Application for Cold War Recognition Certificate U S Residents

Application for Cold War Recognition Certificate U S Residents

Application for Cold War Recognition Certificate

U.S. Residents

Instructions: Fill out this application and mail or fax to the Cold War Office with your proof of service.  An acceptable supporting document includes any official government or military document that contains the recipient's name, Social Security Number or Military Service Number or Foreign Service Number, and a date showing at least one day of service during the Cold War era (September 2, 1945 to December 26, 1991).  Examples include DD Form 214, a Leave and Earnings Statement, and the Standard Form 50.

You must certify your honorable service by signing and dating the application and returning with supporting document to:

  CDR, PERSCOM
Cold War Recognition, Hoffman II
Attn: TAPC-CWRS, 3N45
200 Stovall Street
Alexandria, VA 22332-0473		 - OR - Fax 1-800-723-9262
*Recipient Name (First, MI, Last):   *Required Field
*ID Type: (SSN, MSN, or FSN) *ID Number:   Examples:
SSN 123-45-6789
MSN RA12-345-678
*Street Address:  
   
   
   
*City:  *State: *Zip:  
 
Applicant Name: (Enter only if different from recipient name):  
Applicant or Recipient Email Address:                
I confirm my (or the recipient's) faithful and honorable service to the nation during the Cold War Era.
Signed: ________________________________________ Date:  
Print the application, sign, attach supporting document, and mail or fax to the address listed above.

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. 3013, Secretary of the Army; Public Law 105-85, Fiscal Year 98,National Defense Authorization Act; and Executive Order 9397.

PRINCIPAL PURPOSE: To secure sufficient information from the individual so to determine eligibility and to process the individuals' requests for the Cold War Recognition Certificate.

ROUTINE USES: Information is used for official purposes within the Department of Defense; specifically, to process requests for Cold War Certificates.  This information may be used in accordance with established Routine Uses for all Department of Defense and Department of the Army system notices.

DISCLOSURE: Disclosure of the Social Security Number and other personal information is voluntary.  However, failure to provide complete information may hinder proper identification of the requester, and may prevent the agency from determining eligibility of the requester for the certificate.