THIS FORM IS USED TO OBTAIN FAMILY
INFORMATION NEEDED TO EVALUATE AND DOCUMENT THE NEED OF MILITARY
FAMILY MEMBER FOR SPECIAL MEDICAL AND EDUCATIONAL SERVICES. THE
INFORMATION IS COLLECTED PRIOR TO NEW ASSIGNMENTS. THE DATA IS
NEEDED TO ENSURE PROPER MEDICAL AND EDUCATIONAL NEEDS ARE AVAILABLE
AT NEW ASSIGNMENT. FAILURE TO RESPOND COULD PRECLUDE PROCESSING
ASSIGNMENT.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.