1175 Legal Assistance Record

OMB CONTROL NUMBER: EXPIRATION DATE:		PRIVACY ACT STATEMENT Authority: Primarily 10 U.S.C. 8013; 10 U.S.C. 8037; and E.O. 9397. Purpose(s): To obtain information required for official purposes, to include claims adjudication, administration of military justice, civil litigation (including bankruptcy and patents), legal assistance matters (WebLions), and management of Judge Advocate personnel assignment, duties, and related matters such as attorney licenses, continuation pay, and deployments. Routine Uses: The Privacy Act, 5 U.S.C. 552a,"Routine Uses is applicable as is the DoD "Blanket Routine Uses" published at the beginning of the Air Force's compilation of systems of records notices, located at http://dpclo.defense.gov/Privacy/DODComponentArticleList/tabid/6799/Category/277/department-of-the-air-force.aspx; and other Routine Uses listed under the Legal Assistance and Judge Advocate Personnel Records Air Force Judge Advocate Privacy Act System of Record Notices. Such routine uses outside of DoD for other than DoD official purposes include responding to congressional requests and law enforcement requests. These routine uses may also be reviewed at the defense link. Disclosure: Disclosure is voluntary with respect to social security numbers requested, except for the payment of claims, which is required for payment purposes. Non-disclosure of requested personal information may result in the inability of JACG personnel to provide appropriate legal assistance or properly manage Judge Advocate personnel assignments, duties, and related matters. Disclosure is non-voluntary with respect to the administration of military justice. System of Records Notice: 051 AFJA B (Invention, Patent Application, Application Security, and Patent Files); 051 AF JA C (Legal Assistance Administration); (Judge Advocate Personnel Records); 051 AF JA D (Litigation Records (Except Patents); 051 AF JA F (Courts Martial and Article 15 Records); 051 AF JA H (Claims Records)
	NAME OF CLIENT (Last, First, Middle Initial)				CLIENT'S GRADE AND STATUS	CLIENT'S DOD ID No. / SSN
	NAME AND RANK OF MILITARY SPONSOR(If applicable)				ORGANIZATION	WORK TELEPHONE NO.
	HOME OR MAILING ADDRESS					HOME TELEPHONE NO.
PRIVILEGED INFORMATION - Information placed on this card is privileged. Neither the lawyer nor such paralegal assistants or clerical personnel that may assist in the case will disclose this information to anyone without the express consent of the client. Furthermore, disclosure may not be ordered by superior military authority.
DATE	LAWYER/ PARALEGAL		SUBJECT CODE	DOCUMENT CODE	REMARKS	TIME SPENT 1/10th hrs	CONFLICT?
SUBJECT CODES ADOPTION/CHANGE OF NAME AUTOMOBILE CHILD CUSTODY CONSUMER AFFAIRS DEPENDENT NON-SUPPORT DOMESTIC RELATIONS IDENTITY THEFT IMMIGRATION/NATURALIZATION LANDLORD-TENANT			NEGLIGENCE/TORTS PATERNITY PERSONAL FINANCE/DEBTS REAL ESTATE RESIDENCE/DOMICILE SPECIAL NEEDS/EFMP SCRA TAXATION USERRA WILLS AND ESTATES OTHER		DOCUMENT CODES ADVANCED MEDICAL DIRECTIVE AFFIDAVIT BILL OF SALE CONTRACT DEED/DEED OF TRUST LEASE LETTER POA (GENERAL) POA (SPECIAL)	POA (HEALTH) PROMISSORY NOTE WILL DRAFTED OTHER
						SPECIAL INTEREST IDENTIFIER

AF FORM 1175, 2018xxxx ^{PREVIOUS EDITIONS ARE OBSOLETE} LEGAL ASSISTANCE RECORD

DISCLOSURE: The public reporting burden for this collection of information, 0701-XXXX, is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mcalex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
DATE	LAWYER/ PARALEGAL	SUBJECT CODE	DOCUMENT CODE	REMARKS	TIME SPENT 1/10th hrs	CONFLICT?

AF FORM 1175, 2018xxxx (Reverse)