Download:
pdf |
pdfELECTION FOR AIR TRANSPORTATION OF REMAINS OF CASUALTIES
DYING IN A THEATER OF COMBAT OPERATIONS
OMB No.
OMB approval expires
The public reporting burden for this collection of information is estimated to average PLQXWHV per response, including the time for reviewing instructions, searching existing data sources, gathering
DQGmaintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
LQFOXGLQJsuggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents
should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a FROOHFWLRQRILQIRUPDWLRQif it does not display a currently valid
OMB control number.
PLEASE RETURN THIS FORM TO ODASD MC&FP; ATTN: CASUALTY; 4000 DEFENSE PENTAGON; WASHINGTON, DC 20301-4000.
PRIVACY ADVISORY
With this form the Department of Defense asks you to document your decisions about the remains of your Service Member. This process includes
providing your name and contact information as well as your relationship to the service member. This collection is authorized by 10 U.S.C. 1481
through 1488, and this form will be filed in the Defense Casualty Information Processing System (DCIPS) as part of the service members Individual
Deceased Personnel File (IDPF), covered by following Department of the Army System of Record Notice:
(https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570058/a0600-8-1c-ahrc-dod/).
Completing this form is voluntary. However, without completing the form, your choices regarding your service member may not be documented or
complied with.
1. NAME OF DECEASED (Last, First, Middle Initial)
2. SERVICE/GRADE OF DECEASED
4. PERSON AUTHORIZED TO DIRECT DISPOSITION (PADD)
a. NAME (Last, First, Middle Initial)
b. RELATIONSHIP TO DECEASED
3. DCIPS CASE NUMBER
c. TELEPHONE NUMBER (Include
Area Code)
d. CURRENT RESIDENCE ADDRESS (Street, Apartment Number, City, State and ZIP Code)
N E E D S
D D
6 7
5. SELECTION OF DISPOSITION OPTIONS
As the Person Authorized to Direct Disposition (PADD) of remains, I acknowledge the air transportation options available to me, and my choice is
reflected below:
OPTION 1
(Initials)
I direct the remains to be transported by military/military contracted aircraft to an airport or military base appropriate to the receiving
funeral home or interment site.
OPTION 2
I direct the remains to be transported by commercial aircraft to an airport appropriate to the receiving funeral home or interment site.
(Initials)
6. NOTES (Airport)
7. GENERAL WAIVER
In the unlikely event that the choice of air transportation selected above is delayed due to circumstances beyond the Military Service's
control, I authorize the Military Service to arrange other transportation, if required, to ensure the timely arrival of my loved one's
remains.
(Initials)
AUTHORIZATION AND SIGNATURES
8.a. SIGNATURE OF PADD
9.a. TYPED OR PRINTED NAME OF WITNESS
DD FORM 3050, 20180918 DRAFT
b. DATE
b. SIGNATURE OF WITNESS
c. DATE
Adobe Professional X
File Type | application/pdf |
File Title | DD Form X639, Election for Air Transportation of Remains of Casualties Dying in a Theater of Combat Operations, 20150129 draft |
Author | WHS/ESD/DD |
File Modified | 2018-09-18 |
File Created | 2012-09-18 |