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SEPARATION ACTION CONTROL SHEET

For use of this form, see AR 635-200; the proponent agency is MILPERCEN.

NAME (Last, First, Middle Initial)

 

 

SSN

UNIT

 

 

DATE PREPARED

ITEM

NO.

 

ACTION

 

DATE

DAYS

REQUIRED

TOTAL

ELAPSED DAYS

 

1.

 

 

Notification to service member of initiation of separation procedures.

 

 

 

 

2.

 

 

Service member acknowledged receipt of notification.

 

 

 

 

3.

 

 

Service member indicated election of rights.

 

 

 

 

4.

 

 

Unit Commanderís recommendation for separation forwarded to:

 

 

 

 

5.

 

 

Separation case received at: _________________________________

 

 

 

 

6.

 

 

Actions completed (Specify):__________________________________

and/or case forwarded to:†† __________________________________

 

 

 

 

7.

 

 

Separation case received at: _________________________________

 

 

 

 

8.

 

 

Actions completed (Specify): _________________________________

and/or case forwarded to:††† _________________________________

 

 

 

 

9.

 

Service member entitled to and elected

Hearing before Administrative Board.

Board convened on: ___________________________________________

 

 

 

 

10.

 

 

Separation case received at: _________________________________

 

 

 

 

11.

 

 

Final Disposition (Specify): _________________________________

 

 

 

 

12.

 

 

Service member separated from the service.

 

 

 

 

13.

 

 

Total days required to process case. _________________________

 

 

 

REMARKS

 

 

 

 

 

 

 

 

 

 

 

 

DA FORM 5138-R, JULY 84††††††††† EDITION OF OCT 82 IS OBSOLETE.

 

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