACCESSING HIGHER EDUCATION TRACK:

33. ENTREPRENEURSHIP TRACK:

33a. ADDITIONAL ENTREPRENEURSHIP TRACK TRAINING (8 WEEK COURSE):

34. CAREER EXPLORATION AND PLANNING TRACK:

SECTION VI – CAPSTONE REVIEW

35. SERVICE MEMBER SIGNATURE & DATE

36. TRANSITION COUNSELOR SIGNATURE & DATE

SECTION VII – COMMANDER OR COMMANDER’S DESIGNEE VERIFICATION

37. APPLICABLE CAREER READINESS STANDARDS MET:

40. COMMANDER OR COMMANDER’S DESIGNEE SIGNATURE & DATE

38. VIABLE ITP COMPLETED:

39. WARM HANDOVERS EXECUTED:

SECTION VIII – WARM HANDOVER TO SUPPORTING AGENCIES CONTACT INFORMATION

41. VETERANS AFFAIRS:

42. DEPARTMENT OF LABOR:

43. OTHER RESOURCE:

SECTION IX – REMARKS

44. REMARKS:

DD FORM 2648, DEC2018 PREVIOUS EDITION IS OBSOLETE. Page 3 of 3

SECTION IX – REMARKS (CONT.)

44. REMARKS (CONT.):