Surviving Family Member Inquiry Form

This form is for survivors of active-duty deaths to submit their questions and/or concerns. By filling out this form, the Defense Department can better serve you and provide a response. A DOD Casualty Assistance program manager will contact you within five business days confirming your information was received.

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By completing the fields below, you will give our representatives enough information to provide the answers you need as quickly as possible. Fields with an asterisk are required.


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Privacy Act Statement

AUTHORITY: 10 U.S.C. 136, Under Secretary of Defense for Personnel and Readiness; 10 U.S.C. 1788, Additional Family Assistance; 10 U.S.C. Chapter 88, Military Family Programs and Military Child Care, Subchapter I, Military Family Programs; 10 U.S.C. 53, Miscellaneous Rights and Benefits; Directive-type Memorandum (DTM)–17–004, DoD Expeditionary Civilian Workforce; DoD Directive 1322.18, Military Training; DoD Instruction (DoDI) 1342.22, Military Family Readiness; DoDI 6490.06, Counseling Services for DoD Military, Guard and Reserve, Certain Affiliated Personnel, and Their Family Members; and DoDI 1322.26, Distributed Learning (DL).

PURPOSE: To submit and track questions, reports of problems, or requests for assistance with Military OneSource websites and applications.

ROUTINE USES: Disclosure of records are generally permitted under 5 U.S.C. 522a(b) of the Privacy Act of 1974, as amended. To contractors, grantees, experts, consultants, students, and others performing or working on a contract, service, grant, cooperative agreement, or other assignment for the Federal Government when necessary to accomplish an agency function related to this system of records. To the appropriate Federal, State, local, territorial, tribal, foreign, or international law enforcement authority or other appropriate entity when necessary pursuant to a showing of compelling circumstances affecting the health or safety of an individual. Additional routine uses are listed in the applicable System of Records Notice, DPR 45, Military OneSource Business Operations Information System, at: https://www.federalregister.gov/d/2022-27671.

DISCLOSURE: Voluntary, however, failure to provide the requested information may inhibit the ability of Military OneSource to provide a response to your customer support request.

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