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AF Form 4380 Air Force Special Needs Screener
What Is AF Form 4380?
AF Form 4380, Air Force Special Needs Screener , is a document completed by all sponsors with family members to accumulate information for determining family member's special needs. Its purpose is to document, plan, and coordinate the health care of family members during relocation, to determine eligibility and suitability for the benefits for various programs, and to compile statistical data.
The latest version of the form was released by the U.S. Air Force (AF) on August 6, 2015 . AF Form 4380 fillable version is available for download below or can be found through the Air Force e-Publishing website. Additional information and filing guidelines can be found in AFI 40-701, Medical Support to Family Member Relocation Clearance, and Exceptional Family Member Program (EFMP).
The completion of this form is required as part of a relocation process if the sponsor has family members, whether they are living together or not. The disclosure of the information is voluntary; however, failure to provide a social security number or other requested information may delay screening of the family member's suitability for relocation at government expense or delay issuance of permanent change of station orders.
Air Force Special Needs Screener
The Air Force ensures specialized medical and educational services are available for all military family members. In order to help them do this, they need to know if any special medical and/or educational needs exist for the military family members. This form will help to ensure that, if necessary, a military family receives continuity of any specialized care they require if the sponsor is selected for an active duty training location.
AF Form 4380 does not affect the scoring of the application package and will only be coordinated with the Air Force Programs for families with special needs if the applicant is selected for an active duty program and if the applicant answers yes to any questions. If necessary, the Air Force Programs for families with special needs will contact the sponsor for additional information and will assist in coordinating relocations for families with specialized medical or educational needs.
AF Form 4380 Instructions
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Section 1 ("Sponsor's Information") requires the sponsor's full name, rank, SSN, current unit and duty station, duty and home telephone number, projected installation for relocation, and projected departure date.
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Section 2 ("Sponsor's Family Information") requires the sponsor to answer several questions. These include:
- Whether the sponsor currently is enrolled in any Service's Exceptional Family Member Program;
- Whether the sponsor's children receive Special Education Services or Early Intervention Services;
- Whether the sponsor's children receive speech therapy, occupational therapy, physical therapy, or counseling services;
- Whether any dependent member of the sponsor's family has been hospitalized for the same condition more than once, has been seen by a medical provider or mental health provider for the same condition more than six times in the last year, and/or has reactive airway disease or asthma;
- Whether the sponsor's family members have a chronic medical condition that requires a re-evaluation or follow-up by a specialist at least once a year.
