Blank Af 4380 PDF Form

What is the purpose of the AF 4380 form?

The AF 4380 form, also known as the Air Force Special Needs Screener, is designed to document and coordinate the health care needs of military family members during relocation. It helps determine eligibility for various benefits and compiles statistical data regarding family member special needs. Completing this form ensures that the Air Force can provide appropriate medical and educational services to families with special needs.

Who is required to complete the AF 4380 form?

All sponsors with family members are required to complete the AF 4380 form as part of their relocation process. This requirement applies regardless of whether the family members are currently living with the sponsor. By filling out this form, sponsors help the Air Force assess and address any special medical or educational needs their family members may have.

What information is collected on the AF 4380 form?

The AF 4380 form collects essential information about the sponsor and their family members, including names, current unit, duty station, and projected installation. It also includes questions about any special education services, therapies, chronic medical conditions, and the need for specialized equipment or modified housing. This information is crucial for the Air Force to ensure that adequate support is available for families with special needs.

What happens if I do not provide the requested information?

While providing information on the AF 4380 form is voluntary, failing to submit the requested details, such as Social Security Numbers or answers to specific questions, may lead to delays. These delays can affect the screening process for family member suitability for relocation at government expense and may postpone the issuance of Permanent Change of Station (PCS) orders.

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

If any of your family members have special needs, as indicated by answering "yes" to questions numbered 2 through 8 on the AF 4380 form, it is recommended that you contact the Exceptional Family Member Program (EFMP-M) Office at your Military Treatment Facility. This step is crucial before proceeding with any further relocation actions, ensuring that your family's needs are adequately addressed.

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 knowingly false statement can result in penalties, including fines or imprisonment. This is outlined in U.S. Code, Title 18, Section 1001, Title 10, Section 907, and Article 107 of the Uniform Code of Military Justice (UCMJ). It is essential to ensure that all information provided is complete and accurate to avoid any potential legal repercussions.

1. Failing to provide the last four digits of the Social Security Number (SSN). This information is crucial for processing.

2. Not answering all questions in the family information section. Each question is designed to assess the needs of family members.

3. Overlooking the requirement to indicate if enrolled in the Exceptional Family Member Program (EFMP). This can impact relocation decisions.

4. Providing incomplete or inaccurate information about family members' medical conditions. This can lead to delays in care and relocation.

5. Not contacting the EFMP Office if any conditions are marked "yes" on questions 2-8. This step is essential for further relocation actions.

6. Failing to sign and date the form. A signature is required to certify the accuracy of the information provided.

7. Ignoring the instructions regarding the voluntary disclosure of information. While it's voluntary, not providing requested details may delay processing.

8. Submitting the form without reviewing it for errors or missing information. A thorough review can prevent complications later.

9. Not keeping a copy of the completed form for personal records. This can be useful for future reference or follow-up.

The AF 4380 form is essential for documenting the special needs of military family members during relocations. Alongside this form, several other documents may be required to ensure a smooth transition. Here’s a list of commonly used forms and documents that often accompany the AF 4380.

• DD Form 2005: This form is used to authorize the release of personal information under the Privacy Act of 1974. It ensures that all data shared is handled appropriately.
• AF Form 1180: This form helps in documenting the medical history of family members. It provides a detailed account of any ongoing treatments or conditions that may need attention during relocation.
• EFMP Enrollment Form: This form is specifically for enrolling family members in the Exceptional Family Member Program. It helps to identify those who require special medical or educational services.
• AF Form 594: This form is used for requesting a dependent travel allowance. It ensures that family members can travel with the service member at government expense.
• AF Form 907: This is a request for a medical evaluation for family members. It is particularly important for those with chronic conditions that may need specialized care.
• DA Form 7425: This form is used to document special education needs. It helps to coordinate necessary educational services for children with disabilities.
• SF 600: This is the chronological record of medical care. It tracks any medical visits and treatments, which is vital for ongoing care during relocations.
• AF Form 623: This form is used for documenting training and educational achievements. It can be helpful for ensuring that family members receive the appropriate educational support.
• AF Form 350: This form is utilized to request a medical appointment for family members. It ensures that any necessary medical evaluations can be scheduled promptly.
• Travel Orders: These are official documents that authorize travel for service members and their families. They outline the specifics of the relocation and any associated benefits.

Having these documents ready can streamline the relocation process and ensure that all family members receive the care and support they need. It’s important to stay organized and informed to make the transition as smooth as possible.

The AF 4380 form, known as the Air Force Special Needs Screener, plays a crucial role in documenting and coordinating the healthcare needs of military families. Several other documents serve similar purposes in various contexts, particularly in assessing needs, eligibility, and providing necessary support. Here’s a list of eight documents that share similarities with the AF 4380 form:

• DD Form 2792 - This form is used to document the special needs of family members in the military, particularly for those enrolled in the Exceptional Family Member Program (EFMP). Like the AF 4380, it aims to ensure proper care and resources are allocated to families with special needs.
• DD Form 1172-2 - This document is essential for verifying eligibility for benefits and services for military dependents. It collects personal information, similar to the AF 4380, to facilitate the provision of healthcare and support services.
• SF 600 - The Chronological Record of Medical Care form is used to document patient encounters and health history. Like the AF 4380, it captures vital health information that can influence treatment and support decisions.
• DA Form 7425 - This form is utilized by the Army to assess the needs of family members with special requirements. It aligns with the AF 4380 in its goal to gather comprehensive information for appropriate care and resource allocation.
• VA Form 21-526EZ - This application for disability compensation is used by veterans and their families to seek benefits. It parallels the AF 4380 by requiring detailed information about health conditions and needs to determine eligibility for support.
• Form I-485 - The Application to Register Permanent Residence or Adjust Status collects information about applicants’ health and background. Like the AF 4380, it ensures that necessary accommodations and resources are considered during the processing of applications.
• Form 990 - This is an informational tax form used by nonprofit organizations to provide the IRS with information about their activities. While it focuses on financial data, it also emphasizes the importance of documenting needs and services, akin to the AF 4380’s focus on healthcare needs.
• CMS-1500 - This is a standard claim form used by healthcare providers to bill Medicare and other insurers. It requires detailed patient information, similar to the AF 4380, to ensure that claims for services are processed correctly and efficiently.

Each of these forms serves a specific purpose, yet they share the common goal of gathering essential information to support individuals and families in need. Understanding these documents can enhance the effectiveness of the services provided to military families and ensure that their unique needs are met.

When filling out the AF 4380 form, it's essential to approach the task with care. Here are five important dos and don'ts to keep in mind:

• Do provide accurate information for each family member, including their medical and educational needs.
• Do read each question carefully before answering to ensure you understand what is being asked.
• Do include the last four digits of your Social Security Number as required.
• Do reach out to the Exceptional Family Member Program (EFMP) Office if you have questions or need assistance.
• Do sign and date the form to confirm that the information is complete and accurate.

• Don't leave any questions unanswered; every item is important for your family's needs assessment.
• Don't provide false information, as this can lead to serious consequences.
• Don't forget to check the appropriate boxes for each question; this ensures clarity in your responses.
• Don't assume that someone else will fill out the form for you; it's your responsibility as the sponsor.
• Don't delay submitting the form, as it can affect your family's relocation process.

Misconceptions about the AF 4380 form can lead to confusion and delays in processing. Here are five common misunderstandings:

• The AF 4380 form is only for families with children. This is not true. The form must be completed by all sponsors with family members, regardless of age. It applies to anyone who may have special medical or educational needs.
• Providing information on the AF 4380 form is mandatory. While it is true that completing the form is a requirement for relocation processing, disclosing specific information is voluntary. However, not providing certain details may delay the screening process.
• The AF 4380 form is only relevant for relocation within the United States. This misconception overlooks that the form is necessary for any relocation, whether domestic or international. It helps ensure that family members receive appropriate care wherever they move.
• Filling out the AF 4380 form is a one-time requirement. In reality, the form may need to be completed each time a family relocates. This ensures that updated information about special needs is always available to service providers.
• The information provided on the AF 4380 form is not confidential. This is incorrect. The form is subject to the Privacy Act of 1974, which means that the information is protected and used only for the purposes stated in the form.

Filling out the AF 4380 form is an essential step for military sponsors with family members who may have special needs. Here are key takeaways to consider:

• Purpose of the Form: The AF 4380 is used to document and coordinate the health care of family members during relocation. It helps determine eligibility for various benefits and compiles important statistical data.
• Voluntary Disclosure: While providing information is voluntary, omitting details such as the Social Security Number (SSN) can delay the screening process for family members' suitability for relocation.
• Who Should Complete It: All sponsors with family members, regardless of whether those members live with them, are required to complete this form during their relocation process.
• Special Needs Identification: The form gathers crucial information about any special medical or educational needs that family members may have, ensuring appropriate services are available.
• Exceptional Family Member Program (EFMP): If any questions related to special needs are answered affirmatively, sponsors should contact the EFMP Office for assistance before proceeding with relocation.
• Accuracy is Critical: Providing complete and accurate information is vital. Inaccuracies can affect travel at government expense and may lead to serious consequences for false statements.
• Signature Requirement: Sponsors must sign and date the form, certifying that the information provided is true and complete to the best of their knowledge.
• Privacy Considerations: The information submitted is protected under the Privacy Act of 1974, ensuring that personal data is handled with confidentiality.
• Contact Information: Sponsors should ensure their contact details, including telephone numbers and projected departure dates, are correctly filled out to facilitate communication during the relocation process.