DD Form 2581-1 Public and Community Service Organization Validation

OMB No. 0704-0324
OMB approval expires

PUBLIC AND COMMUNITY SERVICE ORGANIZATION VALIDATION

The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining 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,
including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0324). 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 collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO:
DMDC, ATTENTION: OPERATION TRANSITION, DODC, 400 GIGLING RD., SEASIDE, CA 93955
2. ADDRESS OF ORGANIZATION (Include Room/Suite Number and
9-digit ZIP Code)

1. NAME OF ORGANIZATION

3. POINT OF CONTACT FOR ORGANIZATION

4. POINT OF CONTACT TELEPHONE NUMBER (Include Area Code)
5. PRIMARY SERVICE CATEGORY(IES) (If your primary service category is not used, go to Item 6.)
a. ELEMENTARY, SECONDARY, OR POSTSECONDARY
SCHOOL TEACHING OR SCHOOL ADMINISTRATION
b. SUPPORT OF ELEMENTARY, SECONDARY, OR
POSTSECONDARY SCHOOL TEACHING OR SCHOOL
ADMINISTRATION
c. SOCIAL SERVICES

d. PUBLIC HEALTH CARE

h. CONSERVATION

e. LAW ENFORCEMENT

i. EMERGENCY
MANAGEMENT

f. PUBLIC HOUSING

j. ENVIRONMENT

g. PUBLIC SAFETY

k. JOB TRAINING

6. IF YOUR ORGANIZATION PROVIDES PRIMARY FUNCTIONS OTHER THAN THOSE LISTED IN ITEM 5, BRIEFLY DESCRIBE THESE MAJOR
FUNCTIONS.

-NEEDS DD 677. TYPE OF SERVICE
a. PUBLIC (Federal, State, or Local Government go to Item 8)
8. PUBLIC SERVICE HEADQUARTERS AGENCY
a. ORGANIZATION NAME AND ADDRESS (Include 9-digit ZIP Code)

b. COMMUNITY (Non-profit Organization or Association go to Item 9)
b. HEADQUARTERS POINT OF CONTACT AND POSITION

c. POINT OF CONTACT TELEPHONE NUMBER (Include Area Code)
9. COMMUNITY SERVICE/NON-PROFIT ORGANIZATION
IMPORTANT: Please attach a copy of the IRS Letter of Determination indicating your organization has received IRS 501(C)(3) and (4)
tax-exempt status. Also include a copy of your organization's annual report, mission statement, or other documentation of its function.
Indicate below if your organization is affiliated with the United Way, Combined Federal Campaign or some other non-profit association.
a. AFFILIATE NAME AND ADDRESS (Include 9-digit ZIP Code)

b. AFFILIATE POINT OF CONTACT AND POSITION

c. POINT OF CONTACT TELEPHONE NUMBER (Include Area Code)
10. AGREEMENT
I understand this form provides information to help the Department of Defense establish a Public and Community Service organizational
registry which will be accessible to departing Service members. I also understand certain individuals may receive additional entitlements based
on the information specified in Public Law 102-484. I certify the information provided is true, accurate and complete. I acknowledge that
any false statement may be punishable pursuant to Title 18 U.S.C. Section 1001.
a. NAME (Print or Type)

b. TITLE

DD FORM 2581-1, 20070319 DRAFT

c. SIGNATURE

PREVIOUS EDITION IS OBSOLETE.

d. DATE
(YYYYMMDD)

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INSTRUCTIONS FOR COMPLETING DD FORM 2581-1
This form collects information to be used to certify an
organization on the Public and Community Service
Organization Registry under the provisions of Section 4462 of
Public Law 102-484.
Public service organizations are defined as Federal, state,
or local governmental entities.
Community service organizations are non-profit
organizations or associations which provide or coordinate the
delivery of services in the public interest. Organizations
affiliated with the United Way or Combined Federal Campaign
presumptively qualify as community service organizations.
Organizations involved in the following activities will not be
considered public or community service organizations:
(1) Businesses organized for profit;
(2) Labor unions;
(3) Partisan political organizations; and
(4) Organizations engaged in religious activities, unless
such activities are unrelated to religious instruction, worship
services, or any form of proselytization.
Public Law 102-484 also provides that certain members of
the military services retiring early from active duty receive
additional military retirement credits by working in public or
community service organizations. To receive this credit, the
retiree's employing organization must be on the Public and
Community Service Organization Registry and have as its
primary function(s) one or more of the following categories of
public or community service:
a. Elementary, secondary, or postsecondary school
teaching or school administration;
b. Support of elementary, secondary, postsecondary
school teaching or school administration;
c. Social services;
d. Public health care;
e. Law enforcement;
f. Public housing;
g. Public safety;
h. Conservation;
i. Emergency management;
j. Environment;
k. Job training.

-NEEDS DD 67-

ALL ITEMS MUST BE COMPLETED.
1. NAME OF ORGANIZATION. Print or type the name of
your organization. Please be specific. For example, if the
police department of the city of Oakdale is registering, use
"Oakdale Police Department" as the organization instead of
the "City of Oakdale."
2. ADDRESS OF ORGANIZATION. Enter the address of
your organization exactly as you would like it to appear on
information mailed to you. Please avoid P.O. Boxes when
possible.

DD FORM 2581-1 (BACK), 20070319 DRAFT

3. POINT OF CONTACT FOR ORGANIZATION. Provide the
name and job title of a person who can answer specific questions
about the organization.
4. POINT OF CONTACT TELEPHONE NUMBER. Enter the
area code and telephone number for the point of contact. Please
enter a direct line or voice mail extension if available.
5. PRIMARY SERVICE CATEGORY(IES). Select the category
that represents the core mission of your organization or
department. If you provide primary services in two or more of the
categories, select all applicable categories. As discussed above,
the organization's primary functions must be in one or more of
the listed categories (5a-5k) for a military retiree to be eligible for
additional retirement credit. If your primary service category is
not listed, go to Item 6.
6. ORGANIZATION FUNCTIONS. If your organization provides
primary services in categories other than 5a-5k, briefly describe
those function(s).
7. TYPE OF SERVICE. Indicate whether your organization
provides public or community service by checking the appropriate block. Public service refers to Federal, state, local
government organizations or agencies. Community service
refers to certified nonprofit organizations or associations.
8. PUBLIC SERVICE HEADQUARTERS AGENCY. If public
service, provide the name and address or the organization, if
any, to which your organization reports. Include the name, job
title, and telephone number of a person who can answer specific
questions about the headquarters organization.
9. COMMUNITY SERVICE/NON-PROFIT ORGANIZATION.
If a community service organization, attach a copy of the IRS
Letter of Determination indicating that your organization has
received IRS 501(C)(3) and (4) tax-exempt status. A community
service organization will NOT be validated without the Letter of
Determination. Also include a copy of your organization's annual
report or mission statement or attach other documentation about
your organization's functions.
Provide the name and address of the organization, if any, to
which your organization reports or with which it is affiliated.
Provide the name, job title, and telephone number of a person
who can answer specific questions about the headquarters
affiliate.
10. AGREEMENT. Completion of this section and a signature by
an organization's representative attests to the informa- tion's
accuracy and completeness. Mail or fax the completed form to:
DMDC
ATTN: Operation Transition, DODC
400 Gigling Rd.
Seaside, CA 93955
FAX: (831) 583-2475
Please call the Defense Manpower Data Center (DMDC)
Help Desk at 1-800-727-3677 between the hours of 6 AM and 4
PM Pacific time if you have questions or need assistance with
this form.
COMMUNITY SERVICE ORGANIZATIONS: Remember to
attach a copy of your IRS Letter of Determination and an annual
report or mission statement.