Loading
Form preview picture

Get DA 7415 2002

10. The above information is true and correct to the best of my knowledge. a. SIGNATURE OF SOLDIER DA FORM 7415 SEP 2002 b. U.S. DOD Form dod-da-7415 EXCEPTIONAL FAMILY MEMBER PROGRAM EFMP QUERYING SHEET For use of this form see AR 608-75 the proponent agency is OACSIM AUTHORITY PRIVACY ACT STATEMENT 5 USC Section 301 Departmental Regulations 10 USC1071-1085 10 USC Section 3013 Secretary of the Army E.O. 9397 SSN and Army Regulation 608-75 EFMP. PRINCIPAL PURPOSE ROUTINE USES To identify soldiers that have family members for enrollment in the EFMP. To federal state and local medical agencies in order to provide an exceptional family member with medical treatment when the Department of the Army does not have a suitable treatment facility. DISCLOSURE Disclosure of the requested information is mandatory. Failure to provide the information may result in disciplinary and/or administrative action* Additionally failure to provide the information may result in an EFM not receiving necessary medical care. 1. NAME OF SOLDIER 2. SSN 3. RANK 4. UNIT 5a* HOME ADDRESS b. HOME PHONE NUMBER 6a* DUTY ADDRESS b. DUTY PHONE NUMBER c* FAX NUMBER d. EMAIL ADDRESS 7. Do you have a family member child or adult with a physical emotional developmental or intellectual disorder that requires special treatment therapy education training counseling equipment assistance or medical care above the level of a general practitioner 8. If the answer to the above question is yes is the family member enrolled in EFMP YES NO 9. The EFMP works with the other military and civilian agencies to provide comprehensive coordinated community support educational housing personnel and medical services to families with special needs. Enrollment in EFMP is mandatory and benefits the family by considering medical and special education needs in the military personnel assignment process. Medical needs are considered in the worldwide assignment process whereas special education needs are only considered in overseas assignments. 9397 SSN and Army Regulation 608-75 EFMP. PRINCIPAL PURPOSE ROUTINE USES To identify soldiers that have family members for enrollment in the EFMP. To federal state and local medical agencies in order to provide an exceptional family member with medical treatment when the Department of the Army does not have a suitable treatment facility. To federal state and local medical agencies in order to provide an exceptional family member with medical treatment when the Department of the Army does not have a suitable treatment facility. DISCLOSURE Disclosure of the requested information is mandatory. Failure to provide the information may result in disciplinary and/or administrative action* Additionally failure to provide the information may result in an EFM not receiving necessary medical care. DISCLOSURE Disclosure of the requested information is mandatory. Failure to provide the information may result in disciplinary and/or administrative action* Additionally failure to provide the information may result in an EFM not receiving necessary medical care. 1. NAME OF SOLDIER 2. SSN 3. RANK 4. UNIT 5a* HOME ADDRESS b. HOME PHONE NUMBER 6a* DUTY ADDRESS b. .

How It Works

dod-da-7415 rating
4Satisfied
53 votes

Tips on how to fill out, edit and sign Proponent online

How to fill out and sign Enrollment online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

The times of terrifying complex tax and legal forms are over. With US Legal Forms completing official documents is anxiety-free. The leading editor is directly at your fingertips giving you a wide variety of advantageous instruments for filling out a DA 7415. These tips, combined with the editor will help you through the complete process.

  1. Select the Get Form option to start editing.
  2. Turn on the Wizard mode in the top toolbar to obtain additional recommendations.
  3. Fill in every fillable field.
  4. Ensure that the data you add to the DA 7415 is updated and accurate.
  5. Include the date to the record with the Date tool.
  6. Click the Sign icon and make a digital signature. You can use 3 options; typing, drawing, or uploading one.
  7. Make certain every field has been filled in properly.
  8. Click Done in the top right corne to save the sample. There are several choices for receiving the doc. As an instant download, an attachment in an email or through the mail as a hard copy.

We make completing any DA 7415 less difficult. Get started now!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Video instructions and help with filling out and completing USC1071-1085

Follow the instructions in this video guide to prepare a legally-binding Form. Save your time and money by using web templates delivered by experts.

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to DA 7415

  • 2000
  • YYYYMMDD
  • dod-da-7415
  • 2002
  • USC1071-1085
  • USAPA
  • QUERYING
  • V1
  • proponent
  • additionally
  • developmental
  • enrollment
  • Sep
  • Departmental
  • Practitioner
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.