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The AF Form 1466 serves as a crucial document within the realm of military family travel, focusing specifically on medical and educational clearances required for dependents accompanying active-duty members. Its primary purpose is to collect relevant information used by military personnel to evaluate whether adequate medical and educational services will be available at the new duty station. The form integrates multiple facets of travel authorization, detailing the responsibilities of both military personnel and civilian employees. Alongside facilitating necessary medical evaluations, it ensures that families with special needs receive appropriate consideration regarding their travel arrangements. The completion of this form is mandatory for military members and voluntary for civilian employees, with stipulations in place for accuracy and completeness. Notably, the AF Form 1466 is governed under various legal authorities, including Title 10 and Title 20 of the U.S. Code, along with specific mandates pertaining to the Health Insurance Portability and Accountability Act. This form not only facilitates the movement of families but also plays a significant role in safeguarding their health and educational requirements during the transition to a new location.

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

File Breakdown

Fact Name Description
Governing Authorities This form is governed by various laws including 10 USC 3013, 5013, and 8013, as well as 20 USC 921-932 and EO 9397.
Primary Purpose The information collected will be used by Military Departments to assess the medical and educational needs of family members for travel authorization.
Voluntary Disclosure Civilian employees can voluntarily provide information, but failure to respond may hinder their travel application. For military personnel, disclosure is mandatory.
HIPAA Compliance The authorization for releasing medical information adheres to Public Law 104-191, which is the Health Insurance Portability and Accountability Act (HIPAA).
Authorization Duration The authorization stays in effect until the dependent no longer qualifies or the sponsor’s military service ends, unless revoked in writing.

Guide to Using Af 1466

Completing the AF Form 1466 is a crucial step in ensuring that family members receive the necessary medical and educational clearances for travel. This process requires careful attention to detail to avoid any delays in recommendation processing. Follow the steps below to accurately fill out the form.

  1. Start with the Sponsor's Data: Fill in your name with your last, first, and middle initial in Section I. Complete the grade, Social Security Number (SSN), duty or home phone, present unit/location, current Military Personnel Flight (MPF) location, and the month/year of your projected travel.
  2. Indicate the Projected Unit: Enter the projected unit/location and PAS code, checking the appropriate box for join spouse or not.
  3. Provide Additional Details: Answer questions regarding any special duties and whether the family is traveling to geographically remote locations.
  4. List Family Members Not Traveling: In Section II, certify that the identified family members will not accompany you and explain the process if your plans change.
  5. Complete Family Members Requesting Command Sponsorship: In Section III, list all family members requesting command sponsorship. Ensure to fill out the required supplemental forms for family members with special needs.
  6. Identify Available Resources: Note the education and medical records for family members needing command sponsorship in Section IV, specifying any special conditions.
  7. Provide Medical Evaluations: In Section VI and VII, ensure all necessary medical evaluations are completed and any comments needed are filled in.
  8. Sign and Date the Form: After verifying all information is accurate, the sponsor must sign and date the form at the end of Section V.
  9. Endorsements: Ensure any endorsements from medical providers and special needs coordinators are included in subsequent sections of the form.
  10. Submit the Form: After completing all required sections, submit the form along with any attached documents to the appropriate military personnel office.

Get Answers on Af 1466

What is AF Form 1466 and its purpose?

The AF Form 1466 is a request for medical and education clearance for family members traveling with military personnel. Its primary purpose is to evaluate and document the medical and educational needs of family members. This information helps military assignment personnel authorize family member travel at government expense, based on the availability of needed services at the new duty location. Civilian personnel offices use the form to ensure that appropriate medical and educational services are available for family members.

Who is required to complete AF Form 1466?

Military personnel must complete the AF Form 1466 as it is mandatory for processing family travel. Civilian employees and applicants for civilian employment can voluntarily submit the form. However, not providing the required information may delay travel applications for those associated with civilian employment.

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

Providing false or incomplete information on the AF Form 1466 can lead to serious consequences. Military personnel may face administrative sanctions or punishment under the Uniform Code of Military Justice for dereliction of duty or false official statements. Civilian employees may experience delays or complications with their applications for travel or command sponsorship.

How does the AF Form 1466 protect my family's medical information?

The AF Form 1466 complies with the Privacy Act and specifies that the information gathered will be used solely by military personnel to assess family members' medical and educational needs. Access to medical information is limited to designated representatives, ensuring that only authorized personnel can view sensitive data.

What information is required in the AF Form 1466?

The AF Form 1466 requires detailed information about the sponsor and family members, including:

  • Name, grade, and social security number of the sponsor
  • Projected travel dates and duty locations
  • Details on family members accompanying or not accompanying the sponsor
  • Medical and educational needs of family members

Providing comprehensive and accurate data helps facilitate the approval process for travel.

What should I do if my family's medical or educational needs change after submitting the form?

You must inform the Special Needs Coordinator of any changes to your family's health or educational conditions before travel. Failing to report such changes can impact travel approval and result in disciplinary actions for providing a false official statement.

Is there a specific time frame for the authorization of medical information on AF Form 1466?

The authorization for the release of medical information begins on the date you sign the form. It will remain in effect until either the family member no longer qualifies as a dependent or the sponsor leaves active military service. You also have the right to revoke this authorization at any time, which must be done in writing.

What happens if my family members require special help during travel?

If any family members have special medical needs, you must complete additional forms such as the DD Form 2792, which focuses on medical summaries and related conditions. This is essential to ensure that necessary care and services are available based on your family's specific needs during travel.

Common mistakes

Filling out the AF Form 1466 correctly is crucial to ensure a smooth application process for family travel. Unfortunately, many applicants make common mistakes that can lead to delays or complications. One major error is failing to provide complete information in the sponsor's data section. Each entry, especially the sponsor's name, grade, and SSN, must be accurate and fully completed. Omitting details can result in the form being returned or rejected.

Another frequent mistake occurs in Section II, where family members not traveling are listed. Sponsors often miscount the number of family members who will not accompany them. This section must accurately reflect the current family configuration; otherwise, it could lead to unnecessary complications later. Additionally, it's vital to remember to include the correct relationship and ages of the listed family members.

Many individuals overlook the necessary accompanying forms in Section III. Sponsors neglect to attach DD Form 2792 for medical summaries or other required documents, which can lead to processing delays. If special medical needs exist, ensure all relevant documentation is completed and included. Without this information, clarifying medical requirements may become difficult.

In Section IV, the requirement to indicate the location of medical records is often missed. Applicants commonly forget to check the box for "Copies Provided" if they are submitting their own medical records. Not providing this information can disrupt the review process and lead to urgent follow-ups.

Providing unclear or vague responses in Section V is another common error. Sponsors should avoid ambiguity and give direct answers regarding any known medical or educational conditions. Failure to do so can be construed as withholding information, which may lead to severe consequences, including disciplinary actions.

Many applicants also fail to understand the importance of updating information. Changes in a family member's health or educational status must be reported, but often this crucial detail gets overlooked. Sponsors should inform the Special Needs Coordinator promptly if any conditions change, ensuring that the form remains up-to-date and accurate.

Finally, one of the essential mistakes is not keeping a copy of the submitted form. Sponsors should always retain a copy of the AF Form 1466 for their records. Having this document will aid in any future issues or facilitate discussions about the application process.

Documents used along the form

The AF Form 1466, which is the Request for Family Member's Medical and Education Clearance for Travel, is vital for military personnel looking to travel with their dependents. However, several other forms and documents often accompany it to ensure all medical and educational needs are sufficiently addressed. Below is a list of documents that are frequently used alongside the AF Form 1466.

  • DD Form 2792: This is the Family Member Medical Summary, which provides comprehensive medical information about each family member. It is crucial for identifying any special medical needs that must be met at the new duty location.
  • DD Form 2792-1: This form is the Family Member Special Education/Early Intervention Summary. It is specifically for school-aged children or those receiving early intervention services and helps document their educational requirements while traveling.
  • AF Form 1466D: Known as the Dental Health Summary, this form is required for family members over the age of two. It captures any dental health issues that need to be addressed and ensures access to appropriate dental care upon arrival at the new location.
  • AF Form 688: The Physician’s Letter is used to provide a detailed medical recommendation for family members with special needs. It assists gaining medical facilities in understanding the level of care required.
  • Special Needs Coordination (SNC) Form: This document captures information about family members with special needs and ensures that proper resources and services are available in the new duty installation.
  • TRICARE Enrollment Forms: For family members, especially those with specific medical or educational needs, TRICARE enrollment ensures access to health care services. It must be updated when moving to a new installation.
  • Additional Medical Records: Copies of pertinent medical information and history may be required. These documents provide essential background to new healthcare providers, ensuring continuity of care.

These accompanying documents play a crucial role in the efficient processing of requests for family member travel and ensuring that all medical and educational needs are met. Familiarity with these forms will enhance the travel preparation experience for military personnel and their families.

Similar forms

  • DD Form 2792: This document is a Family Member Medical Summary used to report medical conditions of dependents. Similar to AF Form 1466, it assesses medical needs to determine travel eligibility. Both forms collect critical health information pertinent to the family member's suitability for government-sponsored travel.
  • DD Form 2792-1: This form focuses specifically on special education needs, including details for children requiring additional educational services. Like the AF Form 1466, it helps identify the necessary resources for dependents to ensure adequate provision during military assignments.
  • AF Form 1466D: This document summarizes dental health for dependents over the age of two. It parallels AF Form 1466 in that both are used to evaluate specific health requirements that can influence travel approvals for military families.
  • SF 600: This is a chronologic record of medical care. It serves a similar purpose to the AF Form 1466 by documenting ongoing health issues and treatment history, which helps assess the health conditions affecting family travel.
  • DA Form 4187: Often called the Personnel Action Form, this document facilitates official requests for changes in military personnel assignments. Like the AF Form 1466, it must be completed thoroughly to avoid delays or complications in travel orders affected by family medical concerns.
  • DD Form 2206: This form is related to family members' expenses and financial benefits due to medical conditions. It shares similarities with AF Form 1466 in terms of managing benefits and entitlements based on health assessments of dependents.
  • DA Form 5305: Used for requesting a compassionate reassignment, this form is often completed when a family member requires special accommodations. This is similar to the AF Form 1466, which evaluates needs based on family health and educational requirements that could impact military relocations.
  • VA Form 21-526EZ: This is a claim for disability compensation. While more focused on veterans, it reflects a thorough assessment of health conditions, akin to how the AF Form 1466 evaluates dependents’ needs to facilitate appropriate military assignments and care.

Dos and Don'ts

When filling out the AF 1466 form, it's essential to approach the task with care. Here are some do's and don'ts to guide you:

  • Do provide accurate and complete information.
  • Do ensure all required signatures are obtained.
  • Do submit relevant medical documents for each family member as necessary.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank; every field must be filled out.
  • Don't provide misleading or false information.
  • Don't forget to inform the Special Needs Coordinator of any changes to family health conditions.

Following these guidelines will help ensure a smooth processing of your request.

Misconceptions

  • Misconception 1: The AF 1466 form is a lengthy and complicated document.
  • While it may seem daunting at first glance, the AF 1466 is designed to be straightforward. Its purpose is clear: to facilitate the medical and educational clearance of family members for travel. Each section guides you through the necessary information.

  • Misconception 2: Only military personnel need to fill out the AF 1466 form.
  • Both military personnel and civilian employees are required to complete this form if they plan to travel with family members at government expense. Understanding the requirements for both categories is essential for proper processing.

  • Misconception 3: The information provided on the AF 1466 form is not protected.
  • This is incorrect. The form is governed by the Privacy Act, meaning the information collected is protected and used only for specific purposes, primarily to evaluate medical and educational needs.

  • Misconception 4: You don’t need to disclose existing medical conditions.
  • In fact, it is crucial to fully disclose any known medical or special educational conditions for each family member. Failure to do so can result in significant consequences, including disciplinary action.

  • Misconception 5: The AF 1466 form is not necessary for family members traveling within the United States.
  • While this form is particularly important for overseas travel, it may still be required for certain assignments within the U.S. It’s always best to check with your command for specific requirements.

  • Misconception 6: Filling out the AF 1466 is voluntary.
  • The form is mandatory for military personnel and strongly recommended for civilian employees when seeking approval for family travel. Not completing it can delay or prevent travel authorization.

  • Misconception 7: Providing false information on the AF 1466 form is insignificant.
  • This is a serious misunderstanding. Providing false information can lead to administrative sanctions or even punishment under the Uniform Code of Military Justice. Accuracy is essential.

  • Misconception 8: The AF 1466 form only assesses medical needs.
  • While the form primarily focuses on medical conditions, it also addresses educational needs. This includes information about special education services or any developmental delays that may affect the family members.

  • Misconception 9: Once submitted, there’s no way to update the information provided.
  • That’s incorrect! If any circumstances change regarding a family member’s health or educational status, the sponsor must inform the Special Needs Coordinator as soon as possible. This helps ensure accurate assessment and planning.

Key takeaways

  • The AF Form 1466 must be completed accurately to ensure successful processing of a family member's medical and educational clearance for travel. Incorrect or missing information may delay travel recommendations.

  • This form is mandatory for military personnel and is voluntary for civilian employees. However, failure to provide necessary information may impact eligibility for command-sponsored travel.

  • Family members requesting sponsorship to travel must be listed, and additional documentation, such as the DD Form 2792, may be required for those with special medical needs.

  • The form authorizes medical facilities to disclose protected health information for the purpose of assessing whether adequate resources are available for family members at the gaining location.

  • It is important to notify the Special Needs Coordinator of any changes in health or educational conditions, as this information is crucial for travel approval and ensuring that appropriate services are available.