Form TBD Army Survivor Advisory Working Group

OMB CONTROL NUMBER: 0702-0144
OMB EXPIRATION DATE: 07/31/2021

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ARMY SURVIVOR ADVISORY WORKING GROUP
Nominations are being accepted for Army Survivors to serve for the 2020-2023 Army Survivor Advisory
Working Group (SAWG) term. The Chief of Staff of the Army established the Army SAWG in 2007 to
provide advice and recommendations regarding vital Active Component, Army National Guard, and
U.S. Army Reserve Survivor quality of life issues. Advisors also provide an assessment of how current
Survivor programs and initiatives may affect the Survivor community.
The Army SAWG is a diverse group of Army Survivors who represent the Total Army and suffered loss
in a variety of ways. The Army SAWG charter includes specific demographic requirements in order to
represent all Army Survivors.
The Army SAWG application packet includes:

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Authorization for Disclosure of Information
Personal data sheet
Personal statement
Sample Army SAWG issue review
Certificate of acknowledgement
Character recommendation from your Survivor Outreach Services coordinator,
Survivor organization leader, volunteer organization leader, or employer.

Completed applications will be reviewed by an Army SAWG selection panel. The Chief of Staff of the
Army will approve new advisor selections and sign an advisor appointment letter.
We encourage interested Army Survivors to apply. Nominations must be submitted using the attached
application packet no later than 1 DEC 2021 to [email protected] for the 2020-2023 Army
SAWG term.

Privacy Act Statement
AUTHORITY: The authorities identified in the applicable system of system of records notice are DODI 5105.18 (DoD Intergovernmental and
Intragovernmental Committee Management Program), Army Regulation 15-39 (Department of the Army Intergovernmental and
Intragovernmental Committee Management Program) and the Survivor Advisory Working Group (SAWG) Charter.
PRINCIPAL PURPOSE: Notification of application for three-year SAWG membership. Applications received will be reviewed and presented
to the Army Chief of Staff for final selection.
ROUTINE USE: The DOD Blanket Routine Uses found at: http://dpcld.defense.gov/privacy/ may apply to this collection.
In addition, individuals from whom information about them is solicited during administrative proceedings must be provided Privacy Act
advisory statements if records of the proceedings will be retrieved by their personal identifiers. 5 U.S.C. § 552a(e)(3). (http://
dpcld.defense.gov/Privacy/Authorities-and-Guidance/)
DISCLOSURE: Furnishing the requested personal data is voluntary. However, selection to serve on the committee is reduced as it will be
difficult to verify Next of Kin status of deceased Army service members.

Authorization For Disclosure of Information
Privacy Notice: The main purpose for collecting the information contained in this application is
to obtain the information necessary to select members for the Army Survivor Advisory Working
Group (SAWG). The SAWG includes members who are government employees and members
of military Families who are not government employees. Disclosure of the information
requested to non-governmental SAWG members is voluntary. However, failure to disclose the
information to non-governmental SAWG members may result in you not being considered for
SAWG membership.
Please Initial One of the Options Below:
________I hereby authorize the U.S. Army, through its agents, to release a copy of my
application for membership in the Survivor Advisor Working Group (SAWG) to current nongovernmental SAWG members, as part of the application review process. I understand this
authorization may be revoked at any time, if requested in writing, except to the extent that action
has already been taken.
________I DO NOT consent to the disclosure of my application to non-governmental SAWG
members.

Use of Personal Information: The personal information contained in your application may only
be used for the purpose of reviewing applications as part of the selection process for
membership in the SAWG. ANY DISCLOSURE OF PERSONAL INFORMATION BY THE
RECIPIENT(S) IS PROHIBITED EXCEPT WHEN IT IS PURSUANT TO THE PURPOSES OF
THIS DISCLOSURE. THE GOVERNMENT CANNOT GUARANTEE THAT THE
ORGANIZATION OR INDIVIDUAL WILL ABIDE BY THE AGREEMENT TO NOT FURTHER
DISCLOSE THE INFORMATION.

__________________________________
Signature of Person and Date

__________________________________
Signature of Person and Date

2020-2023 Army SAWG Application Personal Data

Title
First Name
Last Name
Suffix (if applicable)
Nickname
Defense Enrollment Eligibility Reporting System (DEERS) identification card holder:
Yes

No

Street Address
Street Address 2 (if applicable)
City
State (if applicable)
Postal code
Country
Home Phone (if applicable)
Work Phone (if applicable)
Mobile Phone (if applicable)
Primary Email
Alternate Email (if applicable)
Preferred contact method:
Home

Work

Mobile

Email

Describe your involvement as a survivor in local or national civic/federal organizations
or with non-governmental organizations and offices held, if any

Please share links to your published works to include published articles, blogs, twitter
handles, Facebook, TV/internet interviews/videos, etc. if applicable

Name:

2020-2023 Army SAWG Application Personal Statement
Complete a personal statement in 250 words or less. The statement should explain
your desire to serve on the Army Survivor Advisory Working Group, how you could
impact survivor support and programs, and share a suggestion of a program or policy
initiative you believe would positively impact survivor support.

Name:

2020-2023 Army SAWG Application Sample Issue Review
As an advisor, you will review survivor quality of life issues submitted to the Army
Survivor Advisory Working Group for Department of the Army resolution. The Army
Staff will prepare an information paper for each issue under consideration. Using the
information papers, advisors will be asked to independently prioritize the issues, discuss
the merits of the issue, jointly prioritize the issues, and report the top priorities to the
Chief of Staff of the Army at the Army Survivor Advisory Working Group.
Sample Issue Review
DIRECTIONS: Review the sample Army Survivor Advisory Working Group issue and
Army Staff facts. Write a maximum 100-word recommendation below on whether the
issue should be elevated to the Chief of Staff of the Army for resolution. Conduct
additional independent issue research, if needed, to make informed decisions.
Applicant Response

Sample Army SAWG Issue
Issue: Survivor Investment of Military Death Gratuity and Servicemembers’ Group Life
Insurance (SGLI)
Scope: A Survivor receiving the Military Death Gratuity and SGLI only has 12 months
to place up to the full amount received into a Roth Individual Retirement Account (IRA)
or Coverdell Education Savings Account (ESA). Independent grief studies recommend
that life-altering decisions not be made within the first year after loss. One year is not
enough time for Survivors to make an informed decision resulting in the potential loss of
a valuable investment option.
Recommendation: Extend the time period for Survivors to invest Military Death
Gratuity and SGLI in Roth IRA and/or Coverdell ESA from 12 to 36 months.
Army Staff Facts:
1. The Heroes Earnings Assistance and Relief Tax Act of 2008 (the “HEART Act”),
became law in June 2008.
2. The HEART Act allows recipients of a military death gratuity or a payment from the
SGLI program to roll over the gratuity or payment to a Roth IRA or a Coverdell ESA on
a tax-free basis, notwithstanding any contribution limits that would normally apply to
such contributions. These contributions must be made within one year of receiving the
benefit or payment.

Name:
2020-2023 Army SAWG Application Certificate Of Acknowledgement
Background:
•

The term of appointment for a member of the Army Survivor Advisory Working
Group (SAWG), is a single three-year term.

•

The Army SAWG is held twice a year in the National Capital Region, with travel
funding from the Department of the Army. The SAWG may involve a minimum of
five duty days to include travel, preparatory sessions, and the SAWG meeting.

•

Additional meetings are held telephonically to continue to work issues with
actions officers and provide updates to all the advisors.

Please initial acknowledgement of each of the following statements:
1.
I am expected to attend each SAWG meeting. Failure to attend more
than two SAWG meetings may result in appointment termination. Exemptions are
authorized for deployment or health restrictions, with advance written notification.
2.
I am expected to attend telephonic advisor meetings. Failure to attend
more than four telephonic advisor meetings may result in appointment termination.
Exemptions are authorized for deployment or health restrictions with advance written
notification.
3.
I will acknowledge SAWG tasks emailed by the SAWG point of contact
by the designated suspense date. Suspense dates are typically three weeks. Failure to
electronically acknowledge more than two SAWG tasks by the suspense date may
result in appointment termination. Exemptions are authorized for deployment or health
restrictions with advance written notification.
4.
I will not be authorized travel, lodging, meals, and incidental expense
reimbursements by the Department of the Army if I live within the Washington local
commuting area as defined by Department of Defense Instruction (DoDI) 4515.14,
“Washington Local Commuting Area,” 28 Jun 13. These areas include (but are not
limited to): in Virginia: the counties of Albemarle, Arlington, Clarke, Culpeper, Fairfax,
Fauquier, Greene, King George, Loudoun, Madison, Orange, Prince William,
Spotsylvania, and Stafford. It also includes the cities of Alexandria, Fairfax, Falls
Church, Fredericksburg, and all cities now and hereafter existing in the geographic area
bounded by the outer boundaries of the combined areas of these listed Virginia
counties. In the District of Columbia: the entire area within the boundaries of
Washington, DC. In Maryland: the counties of Anne Arundel, Baltimore, Calvert,

Carroll, Charles, Frederick, Harford, Howard, Montgomery, Prince George’s, St. Mary’s,
and Washington. It also includes the city of Baltimore and all cities now and hereafter
existing in the geographic area bounded by the outer boundaries of the combined areas
of the counties listed above. In Pennsylvania: the county of Adams. In West Virginia:
the counties of Morgan, Berkeley, and Jefferson.
5.
I will be authorized travel, lodging, meals, and incidental expense
reimbursements by the Department of the Army if I live outside the Washington local
commuting area as defined by DoDI 4515.14, “Washington Local Commuting Area,” 28
Jun 13. If my trip includes meals paid for by a senior leader or the government, I will
deduct the meals from my reimbursement voucher.
6.
work.

I will read and sign a nondisclosure agreement related to my SAWG

7.
It is my responsibility to arrange with my employer or school (if
applicable) for my absence to attend SAWG meetings.
8.
I am a competent e-mail, Adobe Acrobat Reader (application that makes
PDF documents), and Microsoft Word user.
9.
I will not be reimbursed for installation of broadband or telephone lines,
for internet or phone connectivity, or for any hardware associated with conducting
official SAWG business.
10.
I will be required to travel and enter a secured government facility. I
possess one of the following at my own expense: a state driver’s license or identification
card; U.S. government common access card; DoD identification card for retirees,
dependents, and inactive reservists; U.S. passport or passport card; foreign passport;
permanent resident card; or alien registration receipt card. I realize state driver's
licenses that are not “Real ID” compliant will not be accepted as a form of identification
when traveling and entering a secured government facility.
11.
I realize I will deliberate over emotionally charged survivor issues and I
am prepared to discuss my own loss and survivor experiences with the SAWG.

_____________________________________
(Signature)
_____________________________________
(Typed Name)