Form IMCOM Form 44 IMCOM Form 44 Application for Survivor Access Card

CUI (when filled in)

APPLICATION FOR SURVIVOR ACCESS CARD
OMB CONTROL NUMBER: 0702-0152
OMB EXPIRATION DATE: 01/31/2025

AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0702-0152, is estimated to average 1 hour 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 the burden estimate or burden reduction suggestions to the
Department of Defense, Washington Headquarters Services, at [email protected].
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.
PRIVACY ACT STATEMENT OF 1974
AUTHORITY: 5 U.S.C. 301; Department Regulations; 10 U.S.C. 3013, Secretary of the Army; Section 626 of the National Defense
Authorization Act (NDAA) For Fiscal Year 2019, Access to Military Installations for Certain Surviving Spouses and other Next of Kin of
Members of the Armed Forces Who Die While on Active Duty or On Certain Reserve Duty; Army Regulation 190-13, The Army Physical
Security Program
PURPOSE: To provide installation commanders and law enforcement officials with the means by which information may be accurately
identified to determine if an applicant meets authorized access requirements.
ROUTINE USES: The “Blanket Routine Uses” set forth at the beginning of the Army’s compilation of System Records Notices apply to
this system.
DISCLOSURE: Voluntary; however, failure to provide the requested information may result in denial of access to U.S. Army Installations.

SECTION I – APPLICANT INFORMATION
Full Name (Last, First, Middle):

Date of Birth (YYYY/MM/DD):

Current Address (Street, City, State):
Home Phone:

Cell Phone:

E-mail Address:

Driver License Number:

State of Issuance:

Service Member’s Name:

Branch of Service:

Rank of Service Member:

Relationship to Service Member:

Applicant Certification: I certify the information provided is true and accurate, and I am providing it with the purpose of receiving the
Survivor Access Card. I understand I must give ______________________________ Visitor Control Center (VCC) consent to conduct
a criminal history screening prior to the issuance of a Survivor Access Card. Failure to do so will result in the termination of the
application process. I understand that this background screening will determine my eligibility for access onto Army installations.

Applicant Printed Name

Applicant Signature

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Date

Controlled by: IMCOM, G9, Family Programs
CUI Category: PRVCY
POC: SOS Survivor Advocate

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SECTION II – APPLICANT DOCUMENTATION REQUIREMENTS
Two forms of Identification Card (ID)
1. A valid (unexpired) State issued photo ID
2. Any form of ID from the List of Acceptable Documents
Applicants are required to provide proof of identity in original form, in person, at time of Survivor Access Card issue.

SECTION III – PHYSICAL SECURITY OFFICE VERIFICATION
(For Physical Security Office use only)

Date of NCIC III background check:

Is Approved:

Is Disapproved:

If disapproved; Derogatory information in report:
More information is needed:
Printed Name of Government personnel performing Fitness Determination :
Signature of Government personnel performing Fitness Determination:
Phone number of Government personnel performing Fitness Determination:

SECTION IV – SURVIVOR OUTREACH SERVICE VERIFICATION
IS APPLICANT CLEARED FOR CARD ISSUANCE:
Installation of Survivor Outreach Service Office:
Printed Name of Survivor Outreach Services/ACS staff member:
Signature of Survivor Outreach Services/ACS staff member:

Date:

Expiration Date of Survivor Access Card:
Verified in Defense Information Processing System:

SOS Module:

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Controlled by: IMCOM, G9, Family Programs
CUI Category: PRVCY
POC: SOS Survivor Advocate

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Survivor Access Card FAQs
1.

What is the purpose of the IMCOM Form 44?
Section 626 of Public Law, 115-232, the John S. McCann National Defense Authorization Act for Fiscal Year 2019 recognizes
Survivors as having long term unescorted access to Army installations. The Survivor Access Card is intended for recognition and
installation access to receive services, attend events, view memorials, and similar activities. The Survivor Access Card does not
provide additional benefits or entitlements not already authorized to eligible surviving Family members. For example, it does not
provide Army and Air Force Exchange Service (AAFES) Exchange or Defense Commissary Agency (DeCA) privileges, and cannot be
used to prove eligibility for the Survivor Family Program discount at Armed Forces Recreation Centers (AFRCs).

2.

What are the two different types of Survivor Access Cards?
The two different types of Survivors Access Cards are the Digital Automated Installation Entry (AIE) Survivor Access Card and DA
Form 1602. Installations that have the Army’s Digital AIE system will issue the Digital AIE Survivor Access Card. Otherwise, they
will use the DA Form 1602.

3.

Who is eligible for the Survivor Access Card?
Eligible surviving Family members are those who meet the criteria to receive the Gold Star Lapel Button or Next of Kin (NOK)
Lapel Button including widow or widower, parent, child, stepchild, child through adoption, brother, half–brother, sister and half–
sister and step-siblings. Surviving Family members who already have a military identification card granting installation access,
such as a DD Form 1173 or Common Access Card (CAC) are not eligible to receive the Survivor Access Card.

4.

What documentation is needed to obtain the Survivor Access Card?
In addition to providing personal identification, surviving Family members will need to complete IMCOM Form 44, which is the
application for a Survivor Access Card. The information provided on this form will be used to perform a background check prior to
issuance of the Survivor Access Card. Surviving Family members are required to provide two forms of identity in original form, in
person, at time of Survivor Access Card issue. Refer to page 1 for a complete listing of acceptable forms of identification.

5.

How long is the Survivor Access Card valid?
The Survivor Access Card is valid for three years at Army Installations and may be renewed upon expiration.

6.

How can Surviving Family members renew their Survivor Access Card after the 3 year period of issuance?

Surviving Family members will need to initiate the renewal process by contacting their Survivor Outreach Service Coordinator to
request a new card. Survivors will need to provide the same documentation needed for the initial card request. Expired Survivor
Access Cards are required to be turned in before the issuance of a new card.
7.

Where do I send my completed application?

Surviving Family members can submit the completed application to their Army Survivor Outreach
Service Coordinator. The mailing address of the Survivor Outreach Service Office is located at the
Digital Garrison mobile APP. The Digital Garrison App provides information and facilitates access to
a full array of on-post services. The app can be downloaded on Android and Apple devices. Within
the easy-to-use app, Survivors of the Fallen can access an installation directory, gate information
and hours, Survivor Access Card information, Gold Star Lapel Pin and Next of Kin Lapel Button
replacement instructions, DFAS MYPay Account instructions and much more.
8.

Who can I contact for additional information and to initiate the process?
The Army has a network of Survivor Outreach Service Coordinators at various locations. If you have
questions about this form or how to fill it out, please contact the Survivor Outreach Service Coordinator
at the installation closest to you by using the Survivor Outreach Service Staff finder located at
https://dcsg9.army.mil/safr/sos/sos-find.html or by scanning the QR code to the right.

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Controlled by: IMCOM, G9, Family Programs
CUI Category: PRVCY
POC: SOS Survivor Advocate