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The AF Form 1466, known as the Request for Family Member's Medical and Education Clearance for Travel, serves a crucial role in ensuring that family members of military personnel receive the appropriate medical and educational evaluations prior to travel. This form is rooted in legal frameworks such as the Privacy Act and several sections of the United States Code. It allows military assignment personnel to assess whether family members have the necessary medical resources available at their intended duty location. By documenting significant family medical and educational needs, the form ensures that service members can make informed decisions regarding command-sponsored travel. Understanding the specific requirements of this form, such as mandatory fields and the importance of accurate information, is essential for a smooth application process. Military families often navigate complex transitions; therefore, the AF Form 1466 facilitates necessary coordination with medical and educational professionals, making it a linchpin in the travel clearance process. Its structured approach to gathering sensitive information aims not only to protect privacy but also to optimize available support services that dependents may require, whether for medical, educational, or other special needs.

Af 1466 Example

REQUEST FOR FAMILY MEMBER'S MEDICAL AND EDUCATION CLEARANCE FOR TRAVEL

PRIVACY ACT STATEMENT

AUTHORITY: 10 USC 3013, 5013, and 8013; 20 USC 921 - 932; and EO 9397.

PRINCIPAL PURPOSE(S): Information will only be used by personnel of the Military Departments to evaluate and document the medical and

educational needs of family members. This information will enable: (1) Military assignment personnel to authorize family member travel at government expense based on availability of needed services at the gaining installation; and (2) Civilian personnel offices to determine the availability of medical/educational services to meet the medical needs of family members of DoD and Military Department civilian employees.

ROUTINE USE(S): None.

DISCLOSURE: Voluntary for civilian employees and applicants for civilian employment; failure to respond will preclude the successful processing of an application for family travel/command sponsorship. Mandatory for military personnel; failure or refusal to provide the information or providing false information may result in administrative sanctions or punishment under either Article 92 (dereliction of duty) or Article 107 (false official statement), Uniform Code of Military Justice.

AUTHORIZATION FOR DISCLOSURE OF MEDICAL INFORMATION

Authority - Public 104-191, "Health Insurance Portability and Accountability Act (HIPAA)", August 21, 1996.

This form will not be used for authorization to disclose psychotherapy notes, alcohol or drug abuse patient information from medical records or for authorization to disclose information from records of an alcohol or drug abuse treatment program.

I authorize

 

(MTF/DTF) to release my patient information to the

Exceptional Family Member/Special Needs Program to be used in the assignment coordination process. The information on this form and addenda will be used to determine whether there are adequate medical, housing and community resources to meet your special medical needs at the sponsor's proposed duty locations.

a.The military medical department will use the information to make recommendations on the availability of care in communities where the sponsor may be assigned or employed.

b.Information that you have a special need (not the nature or scope of the need) may be included in the sponsor's personnel record or be maintained in the community office responsible for supporting families with special needs.

c.The authorization applies to the summary data included on the medical summary form, its addenda and subsequent updates to information on this form. These data may be stored in electronic databases used for medical management or dedicated to the assignment coordination process. Only representatives from the medical department and the offices responsible for EFMP assignment coordination will have access to the information.

Start Date: The authorization start date is the date that you sign this form authorizing the release of information.

Expiration Date: The authorization shall continue until you no longer meet the criteria to qualify as a dependent (active duty family members) or no longer desire to travel overseas at government expense (civilian employee family members), or the sponsor is no longer in active military service or employment of the U.S. Government overseas.

I understand that:

a.I have the right to revoke this authorization at any time. My revocation must be in writing and provided to the facility where my medical records are kept. I am aware that if I later revoke this authorization, the person(s) I herein name will have used and/or disclosed my protected information on the basis of this authorization.

b.If I authorize my protected health information to be disclosed to someone who is not required to comply with federal privacy protection regulations, then such information may be re-disclosed and would no longer be protected.

c.I have a right to inspect and receive a copy of my own protected health information to be used or disclosed, in accordance with the requirements of the federal privacy protection regulations found in the Privacy Act and 45 CFR § 164.524. I request and authorize the named provider/treatment facility to release the information described above to the named individual/organization indicated.

d.The Military Health System (which includes the TRICARE Health Plan) may not condition treatment in MTFs/DTFs, payment by the TRICARE Health Plan, enrollment in the TRICARE Health Plan or eligibility for TRICARE Health Plan benefits on failure to obtain this authorization.

SIGNATURE OF PATIENT/PARENT/GUARDIAN

RELATIONSHIP TO PATIENT(S)(If applicable)

DATE (YYYYMMDD)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AF FORM 1466 20111011

PREVIOUS EDITION IS OBSOLETE

Page 1

REQUEST FOR FAMILY MEMBER'S MEDICAL AND EDUCATION CLEARANCE FOR TRAVEL

(This Form is Subject to the Privacy Act of 1974 - USE BLANKET PAS - DD FORM 2005.)

SECTION I - SPONSOR'S DATA

A. NAME (Last, First, Middle Initial)

B. GRADE

C. SSN

D. DUTY / HOME PHONE

E. PRESENT UNIT/LOCATION

F. CURRENT MPF LOCATION OF SPONSOR

G.MO/YR OF SPONSOR TRAVEL:

/

H. PROJECTED UNIT / LOCATION/PAS CODE

I. JOIN SPOUSE ASSIGNMENT

YES

NO

J. GAINING MAJCOM

K. PROJECTED AFSC

L.PREVIOUSLY Q-CODED

YES

NO

M. If Spouse is Active Duty: Name:Branch:

N. IS THE MEMBER BEING ASSIGNED TO STATE DEPARTMENT DUTIES OR OTHER GEOGRAPHICALLY REMOTE LOCATIONS? YES

SSN:

NO

If family destination is other than a catchment area for an AF MTF, the sending installation must refer to EFMP-M guidance on areas of responsibility for remote clearances and embassy/attache' clearance processing.

SECTION II - FAMILY MEMBERS NOT TRAVELING

I hereby certify the following family members will NOT accompany me as command-sponsored dependents at any time during this assignment. I understand that if these plans change, I must reaccomplish this form to include the following family members and notify the Special Needs Coordinator at my current base of assignment..

FAMILY MEMBER'S NAME

(Last, First, Middle Initial)

RELATIONSHIP

AGE

The above listed (number) family members will NOT accompany me at the gaining location.

Sponsor's Signature

SECTION III - FAMILY MEMBERS REQUESTING COMMAND SPONSORSHIP TO TRAVEL

INSTRUCTIONS

Sponsors are required to list all family members requesting command sponsorship for the purpose of accompanying the military sponsor in the projected duty location. Page 3 of this form must be completed in its entirety for each family member listed to avoid delays in travel recommendation processing.

Additionally:

A.ALL sponsors with school-aged children, including those who are home-schooled, and those enrolled in Early Intervention who intend to travel OCONUS must complete DD Form 2792-1, Family Member Special Education/Early Intervention Summary. Attach copies of Individualized Education Plan (IEP) and/or Individualized Family Service Plan (IFSP), where applicable.

B.Sponsors must submit completed DD Form 2792, Family Member Medical Summary with Addendum 1, Asthma/Reactive Airway Disease Summary, Addendum 2, Mental Health Summary Addendum 3, Autism, for each family member with a special medical need who is requesting travel. If no special need is known for a family member, sponsor must check "None". OCONUS locations may require the use of these forms for travel considerations for ALL family members requesting OCONUS travel.

C.Sponsors must complete AF Form 1466D, Dental Health Summary,for all EFMP family members over the age of 2 traveling to any location and all members over the age of two traveling OCONUS. OCONUS locations may require the use of these forms for travel considerations for ALL family members requesting OCONUS travel.

D.Definitions:

1.Medical - Potentially life-threatening conditions and/or chronic medical/physical conditions within the last five years, requiring follow-up support more than once a year, or specialty care.

Emotional/Behavioral - Any of the following: current or chronic mental health conditions; inpatient or intensive outpatient mental health services within the last 5 years; greater than one visit monthly for more than 6 months required at the present time. This includes medical care from any mental health provider, a primary care manager, other health care provider, or legal social service involvement.

2.Dental - Care beyond routine annual dental exam or cleaning.

3.Educational - Any child using or intending to use special education services, including any child with an IEP or an IFSP, or a child (aged birth - 3 years) with a high probability of having a developmental delay.

4.Early Intervention or Related Services - Occupational Therapy, Physical Therapy, Speech Therapy, Mental Health, Audiological, or other related services recommended on an IEP or IFSP for the support of appropriate education, as would be covered by State Part B or Part C Services under IDEA. Mark if ever received.

5.Modified Housing/Environmental modifications - Special housing requirements for documented needs, such as wheelchair accessibility.

6.None - No known medical conditions AND no specialized educational services needed. Requires only annual/semi-annual routine visits to primary care manager.

E.Location of medical records: For each family member listed in Section IV, indicate the location of stored medical records. Check "Copies Provided" if the sponsor and/or family member has provided copies of medical records not normally available through the MTF to support consideration of travel.

F.Month and Year of projected travel to Projected Location: Submit dates of travel of family members if different than travel date of sponsor shown in Section 1.G. above.

AF FORM 1466 20111011

PREVIOUS EDITION IS OBSOLETE

Page 2

SPONSOR (Last, First MI):SSN:

SECTION IV - FAMILY MEMBERS REQUESTING COMMAND SPONSORSHIP TO TRAVEL (Continued)

 

 

FAMILY MEMBERS ACCOMPANYING SPONSOR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CHECK ALL CONDITIONS THAT APPLY

 

 

 

 

 

 

FAMILY MEMBER'S NAME

RELATIONSHIP

 

AGE

GRADE

LOCATION OF

COPIES

 

MONTH / YEAR

MEDICAL /

DENTAL

EDUCA -

EI or RS

MODIFIED

NONE

 

 

 

 

 

(Last, First, Middle Initial)

 

IN

PROVIDED

 

EMOTIONAL /

 

 

 

 

 

 

 

 

SCHOOL

MEDICAL RECORDS

 

 

 

 

OF TRAVEL

BEHAVIORAL

 

 

 

TIONAL

SERVICES

HOUSING

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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SECTION V - CERTIFICATION OF APPLICANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I certify that I have read and understand the previous instructions and that those entries made by me are true, complete, and correct to the best of my knowledge and belief.

 

 

 

 

Initials

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand that I must inform the Special Needs Coordinator (SNC) of any changes to health/educational conditions prior to travel of family member listed in Section IV.

 

 

 

 

 

 

I understand that insufficient and/or inaccurate information may affect family member travel.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand that a knowing and willful false statement on this form can be punishable by fine or imprisonment. (See U.S. Code, Title 18, Section 1001; Title 10, Section 907;

 

 

 

 

 

 

Article 107 UCMJ, Article 92 UCMJ).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have disclosed to the SNC all known medical or special educational conditions for all family members planning travel.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand that failure to report these conditions may result in disciplinary action as a false official statement. Attempts to obtain a benefit, to include medical care or

 

 

 

 

 

 

 

 

 

government sponsored travel by withholding information regarding my family member care histories may be reported to my commander.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand that choosing to take family members who are not recommended for government sponsored travel, at my own expense, may result in disciplinary

 

 

 

 

 

 

 

 

 

action, significant personal expense, and may place family member in a location where necessary care or services are not available to them.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I understand I may request EFMP Reassignment via vMPF if one or more of my family members are not recommend for travel, or elect OCONUS travel unaccompanied.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

PRINTED NAME AND GRADE OF SPONSOR

 

 

 

 

 

 

 

 

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AF FORM 1466 20111011

PREVIOUS EDITION IS OBSOLETE

Page 3

 

SPONSOR NAME (Last, First MI):SSN:

SECTION VI - MEDICAL PROVIDER EVALUATION

 

 

 

 

 

Inquiry

 

 

 

 

 

YES

 

NO

 

A. All Family Members' Medical Records Reviewed?

(If NO, comments required below).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. All Family Members in Section IV Interviewed?

(If NO, comments required below).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Special Medical Conditions Identified?

(If YES, complete DD Form 2792).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. All Family Members' AF Form 1466D reviewed?

(If NO, comments required below).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Any unresolved dental care needs/problems identified on the AF Form 1466D?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have confirmed the following presence or absence of specialty consultations and of pharmacy data indicating further review

or potential special needs may be warranted. Comments required.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMENTS:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have seen and interviewed all family members requesting travel and determined that FDI is

is not

required.

 

 

Number of DD Form 2792s attached.

 

Number of DD Form 2792-1s attached.

Number of AF Form 1466Ds attached

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

TYPE/PRINT NAME AND GRADE OF MEDICAL PROVIDER

 

 

 

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION VII - SPECIAL NEEDS COORDINATOR ENDORSEMENT

 

 

 

 

 

 

 

 

INQUIRY

 

 

 

 

YES

NO

 

 

 

A. History of Family Advocacy Involvement? (If YES, complete DD Form 2792, Addendum 2)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B. History of Mental Health Needs? (If YES, complete DD Form 2792, Addendum 2)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C. Has artificial openings / requires prosthetics? (If YES, complete DD Form 2792. Ensure Part B, Section 8, is completed.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D. Requires Modified Housing? (If YES, complete DD Form 2792. Ensure Part B, Section 9, is completed.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E. Requires Adaptive Equipment / Special Medical Equipment? (If YES, complete DD Form 2792. Ensure Part B, Section 10, is completed.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F. Has Individualized Education Plan for Special Education? (If YES, complete DD Form 2792-1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G. Has Individualized Family Service Plan or high probability for development delay. (If YES, complete DD Form 2792-1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMMENTS REQUIRED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

TYPE/PRINT NAME AND GRADE OF SPECIAL NEEDS COORDINATOR

 

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION VIII - CERTIFICATION BY LOSING BASE MDG / SGH

 

 

 

Any YES response in Sections VI C or VII require forwarding this AF FORM 1466 to the gaining base for review via Facility Determination Inquiry.

 

 

Comments Required:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have reviewed all information collected and find it sufficient for medical decision making.

 

 

 

Comments reviewed and determined that FDI is

is not

required.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of DD Form 2792s attached.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of AF Form 1466Ds attached.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Number of DD Form 2792-1s attached.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

NAME & GRADE OF LOSING SGH

 

 

 

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AF FORM 1466 20111011

PREVIOUS EDITION IS OBSOLETE

Page 4

 

SPONSOR NAME (Last, First MI):

 

 

 

 

 

 

 

 

 

SSN:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTION IX - FACILITY DETERMINATION INQUIRY, DISPOSITION BY MDG / SGH

 

 

Family member(s) travel is recommended.

 

 

 

Family member(s) require(s) FDI. Note: Orders may not be issued until FDI

 

 

 

 

 

 

 

 

completed by Gaining SGH.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

 

 

TYPE / PRINT NAME AND GRADE OF LOSING BASE SGH

 

 

 

SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of Losing Installation (PRINT LEGIBLY)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Family member(s) travel is recommended.

 

 

 

 

 

 

Family member(s) travel is not recommended.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL COMMMENTS

Check all that apply:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Family Member Name

Care

Care

 

Care/Services

Recommend

Other

 

available in

available in

 

not available

Care

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MTF

local area

 

 

Coordination

 

 

 

 

 

 

 

 

 

 

 

 

 

 

through PCS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE

TYPE / PRINT NAME AND GRADE OF GAINING BASE SGH

SIGNATURE

Name of Gaining Installation (PRINT LEGIBLY)

AF FORM 1466 20111011

PREVIOUS EDITION IS OBSOLETE

Page 5

Form Characteristics

Fact Name Details
Form Title Request for Family Member's Medical and Education Clearance for Travel
Governing Authority 10 USC 3013, 5013, 8013; 20 USC 921 - 932; EO 9397
Purpose This form helps assess and document the medical and educational needs of family members.
Mandatory Disclosure It is mandatory for military personnel to provide their information. Failure may lead to sanctions.
Voluntary Disclosure Civilians may choose whether to fill out the form; not doing so could delay processing family travel applications.
HIPAA Compliance The form complies with the Health Insurance Portability and Accountability Act (HIPAA) for medical records management.
Expiration of Authorization The authorization continues until certain criteria are no longer met, such as dependeny status or employment termination.
Signature Requirement The form must be signed by the patient or their guardian, confirming understanding of the information provided.

Guidelines on Utilizing Af 1466

Completing the AF 1466 form accurately is essential for facilitating medical and education clearance for family members to travel. The following steps outline the process to fill out the form correctly.

  1. Locate the AF 1466 form, which can usually be found on the official military or Department of Defense website.
  2. Begin filling out the "Sponsor's Data" section at the top of the form. This includes your full name, grade, Social Security Number (SSN), phone number, current unit, and current Military Personnel Flight (MPF) location.
  3. Complete the fields related to your projected travel. Include the month/year of your travel, projected unit/location, and Major Command (MAJCOM). Specify whether you join spouse assignment on the designated line.
  4. Address the question of whether you're being assigned to state department duties or other remote locations, answering “Yes” or “No” as appropriate.
  5. Proceed to Section II for family members not traveling. List the family members who will not accompany you, specifying their name, relationship, and age. Certify your statements by signing this section.
  6. Move to Section III for family members requesting command sponsorship to travel. Each family member listed requires additional information for accurate processing.
  7. In Section IV, list family member details, checking the relevant boxes that apply to each member requesting sponsorship. Indicate the location of their medical records.
  8. Fill out Section V, certifying that the information provided is true and complete. Sign and date this section.
  9. Skip to Section VI, where the medical provider evaluates each family member's records. Ensure they complete this section accurately.
  10. In Section VII, the Special Needs Coordinator reviews the request and checks appropriate boxes based on existing conditions or needs.
  11. Section VIII requires certification by the losing base’s medical department. They must confirm the information collected is sufficient for decision-making.
  12. Finally, complete Section IX, addressing travel recommendations for family members based on medical evaluations. Ensure that signatures are collected where necessary.

After you have filled out the form, review all the information to confirm its accuracy before submission. Be sure to keep copies for your records. Your timely and precise submission of this form will aid in the processing of any travel arrangements for your family members.

What You Should Know About This Form

What is the purpose of the AF Form 1466?

The AF Form 1466 is a request for medical and education clearance for family members traveling with military personnel. It helps military assignment personnel assess the medical and educational needs of these family members. The information gathered ensures that adequate services are available at the destination, which may include government-funded travel approval for eligible family members.

Who is required to complete the AF Form 1466?

Completion of the AF Form 1466 is mandatory for military personnel. Civilian employees and applicants for civilian employment have the option to provide this information voluntarily. Lack of response from civilian applicants may impede their application process for family travel, while military personnel must provide accurate information to avoid administrative sanctions.

What information will be gathered using this form?

The form requires detailed information about the sponsor, such as name, grade, and duty location. It also collects data about family members, including their medical and educational needs. If family members require command sponsorship to travel, additional documents, such as medical summaries and educational plans, must be submitted alongside the form.

What happens if I do not provide accurate information on the AF Form 1466?

Providing false or incomplete information on the AF Form 1466 can lead to serious consequences. Military personnel may face disciplinary action under the Uniform Code of Military Justice (UCMJ), while civilian employees might experience delays or denial of travel requests due to misinformation. It is crucial to disclose all known medical or educational conditions to avoid such issues.

Can I revoke my authorization to disclose information in the future?

Yes, you can revoke your authorization to release your medical and educational information at any time. This revocation must be done in writing and submitted to the medical facility where your records are kept. However, it's important to note that any previously released information based on your authorization will not be retracted.

What is the expiration date of the authorization provided in the form?

The authorization continues until specific conditions change, including the dependent no longer qualifying as a dependent, your desire to travel overseas no longer being present, or if the active-duty sponsor ends military service. It is vital to remain informed about these criteria to ensure that your authorization remains valid.

What types of medical and educational needs are considered in the AF Form 1466?

The form addresses a wide range of needs, including chronic medical conditions that require regular follow-up care, emotional and behavioral health issues, dental care beyond routine examinations, and educational requirements for children with Individualized Education Programs (IEPs). Providing comprehensive details about these conditions will assist in securing appropriate support at the new duty location.

Common mistakes

Completing the AF 1466 form can be a daunting task for many. One common mistake is failing to provide complete and accurate personal information. Each section requires specific details, including names, Social Security Numbers, and phone numbers. Omitting any of these can lead to delays in processing, so verifying that all information entered is correct is essential.

Another frequent error is not listing all family members who will accompany the military sponsor. Sponsors must ensure that every family member requesting command sponsorship is included in the form. Neglecting any family member can complicate the approval process, resulting in significant setbacks.

A third mistake involves misunderstanding the authorization and purpose of the form. Many individuals assume they only need to provide medical information. However, the AF 1466 requires extensive details about educational needs, housing, and any special conditions. It is crucial for sponsors to fully comprehend the requirements outlined in the form to avoid incomplete submissions.

Inaccurate medical history is also a common issue. People may fail to disclose relevant medical conditions, or they may provide outdated information. This omission can lead to potential consequences, including disciplinary action for submitting false statements. All family members' medical records should be thoroughly reviewed prior to completion of the form.

Additionally, individuals often neglect the need for supporting documents. Attachments, such as the DD Form 2792 or Individualized Education Plans (IEPs), are sometimes incorrectly assumed to be optional. It is imperative to complete and submit all necessary forms to ensure adherence to requirements.

People frequently misinterpret the timelines associated with travel dates. The projected month and year for travel must be documented correctly. If the travel dates for family members differ from those of the sponsor, it must be clearly noted to avoid confusion during the processing phase.

Another mistake involves skipping the certification section. Applicants must certify that their entries are true and accurate. Failure to sign and date this section can result in the form being returned or rejected, which adds unnecessary delays to an already complicated process.

Many overlook the importance of reviewing the form after completion. Errors in spelling, incorrect dates, and missing signatures are common pitfalls that can easily be avoided with a thorough review. A double-check can save time and reduce the frustration of having to redo the form.

Some individuals ignore the necessity to communicate changes. If a family member's medical or educational conditions change before travel, the Special Needs Coordinator must be informed immediately. Not doing so may complicate the approval process.

Finally, people often disregard the implications of non-compliance. Understanding that incomplete or inaccurate forms may lead to sanctions or disciplinary action is critical. This awareness can motivate sponsors to approach the form with the seriousness it deserves, ultimately facilitating a smoother travel experience.

Documents used along the form

The AF Form 1466 is crucial for military families seeking travel clearances for their dependents. It's typically accompanied by several additional forms and documents that ensure proper assessment of medical and educational needs. Each of these documents plays a specific role in coordinating care and support for family members while considering their unique circumstances.

  • DD Form 2792: This form, known as the Family Member Medical Summary, collects detailed medical information about dependents. It is essential for assessing any special health care needs of family members traveling with military sponsors.
  • DD Form 2792-1: This form is a Special Education/Early Intervention Summary for family members who require special education services. It provides an overview of educational needs and any existing Individualized Education Plans (IEPs) or Individualized Family Service Plans (IFSPs).
  • AF Form 1466D: The Dental Health Summary is required for all exceptional family members over two years of age. It gathers information on dental care needs to ensure smooth travel for family members with specific dental requirements.
  • Medical Records Release Authorization: This document allows military treatment facilities to share protected health information with appropriate personnel involved in the Exceptional Family Member Program (EFMP). It ensures that necessary medical data is available during the assignment process.
  • Family Needs Assessment: This assessment identifies additional support needs for dependents, ensuring that all medical, dental, and educational services are appropriately addressed for the family during travel and relocation.
  • Special Needs Coordinator (SNC) Endorsement: This endorsement from a designated SNC confirms that a thorough review has been conducted regarding the special needs of family members. It yields recommendations based on available resources at the gaining location.
  • Facility Determination Inquiry (FDI): This inquiry is crucial for understanding if the gaining installation can adequately meet the unique health care needs of family members. It looks at the availability of necessary services and support.
  • Hazard Evaluation Form: This form assesses potential environmental hazards at the new location, ensuring that any potential risks are considered and managed in relation to a dependent's medical condition.
  • Command Sponsorship Application: This application outlines the request for command sponsorship for family members, allowing them to travel alongside the military sponsor. It ensures that all necessary documentation is submitted for approval.

Completing these forms accurately and promptly enhances the overall travel process while ensuring that family members' special needs are adequately addressed. Awareness of these associated documents can greatly aid in maneuvering through the complexities often present in military relocations and travel planning.

Similar forms

  • DD Form 2792: This form is used to provide a family member's medical summary. Similar to the AF 1466, it helps in evaluating medical needs for family members under military duty and ensures that adequate medical care is available at new assignments.

  • DD Form 2792-1: This form pertains to special education needs of family members. Just like the AF 1466, it is required for military families with school-aged children who may need specific educational services at their new location.

  • AF Form 1466D: This form is the Dental Health Summary for family members. It shares a primary purpose with the AF 1466 in assessing the dental requirements for family members before relocating, ensuring proper dental care will be accessible.

  • DA Form 7425: This document is used for requesting a medical evaluation for soldiers and their families. Similar to the AF 1466, it focuses on evaluating medical conditions to facilitate travel and assignment planning.

  • SF 600: The Chronological Record of Medical Care is a record used to document medical visits and treatments. Like the AF 1466, it provides important health information necessary for the management of family members while traveling.

Dos and Don'ts

When filling out the AF 1466 form, keep these important tips in mind:

  • Do ensure accuracy: Double-check that all personal and family member information is correct. This helps avoid processing delays.
  • Do disclose all relevant medical needs: Be open about any medical or educational requirements for your family members. This is crucial for proper travel recommendations.
  • Don't leave fields blank: Complete every section of the form. Incomplete forms can lead to unnecessary complications.
  • Don't procrastinate: Submit the form as soon as you have all the information. Early submission is key to timely processing.

Misconceptions

  • Misconception: The AF 1466 form is only necessary for military personnel. This form is essential for both military personnel and civilian employees of the Department of Defense who wish to travel with their family members. That means if you’re a civilian employee, you must also complete it if your family members are traveling with you.
  • Misconception: Information provided on the AF 1466 form is not confidential. In fact, the AF 1466 is subject to the Privacy Act of 1974. The information is handled with strict confidentiality and is used solely for the purposes outlined in the form, such as assessing medical and educational needs for family travel.
  • Misconception: The AF 1466 form can be ignored if there are no known medical conditions. Even if your family members are in good health, you must complete the form. It helps ensure that any potential needs are documented, which is crucial for future travels or emergencies.
  • Misconception: Submission of the AF 1466 guarantees automatic approval for travel. Completing the form does not mean you will automatically receive approval. The reviewers will assess the information to determine if the necessary medical and educational resources are available at the destination.
  • Misconception: Only immediate family members are included on the AF 1466 form. The form is meant to capture information about all family members who will be traveling with the sponsor. You must include details for each person, even if they are not direct dependents.
  • Misconception: You can submit the AF 1466 without updated information. It's crucial to provide the most current information every time you submit the AF 1466. Outdated or incomplete data could lead to processing delays or even denial of travel, so it’s always best to double-check.

Key takeaways

Understanding how to properly fill out and use the AF 1466 Form is essential for military families. Here are key takeaways that will guide you through the process:

  • The AF 1466 form requests medical and educational clearance for family members traveling with military personnel.
  • It is vital to provide accurate information to avoid delays in processing your application.
  • Military personnel must complete the form; civilians do so voluntarily but cannot successfully process family travel without it.
  • Include all family members requesting travel sponsorship and fill out the necessary sections for each person.
  • Documentation such as Individualized Education Plans (IEPs) and medical summaries is required for family members with special needs.
  • Medical records must be current and accompany the application for each traveling family member.
  • Be aware of the deadlines for submission, particularly if the projected travel dates differ from the military sponsor's.
  • The signature of the sponsor is mandatory, confirming that all information provided is true and complete.
  • Failure to disclose specific medical or educational needs on the form may lead to disciplinary action.
  • Keep copies of all submissions for your records and stay in touch with the Special Needs Coordinator if any information changes.

Utilizing the AF 1466 form correctly minimizes complications and ensures necessary care is available at your new duty station.