Free Af 4380 Form in PDF

Instructions on Writing Af 4380

Filling out the AF 4380 form is a necessary step for Air Force sponsors with family members, especially when preparing for relocation. This form helps the Air Force ensure that any specialized medical and educational needs of military family members are identified and addressed appropriately. It plays a crucial role in planning and coordinating health care, determining eligibility for various programs, and ensuring that family members' needs are met during the relocation process. Accurate and honest completion of the form is essential, as it directly influences the support and services provided.

Steps to Fill Out the AF 4380 Form

1. Enter the sponsor's last four digits of the Social Security Number (SSN) in the designated area.
2. Fill in the sponsor's Name (Last, First, MI).
3. Provide the Current Unit and Duty Station details.
4. Indicate the Projected Installation If Relocating.
5. List the sponsor's Rank.
6. Enter the Duty Telephone Number.
7. Specify the Projected Departure Date.
8. Provide a contact Telephone Number.
9. Under the SPONSOR'S FAMILY INFORMATION section, read each question carefully.
10. Indicate your response by placing an X in the appropriate box next to each question to denote a "Yes" or "No" answer.
11. If you marked "Yes" to any questions numbered 2 through 8, stop filling out the form. You are instructed to contact the Exceptional Family Member Program (EFMP-M) Office at the Military Treatment Facility for assistance before proceeding with any further relocation actions.
12. If all applicable sections are completed and no further action is required from the EFMP Office, sign and date the form to certify the accuracy and completeness of the information provided.

It's imperative to understand the significant responsibility that comes with filling out this form. Inaccuracies or omissions can affect your family members' ability to travel at government expense and receive the necessary support. Completing the AF 4380 form with thoroughness and honesty is not only a requirement but a step towards ensuring the well-being of your family during transitions. Remember, providing false information knowingly can lead to severe consequences, including fines or imprisonment under U.S. law.

What is the purpose of the AF Form 4380?

The AF Form 4380, Air Force Special Needs Screener, is designed to document, plan, and coordinate the health care needs of Air Force family members during relocation. It helps determine eligibility and suitability for benefits in various programs. Additionally, it collects statistical data to support the coordination of special medical and educational services for military families.

Is completing the AF Form 4380 mandatory for all sponsors with family members?

Yes, all sponsors with family members, whether living with the sponsor or not, are required to complete the AF Form 4380 as part of their relocation processing. This ensures that the Air Force can provide appropriate support and resources to family members with special needs.

What information is required on the AF Form 4380?

The form asks for the sponsor's information, including the last 4 digits of the Social Security Number, name, current unit and duty station, rank, duty and personal telephone numbers, projected installation if relocating, and projected departure date. Additionally, it includes questions about the family's enrollment in any Exceptional Family Member Program, receipt of special educational or early intervention services, therapy services, medical history, chronic conditions, respiratory issues, and the need for specialized equipment or housing modifications.

What happens if a family member has special medical or educational needs?

If any questions numbered 2 through 8 on the form are answered with "Yes," indicating that a family member has special medical or educational needs, sponsors are instructed to contact the Exceptional Family Member Program Office at the Military Treatment Facility for assistance before proceeding with any relocation actions.

What are the consequences of not providing accurate information on the AF Form 4380?

Failure to provide accurate and complete information on the AF Form 4380 may delay or affect travel at government expense for family members. It is crucial to provide truthful information, as making a knowing and willful false official statement can result in fines or imprisonment.

Is the disclosure of information on the AF Form 4380 voluntary?

Yes, disclosure of information on the AF Form 4380 is voluntary. However, failing to provide the Social Security Number or other requested information may delay the screening of family members for relocation suitability at government expense or the issuance of Permanent Change of Station (PCS) orders.

Under what authority is the AF Form 4380 issued?

The AF Form 4380 is issued under the authority of 10 U.S.C. 55, 10 U.S.C. 8013, and Executive Order 9397, as amended. These statutes and orders provide the legal framework for collecting and using the data gathered through this form.

How is the information used from the AF Form 4380?

The information collected on the AF Form 4380 is used for several purposes: facilitating health care planning and coordination for military family members during relocation, determining eligibility and suitability for various support programs, providing specialized services, and compiling statistical data to improve support for families with special needs.

Filling out the AF 4380 form, which serves as an Airforce Special Needs Screener, is an essential step for military families preparing for relocation. One common mistake that occurs is the incomplete filling of personal information. The form requires the last four digits of the Social Security Number (SSN) and detailed sponsor's family information. Often, individuals may overlook or mistakenly believe they have filled in all required fields, including the projected departure date and the duty telephone number. Ensuring every piece of requested information is accurately provided is crucial for the timely and efficient processing of the form.

Another notable mistake involves misunderstanding the purpose and requirement of the questions related to the Exceptional Family Member Program (EFMP) and services received by family members. Some individuals may inadvertently skip or incorrectly answer questions regarding special education, early intervention services, or chronic medical conditions requiring specialist evaluation. This oversight can result in delays or complications in obtaining necessary support and resources, emphasizing the importance of thoroughly reviewing and accurately responding to each query.

A third error often seen is the failure to contact the Exceptional Family Member Program (EFMP-M) Office at the Military Treatment Facility for assistance when indicating 'Yes' to any of the questions numbered 2 through 8. The form specifies that upon such responses, sponsors should seek further guidance before proceeding with relocation actions. Ignoring this step can lead to potential challenges in ensuring that specialized medical and educational services are available and accessible at the new location, which could adversely affect the family member's well-being and the family's overall relocation experience.

Lastly, individuals sometimes forget to certify their information is complete and accurate to the best of their knowledge by overlooking the signature and date sections at the end of the form. This oversight can delay the processing of the AF 4380 form significantly since an unsigned form is deemed incomplete and cannot be processed. Acknowledgment of the statement regarding the provision of accurate information and the consequences of making a false official statement is not only a procedural formality but a legal requirement that underscores the seriousness with which this information must be treated.

When completing the Air Force Special Needs Screener (AF Form 4380), various other forms and documents may be necessary to provide a comprehensive overview of a family member's needs or to ensure all relocation and special care requirements are met. These documents not only support the information provided in the AF Form 4380 but also facilitate the processing of requests and the implementation of support services. Below is a list of documents often used in conjunction with the AF Form 4380:

• DD Form 1172 – Application for Identification Card/DEERS Enrollment. This document is necessary for enrolling family members in the Defense Enrollment Eligibility Reporting System (DEERS), which is essential for qualifying for various military benefits, including medical.
• DD Form 2792 – Family Member Medical Summary. Required for all family members who have long-term medical conditions or special education needs, this form assists in documenting their medical status and is key in the Exceptional Family Member Program (EFMP) enrollment process.
• DD Form 2792-1 – Special Education/Early Intervention Summary. This form is filled out for children who require special education services or are part of an early intervention program, essential for ensuring proper support is available at the new station.
• DA Form 5888 – Family Member Deployment Screening Sheet. Used by the Army, this form screens for family member suitability for overseas assignments, similar to some of the assessments in AF Form 4380.
• Health Information Privacy (HIPAA) Authorization Form – Allows for the sharing of protected health information between healthcare providers and the EFMP coordinators or relevant military departments.
• Individualized Education Program (IEP) Documents – These documents outline special education services for a child. They are critical for enrollment in the EFMP and ensuring that appropriate educational services are available at the new location.
• Proof of Guardianship or Custody – Legal documents verifying guardianship or custody of dependent family members, necessary for the processing of benefits and support services.
• Medical Provider Letters – Letters from a family member’s physicians or specialists detailing the nature of medical conditions, treatments, and recommendations for care continuity.
• PCS Orders – Official orders for Permanent Change of Station. These documents are essential for organizing relocation support and services for family members with special needs.
• Privacy Act Statement (PAS) – DD Form 2005 – Used alongside AF Form 4380 to inform servicemembers about their rights under the Privacy Act of 1974 regarding the handling of their personal information.

These documents, when used together with AF Form 4380, form a comprehensive support network to ensure families receive the necessary services and accommodations during relocations or when accessing various programs. It is vital for service members to understand the purpose and requirement of each document to facilitate a smooth transition and to ensure the best possible care for their family members with special needs.

The DD Form 2792, or the Exceptional Family Member Program (EFMP) Medical Summary, shares key similarities with the AF Form 4380 in its purpose and use within military family relocations. Both forms are designed to gather detailed information about the medical and educational needs of military family members. This information aids in ensuring that the necessary services are available at the new duty station, thereby facilitating a smooth transition for families with special needs.

The DD Form 2606, Child Development Program Request for Care Record, also aligns with the AF Form 4380, though it focuses more specifically on child care needs within military installations. Like the AF 4380, this form collects critical information that helps in planning and providing appropriate care, highlighting the military's commitment to supporting its personnel's families by understanding their specific requirements.

The DA Form 5888, Family Member Deployment Screening Sheet, serves a similar purpose within the Army as the AF Form 4380 does in the Air Force. It is utilized to screen family members for special medical or educational needs before deployment or relocation. Both forms ensure the preparedness and wellbeing of military families by identifying and addressing any potential challenges in advance.

The Health Insurance Portability and Accountability Act (HIPAA) Authorization Form, while not military-specific, parallels the AF Form 4380 in its handling of sensitive health information. Both documents adhere to privacy standards, requiring consent to release medical details crucial for ensuring the provision of appropriate health services and support.

The DD Form 1750, Packing List, though not directly related to special needs, is similar in its logistical function for military families during relocations. It organizes essential information about household items, paralleling the AF Form 4380’s role in preparing for a family's medical and educational needs during moves.

The 504 Plan documents, used in civilian education systems, bear resemblance to the AF Form 4380 in their goal of supporting individuals with special needs. They outline accommodations and support for students, akin to how the AF 4380 facilitates the identification of similar needs within military families, ensuring proper services are available wherever they are stationed.

The Individualized Education Program (IEP) documents, another tool from the civilian education sector, resemble the AF Form 4380 in their aim to tailor educational experiences to meet individual needs. Both forms play pivotal roles in planning and coordinating necessary services to support individuals with special needs or disabilities effectively.

The Residential Screening Document, typically used by healthcare and social service agencies, is akin to the AF Form 4380 in its assessment and planning for individuals requiring specialized care. Both documents are crucial for ensuring the appropriate resources and accommodations are in place to meet unique needs.

The Job Accommodation Network (JAN) Individual Accommodation Request Form, used in employment contexts to identify necessary workplace accommodations, parallels the AF Form 4380. Both focus on identifying and planning for special requirements to ensure individuals can fully participate, whether in a job or as part of a military family relocation.

Finally, the Medical Release Form, commonly used across various sectors, shares the AF Form 4380's emphasis on privacy and consent when dealing with personal health information. This form allows for the secure sharing of vital health data, mirroring the AF 4380’s use in compiling and coordinating healthcare and special services for military family members during relocations.

When filling out the AF 4380 form, it's essential to do it correctly to ensure your family members' needs are adequately documented and met. Here are some key points to keep in mind:

Do:

• Read each question carefully. Understanding what is being asked can help you provide the most accurate and relevant information.
• Provide complete information. Include all necessary details regarding your family members' medical and educational needs.
• Contact the EFMP office if needed. If you answer "Yes" to questions regarding special needs, reach out to the Exceptional Family Member Program (EFMP-M) Office for guidance before moving forward with any relocation plans.
• Sign and date the form. Your signature is your attestation that the information provided is accurate to the best of your knowledge and understanding of the requirements.

Don't:

• Skip questions. Failing to answer all questions can delay the processing of your form and the coordination of necessary services.
• Provide incomplete or inaccurate information. This could affect your family member's eligibility for benefits or delay travel and relocation processes.
• Forget to contact the EFMP office if you've answered "Yes" to certain needs. They are a crucial resource in ensuring that your family's needs are met during relocation.
• Ignore the requirements for disclosure. Remember, providing your Social Security Number and other requested details is voluntary but necessary for processing the form and providing assistance.

Misconceptions surrounding the Air Force Form 4380, the Air Force Special Needs Screener, are common, impacting families during crucial relocation periods. Let's clarify seven prevalent misunderstandings:

• Voluntary Completion: Despite the disclosure highlighting voluntary participation, completing the AF 4380 is essential for the seamless relocation of military families with special needs. Omitting this step may delay or complicate the assignment process and access to necessary services.
• Applicability to Active Duty Members Only: The form is mistakenly thought to be exclusive to active-duty service members. In reality, it extends to all sponsors with family members, covering a broader scope within the Air Force community, ensuring comprehensive support is available to those in need.
• Privacy Concerns: Concerns about personal information being improperly shared are based on a misunderstanding of the Privacy Act protections applied to this form. It operates under a blanket PAS, ensuring that sensitive details, especially those concerning health and educational needs, are handled with the utmost confidentiality.
• Special Needs Range: There's a misconception that only severe disabilities must be reported. However, the screener seeks information on a wide range of needs, including educational support and therapy services, to ensure all needs are identified and supported, regardless of their perceived severity.
• Use Limited to Relocation Planning: Some believe its use is restricted to coordinating relocation efforts. While a primary purpose, the form also assists in eligibility assessments for various programs and services, making it a critical document for ongoing family support beyond merely moving.
• One-Time Submission: The assumption that the form requires a one-time submission overlooks the necessity of updates to reflect changes in family members' needs. Regular updates ensure continued access to appropriate resources and supports.
• Impact on PCS Orders: Finally, there's an underestimate of the form's impact on the issuance of Permanent Change of Station (PCS) orders. Failing to provide comprehensive, accurate information can not only delay the screening process but also the receipt of PCS orders, stressing its critical role in military family relocations.

Understanding the truths behind these misconceptions about the AF Form 4380 underscores its importance in the thoughtful consideration and planning for the needs of military families, ensuring their well-being and success in new communities and assignments.

Filling out and using the Air Force Form 4380, the Airforce Special Needs Screener, is a critical step during the relocation process for Air Force personnel with family members. This document serves multiple vital functions, from ensuring that specialized medical and educational services are accessible to compiling necessary statistical data. Here are the key takeaways:

• The form is subject to the Privacy Act of 1974, emphasizing the confidentiality and protection of the information provided.
• Its main purpose is to document, plan, and coordinate healthcare for family members during relocation, determine eligibility for various programs, and gather statistical data.
• Completion of the AF Form 4380 is mandatory for all sponsors with family members as part of the relocation processing.
• It seeks detailed information about any special medical or educational needs that a family member might have.
• The form requires disclosure of participation in any Service's Exceptional Family Member Program (EFMP) and details about any special education or early intervention services being received.
• Questions about chronic medical conditions, hospitalizations, and the need for specialized equipment or housing modifications are included to ensure comprehensive support and planning.
• Responding accurately and completely to AF Form 4380 is vital as it directly impacts the relocation process and the provision of necessary services and support.
• If "Yes" is marked for questions 2 through 8, contact with the Exceptional Family Member Program Office at the Military Treatment Facility is advised before proceeding with any relocation actions.
• The form warns that providing false information knowingly and willfully can lead to penalties, including fines or imprisonment, under U.S. law.
• It must be signed by the sponsor, certifying that the information provided is accurate and complete to the best of their knowledge.

Understanding and properly completing the AF Form 4380 ensures that military families receive the support and resources they need, especially during the often-stressful period of relocation.