Fillable Deployment Verification Form (Child Care Aware)

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Deployment Verification Form (Child Care Aware)

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1515 N. Courthouse Road, 2nd Floor, Arlington, VA 22201
Phone: 1-800-793-0324 | Fax: 703-341-4103 | www.usa.childcareaware.org
Deployment Verification Form
This form must be signed by the military sponsor’s Commanding Officer (CO) in order to verify eligibility.
1. Per FRAGO 01 to EXHORD 300-16, Soldiers desiring to use Deployment Support Services must provide official
orders and a letter from their Command indicating which of the criteria are being met in accordance with Annex F,
Definitions: Eligibility Criteria.
2. In order to assign the applicable benefits, please circle below the criteria the Soldier meets and include the
Soldier’s name, rank, and assigned Unit (please see attached Annex F definitions).
Eligibility Criteria
Name
& Rank
of Soldier
Unit
Criteria 1:
Deployed Contingency
Operations
iteria 2:
Assigned to a Warrior
Transition Unit (WTU)
Criteria
3:
Deployed Rotation Forces
Criteria 4:
Deployed Non
-
Contingency
Operations
3. For Criteria 1, Deployed Contingency Operations, and Criteria 4, Deployed Non-Contingency Operations, the
memo must also state the length of deployment. Please provide the dates of deployment:
__________________ to __________________.
(Beginning Date) (Ending Date)
4. For Criteria 2, Assigned to a Warrior Transition Unit (WTU), the memo may be used for verification. Please provide
the dates of medical treatment and/or care as indicated on the memo: ________________ to ________________.
(Beginning Date) (Ending Date)
5. Failure of the Soldier to provide proof of eligibility (deployment orders and/or this signed form) will preclude the
Soldier from receiving these benefits.
6. Information is subject to review by Army in order to verify eligibility.
Commanding Officer Certification
I hereby certify that the Soldier listed above meets the indicated eligibility criteria to qualify for additional
Deployment Support Services benefits and that to my knowledge all above information is true and correct.
Print Name: __________________________ Signature: __________________________
Official U.S. Army Email Address: _______________________ Rank: ________________________
Title: __________________________ Phone Number: ______________________
1515 N. Courthouse Road, 2nd Floor, Arlington, VA 22201
Phone: 1-800-793-0324 | Fax: 703-341-4103 | www.usa.childcareaware.org
Annex F
Army Child and Youth Services
Deployment Support Services
School Year Fee Policy 2016-2017
Criteria 1. Deployed: Contingency Operations. Contingency operation means a military
operation that: (A) is designated by the Secretary of Defense as an operation in which members
of the armed forces are or may become involved in: military actions, operations, or hostilities
against an enemy of the United States or against an opposing military force; or (B) results in the
call or order to, or retention on, active duty of members of the uniformed services under
section 688, 12301 (a), 12302, 12304, 12304a, 12305, or 12406 of this title, chapter 15 of this
title, section 712 of title 14, or any other provision of law during a war or during a national
emergency declared by the President or Congress.
Criteria 2. Assigned to Warrior Transition Unit (WTU). WTUs provide critical support to
Regular Army Soldiers who are expected to require 6 months or more of rehabilitation
care and complex medical management in an inpatient or outpatient status and to
Reserve component Soldiers who are in need of definitive health care based on medical
conditions identified, incurred or aggravated while in an active duty status, in support of
Overseas Contingency Operations (OCO) and non-OCO activity.
• Army Wounded Warrior (AW2). These Soldiers are classified as severely wounded, ill or
injured Service Members (SM). These are category three (3) individuals (amputation,
severe TBI/PTSD, limited life expectancy, etc.) as prescribed in DODI 1300.24. (AW2 status is
NOT the defining criteria for eligibility of deployment child care support. AW2 Soldiers
MUST be currently assigned to a WTU to be eligible).
• Non-Medical Attendant (NMA). A person selected by an eligible Soldier, and approved
by the Soldier's attending physician and the Medical Treatment Facility (MTF)
commander, who will contribute to the healing and recovery of the Soldier. This
individual is placed on military orders which provide certain benefits to the individual.
The NMA program is designed for seriously wounded, ill and injured Soldiers who could
benefit from the presence and assistance of family or friends. If the Soldier’s primary care
manager (PCM) determines that the Soldier is eligible for NMA assistance, then one person,
designated by the Soldier, is authorized to serve as a NMA. This person provides additional
support as the Soldier recovers, rehabilitates and transitions.
1515 N. Courthouse Road, 2nd Floor, Arlington, VA 22201
Phone: 1-800-793-0324 | Fax: 703-341-4103 | www.usa.childcareaware.org
• Soldiers in Transition. These Soldiers are distinct from Wounded Warriors. They are
Soldiers assigned/attached to the Warrior Transition Units/Community Care Units
(WTU/CCU) who require at least six months of complex care/treatment/case management.
They do not meet AW2 criteria for severely wounded, ill or injured Soldiers as their
condition is not as severe as those that meet AW2 criteria.
Criteria 3. Deployed: Rotational Forces. Forces allocated to a Combatant Command to
execute tasks as assigned by the commander in that commander's area of responsibility for a
specified period of time. Forces identified in the Combatant Commanders annual force
requirements submission, and validated in the global force management process. (Note that
these Forces must fall under the initial paragraph definition of Operational Deployment. As
noted in that paragraph, “Forces operationally employed by Secretary of Defense Orders at their
home station or in "prepare-to-deploy order" (PTDO) status at home station are NOT
operationally deployed”).
Criteria 4. Deployed: Non-Contingency Operations. Operations that don't meet the definition
of contingency operations. For example, humanitarian and civic assistance, which is assistance
to the local populace, specifically authorized by Title 10, United States Code, Section 401, and
funded under separate authorities, provided by predominantly United States forces in
conjunction with military operations.
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Deployment Verification Form (Child Care Aware)

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Completed 20 January 2021

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