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
8.a. Place an X in this box ONLY if you have 89 days or less remaining on active duty before separation or retirement.
(Please read the following instructions: If separating or retiring and you have 89 days or less remaining on active duty before your
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.)
SECTION II - PERSONAL INFORMATION (To be filled out by all applicants)
1. NAME
a. Last Name
2. SSN 3. GRADE
5. SERVICE (X one)
6. DUTY STATION
7. ANTICIPATED DATE OF SEPARATION
(YYYYMMDD)
8. DATE CHECKLIST
PREPARED
(YYYYMMDD)
ARMY
MARINE CORPS
NAVY
AIR FORCE
COAST GUARD
7.a. I AM (X one)
Retiring
Separating
Involuntarily
Separating Voluntarily
4. DATE OF BIRTH
(YYYYMMDD)
AC
AGR
AR
9. Is your spouse/family member/legal guardian/designee present during preseparation counseling?
(X one)
YES NO N/A
5.a. COMPONENT
RPA
FTS
9.a. Are you willing to be contacted after separation or retirement regarding the value of the
transition assistance programs and services you received?
(X one)
YES NO
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.
a. MILITARY INSTALLATION/CITY
b. STATE c. ZIP CODE
b. First Name
c. Middle
Initial
AUTHORITY: 10 U.S.C. 1142, Preseparation Counseling; transmittal of medical records to Department of Veterans Affairs, and E.O. 9397 (SSN) as amended.
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 U.S.C. 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): 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 and other federal agencies for the
purpose of providing transition assistance and available benefits to the eligible Service member. T
he DoD Blanket Routine Uses set forth at the beginning of the Office of
the Secretary of Defense (OSD) compilation of systems of records notices may apply to this system. The complete list of DoD Blanket Routine Uses can be found online at
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/DODwideSORNArticleView/tabid/6797/Article/570563/dmdc-01.aspx
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.
DD FORM 2648, OCT 2015
PREVIOUS EDITION IS OBSOLETE.
Page 1 of 5 Pages
Adobe Professional X
http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx
