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The AF 4380 form, also known as the Air Force Special Needs Screener, plays a crucial role in ensuring that military families receive the necessary support during relocations. This form must be completed by all sponsors with family members, regardless of whether those family members live with them. Its primary purpose is to document and coordinate health care needs, assess eligibility for various benefits, and compile essential statistical data. The information gathered helps the Air Force identify any special medical or educational requirements that family members may have. By doing so, the Air Force can facilitate access to specialized services and ensure that the unique needs of military families are met. Completing the AF 4380 is a voluntary process, but omitting information such as a Social Security Number can lead to delays in relocation or the issuance of Permanent Change of Station (PCS) orders. The form requires sponsors to answer a series of questions regarding their family members’ enrollment in programs like the Exceptional Family Member Program (EFMP) and any ongoing medical or educational services they receive. This proactive approach is designed to identify potential challenges early in the relocation process, allowing for appropriate planning and resource allocation.

Preview - Af 4380 Form

AIRFORCE
SPECIAL
NEEDS
SCREENER
(Completed
by
all
Sponsors
with
Family
Members)
(This
Form
is
Subject
the
the
Privacy
Act
of
1974
-
USE
BLANKET
PAS
-
DD
FORM
2005)
AUTHORITY:
10
U.S.C.
55.
10
U.S.C.
8013
and
E.O.
9397
(SSN)
as
amended.
PURPOSE(S):
Used
to
document,
plan,
and
coordinate
the
health
care
of
family
members
during
relocation;
determine
eligibility
and
suitability
for
benefits
for
various
programs;
and
compile
statistical
data.
ROUTINE
USE:
Used
to
accumulate
information
for
determining
family
member
special
needs.
DISCLOSURE:
Voluntary;
however,
failure
to
provide
SSN
or
other
requested
information
may
delay
screening
of
family
member's
suitability
for
relocation
at
government
expense
or
delay
issuance
of
PCS
orders.
TO:
SPECIAL
NEEDS
COORDINATOR
AND
AIR
FORCE
PERSONNEL
CENTER
(AFPC)
FROM:
Air
Force
Family
Member
Special
Needs
Identification
Screener
The
Air
Force
makes
an
effort
to
ensure
specialized
medical
and
educational
services
are
available
for
all
military
family
members.
In
order
to
help
us
do
this,
we
need
to
know
if
any
special
medical
and/or
educational
needs
exist
for
your
family
members.
You
are
required
to
complete
this
form
as
part
of
your
relocation
processing,
if
you
have
family
members,
whether
they
are
living
with
you
or
not.
SPONSOR
S
INFORMATION
=
(enter
last
4
digits
only)
Sponsor
s
Name
(Last,
First,
Ml)
Rank
Social
Security
Number
(SSN)
(Last
4
digits
only)
Current
Unit
and
Duty
Station
Duty
Telephone
Number
Telephone
Number
Projected
Installation
If
Relocating
Projected
Departure
Date
SPONSOR'S
FAMILY
INFORMATION
Please
read
and
answer
all
questions.
Indicate
(X)
the
appropriate
box.
Thank
you.
1.
Are
your
currently
enrolled
in
any
Service's
Exceptional
Family
Member
Program
(EFMP)?
2.
Do
any
of
your
children
receive
Special
Education
Services?
3.
Do
any
of
your
children
receive
Early
Intervention
Services?
4.
Do
any
of
your
family
members
receive
speech
therapy,
occupational
therapy,
physical
therapy,
or
counseling
services?
5.
Has
any
dependent
member
of
your
family
been
hospitalized
for
the
same
condition
more
than
once?
6.
Has
any
dependent
member
of
your
family
been
seen
by
a
medical
provider
or
mental
health
provider
for
the
same
condition
more
than
once
times
in
the
last
year?
7.
Do
any
of
your
family
members
have
a
chronic
medical
condition
that
requires
at
least
annual
evaluation
or
follow-up
by
a
specialist,
other
than
a
PCM
(such
as
cardiology,
internist,
psychology,
neurology,
8.
Do
any
of
your
dependent
family
members
have
reactive
airway
disease
or
asthma?
9.
Do
any
of
your
family
members
require
specialized
equipment
or
modified
housing?
Yes
Q
No
|
If
yes,
stop
here.
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If
YES
to
any
questions
numbered
2
-
8,
please
contact
the
Exceptional
Family
Member
Program
(EFMP-M)
Office
at
the
Military
Treatment
Facility
for
assistance
prior
to
pursuing
any
further
relocation
actions.
I
certify
that
this
information
is
complete
and
accurate
to
the
best
of
my
knowledge.
I
understand
that
insufficient
and/or
inaccurate
information
may
affect
family
member
travel
at
government
expense.
I
understand
that
making
a
knowing
and
willful
false
official
statement
can
be
punishable
by
fine
or
imprisonment.
(See
U.S.
Code,
Title
18,
Section
1001;
Title
10,
Section
907;
Article
107
UCMJ).
Sponsor's
Signature
Date
AF
FORM
4380,
20150806

Document Specifics

Fact Name Details
Form Purpose The AF 4380 form is designed to document and coordinate the health care needs of family members during military relocations.
Governing Laws This form is governed by 10 U.S.C. 55, 10 U.S.C. 8013, and E.O. 9397 (SSN) as amended.
Privacy Act Compliance The form is subject to the Privacy Act of 1974, ensuring that personal information is protected.
Disclosure Information Providing information on this form is voluntary; however, not supplying the requested details may delay relocation processes.
Special Needs Coordination The information collected helps in determining eligibility for benefits and ensures that specialized services are available for military family members.

Af 4380: Usage Instruction

Completing the AF 4380 form is a crucial step in ensuring that your family members receive the necessary medical and educational services during your relocation. This process helps to document any special needs and coordinate appropriate care. Follow the steps below to accurately fill out the form.

  1. Begin by entering the last four digits of your Social Security Number in the designated field.
  2. Provide your full name, formatted as Last Name, First Name, and Middle Initial.
  3. Fill in your current unit and duty station information.
  4. Indicate the projected installation you will be relocating to.
  5. Specify your rank and provide your duty telephone number.
  6. Enter your projected departure date.
  7. In the "Sponsor's Family Information" section, answer all questions by marking the appropriate box with an "X." Ensure that you read each question carefully.
  8. If any family member requires specialized equipment or modified housing, indicate "Yes" and stop at this point. If not, continue answering the remaining questions.
  9. After completing all questions, review your responses for accuracy and completeness.
  10. Sign and date the form, certifying that the information provided is accurate to the best of your knowledge.

Once you have completed the AF 4380 form, it should be submitted to the Special Needs Coordinator and the Air Force Personnel Center (AFPC). Ensure that all required information is included to avoid any delays in processing your relocation. Proper documentation will facilitate the necessary support for your family members during this transition.

Learn More on Af 4380

What is the purpose of the AF 4380 form?

The AF 4380 form is used to document, plan, and coordinate the health care needs of family members during a military relocation. It helps determine eligibility for various benefits and compiles important statistical data. By completing this form, you enable the Air Force to ensure that specialized medical and educational services are available for your family members.

Who is required to complete the AF 4380 form?

All sponsors with family members must complete the AF 4380 form as part of their relocation processing. This requirement applies regardless of whether the family members are currently living with the sponsor. It is essential to provide accurate information about any special medical or educational needs.

What information is collected on the AF 4380 form?

The form collects various details, including:

  • Sponsor's name, rank, and current duty station
  • Projected installation and departure date
  • Social Security Number (last four digits only)
  • Information about family members' special needs, such as enrollment in the Exceptional Family Member Program (EFMP) and any medical or educational services they receive

What happens if I do not provide the requested information?

While providing information on the AF 4380 form is voluntary, failing to do so may delay the screening of your family members' suitability for relocation at government expense. It could also postpone the issuance of Permanent Change of Station (PCS) orders, which may affect your family's transition.

What should I do if my family members have special needs?

If you answer "yes" to any of the questions regarding your family members' special needs, it is crucial to contact the Exceptional Family Member Program (EFMP-M) Office at your Military Treatment Facility. They can provide assistance and guidance before you proceed with any further relocation actions.

Is the information I provide confidential?

Yes, the information you provide on the AF 4380 form is protected under the Privacy Act of 1974. It is used solely for the purposes outlined in the form, such as planning and coordinating health care for your family members. Your privacy is taken seriously, and the information will only be shared with authorized personnel.

What are the consequences of providing false information on the AF 4380 form?

Providing false information on the AF 4380 form can lead to serious consequences. Making a knowing and willful false statement can result in penalties, including fines or imprisonment. It is essential to ensure that all information is complete and accurate to avoid any legal repercussions and to facilitate your family's relocation process.

Common mistakes

Filling out the AF 4380 form, which is essential for documenting the special needs of military family members, can be a straightforward process if approached with care. However, many individuals make common mistakes that can lead to delays or complications. Understanding these pitfalls can help ensure a smoother experience.

One frequent error is incomplete information. Many sponsors fail to fill in all required fields, particularly in the Sponsor's Information section. Omitting details such as the last four digits of the Social Security Number or the projected departure date can hinder processing. It is crucial to double-check that every box is filled out completely before submission.

Another mistake involves misunderstanding the questions. Some sponsors may misinterpret what is being asked, particularly in the family information section. For instance, failing to recognize that "chronic medical condition" includes conditions like asthma can lead to inaccuracies. Carefully reading each question and considering the implications of the answers is essential.

Additionally, not contacting the Exceptional Family Member Program (EFMP) when necessary is a common oversight. If a sponsor answers "yes" to any questions numbered 2-8, they are instructed to reach out to the EFMP office. Ignoring this step can complicate the relocation process and potentially affect eligibility for necessary services.

Another mistake is providing inaccurate information. Some sponsors may unintentionally report incorrect details about their family members' needs or medical history. This can lead to significant issues, as the form is used to coordinate essential health care services. Honesty and accuracy are critical to ensure that family members receive the appropriate support.

Many individuals also overlook the importance of signing and dating the form. Without a signature, the form is incomplete, and processing will be delayed. This simple step is often forgotten in the rush to submit the form, but it is a vital part of the application process.

Another common error is failing to keep copies of the submitted form. It is advisable for sponsors to retain a copy for their records. This can be helpful for reference in case any questions arise later or if there is a need to follow up on the status of the application.

Moreover, not understanding the implications of the Privacy Act can lead to confusion. The form is subject to specific privacy regulations, and sponsors should be aware of how their information will be used. Familiarizing oneself with these regulations can help alleviate concerns about confidentiality.

Lastly, procrastination can be a significant mistake. Some sponsors delay filling out the form until the last minute, which can lead to rushed and incomplete submissions. Starting the process early allows ample time to gather necessary information and seek assistance if needed.

By being aware of these common mistakes and taking proactive steps to avoid them, sponsors can ensure that the AF 4380 form is filled out accurately and completely, paving the way for a smoother relocation process.

Documents used along the form

The AF 4380 form, known as the Air Force Special Needs Screener, is essential for military families with members who have special medical or educational needs. Alongside this form, several other documents are often required to ensure a smooth relocation process. Below is a list of these documents, each serving a specific purpose.

  • AF Form 5884: This form is used for requesting Exceptional Family Member Program (EFMP) enrollment. It helps identify family members with special needs to ensure they receive appropriate support during relocation.
  • DD Form 2792: This is the Family Member Medical Summary, which provides a detailed medical history of family members. It is crucial for understanding ongoing health issues and ensuring that necessary medical services are available at the new location.
  • DD Form 2792-1: This form serves as the Special Education/Early Intervention Summary. It outlines the educational needs of children, helping to coordinate appropriate educational services at the new duty station.
  • AF Form 700: Known as the Family Care Plan, this document outlines arrangements for the care of dependents in case the service member is unavailable. It is important for ensuring that family members are cared for during deployments or other absences.
  • AF Form 357: This is the Family Care Plan Certificate, which verifies that the Family Care Plan is in place. It ensures that all necessary arrangements for dependent care are documented and approved.
  • AF Form 847: This form is used for requesting changes to the EFMP program. It allows families to update their status or request additional services based on changing needs.
  • DD Form 214: This document provides a record of military service. It is often required for verifying eligibility for various benefits and services related to family members' special needs.
  • Medical Documentation: Any relevant medical records or evaluations from healthcare providers that detail the specific needs of family members. This documentation is vital for ensuring that appropriate care and resources are available at the new location.

Each of these documents plays a crucial role in the relocation process for military families with special needs. Properly completing and submitting them can significantly ease the transition and ensure that all family members receive the necessary support and services.

Similar forms

The AF Form 4380 is similar to the DD Form 2792, also known as the Exceptional Family Member Program (EFMP) Medical Summary. Both forms are designed to gather essential information about family members with special needs. The DD Form 2792 focuses on medical history and current health status, while the AF Form 4380 collects data to ensure appropriate services are available during relocation. Both documents aim to facilitate the care and support of family members with unique requirements, ensuring that military families receive the necessary resources and assistance.

Another comparable document is the DD Form 2792-1, which is the EFMP Special Education Summary. This form specifically addresses educational needs and services for children with disabilities. Similar to the AF Form 4380, it seeks to identify any special requirements that may affect relocation and access to educational resources. Both forms emphasize the importance of understanding the needs of family members to provide appropriate support and services, ultimately helping to ensure a smooth transition during military moves.

The DA Form 7425, known as the Family Member Medical Summary, shares similarities with the AF Form 4380 in that it collects medical information for family members. This form is used by the Army to document health care needs and ensure that necessary medical services are available. Like the AF Form 4380, the DA Form 7425 aims to coordinate care and support for family members, particularly during relocation. Both documents play a crucial role in identifying and addressing the needs of military families.

Additionally, the SF 600, known as the Chronological Record of Medical Care, is another document that serves a similar purpose. This form is used to record the medical history of individuals, including family members. While the AF Form 4380 focuses on special needs related to relocation, the SF 600 provides a comprehensive view of medical care received over time. Both forms are essential for ensuring that family members receive appropriate care and support, especially when relocating to new duty stations.

Lastly, the AF Form 1180, or the Medical and Dental Care for Family Members, is akin to the AF Form 4380 in that it addresses the health care needs of military family members. This form is used to verify eligibility for medical and dental services. Both documents emphasize the necessity of understanding family members' health care requirements to ensure access to appropriate services. By collecting relevant information, they help facilitate the coordination of care during the relocation process.

Dos and Don'ts

When filling out the AF 4380 form, it is essential to approach the process thoughtfully. Below is a list of things you should and shouldn't do to ensure that your submission is complete and accurate.

  • Do read the instructions carefully before starting the form.
  • Do provide accurate information regarding your family members' special needs.
  • Do include the last four digits of your Social Security Number as required.
  • Do check all boxes thoroughly to ensure you have answered each question.
  • Do contact the Exceptional Family Member Program (EFMP) Office if you answer "yes" to questions 2-8.
  • Don't rush through the form; take your time to ensure accuracy.
  • Don't leave any questions unanswered, as this may delay processing.
  • Don't provide false information; this can lead to serious consequences.
  • Don't forget to sign and date the form before submission.
  • Don't hesitate to ask for help if you are unsure about any part of the form.

By following these guidelines, you will help facilitate a smoother process for your family’s relocation and ensure that their special needs are adequately addressed.

Misconceptions

Here are nine common misconceptions about the AF 4380 form:

  • The AF 4380 form is only for active-duty military members. This form is required for all sponsors with family members, regardless of their military status.
  • Completing the AF 4380 is optional. While providing information is voluntary, failure to complete the form can delay relocation and benefits.
  • The AF 4380 only addresses medical needs. It also covers educational needs and helps determine eligibility for various programs.
  • Only family members living with the sponsor need to be reported. All family members, regardless of living arrangements, must be included on the form.
  • The information provided is not confidential. The AF 4380 is subject to the Privacy Act of 1974, ensuring that your information is protected.
  • Submitting the AF 4380 guarantees relocation approval. The form helps assess needs but does not automatically guarantee that relocation will be approved.
  • Once submitted, the AF 4380 cannot be updated. You can update your information if your family's needs change after submission.
  • All questions on the form must be answered with a "yes." You should answer each question honestly, and only indicate "yes" if it applies to your family.
  • The AF 4380 is only relevant during relocation. It is also useful for ongoing assessments of family member needs throughout military service.

Key takeaways

The AF 4380 form, known as the Air Force Special Needs Screener, is a critical document for military families. Below are key takeaways regarding its completion and use:

  • Mandatory Submission: All sponsors with family members must complete this form during relocation processing.
  • Purpose: The form documents and coordinates health care needs for family members and assesses eligibility for various benefits.
  • Voluntary Disclosure: Providing information, including Social Security Numbers, is voluntary. However, lack of information may delay relocation processes.
  • Special Needs Identification: The form helps identify any special medical or educational needs of family members, which is essential for planning services.
  • Exceptional Family Member Program: If any questions regarding special needs are answered affirmatively, it is advised to contact the Exceptional Family Member Program office for assistance.
  • Accuracy Requirement: Sponsors must ensure that all information provided is complete and accurate to avoid complications with travel and relocation.
  • Legal Implications: Providing false information can lead to legal penalties, including fines or imprisonment.
  • Privacy Act Compliance: The form is subject to the Privacy Act of 1974, ensuring that personal information is handled with confidentiality.
  • Submission Destination: The completed form should be sent to the Special Needs Coordinator and the Air Force Personnel Center.

Understanding these key points can facilitate a smoother relocation process for military families and ensure that necessary services are available for those with special needs.