Enclosure (3) to COMDTINST 1750.7C
12. Sponsor Data: The sponsor is the active duty, reserve or retired Coast Guard member.
13. Type of Abuse/Neglect: The form of abuse, neglect or maltreatment experienced by the
individual.
14. Victim Data: The victim is the individual who is the subject of abuse, neglect or maltreatment.
15. Perpetrator Data: The perpetrator is any person who caused the abuse, neglect or maltreatment
of a child, spouse, parent, sibling or elder person, or knowingly allowed abuse or neglect to
occur.
16. Actions Involved in Case to Date: Indicate which military and civilian actions have been
initiated.
17. Does Sponsor Have a Special Needs Family Member?: Indicate whether or not the Sponsor has
a dependent with special needs and, if yes, indicate enrollment in the Special Needs Program.
18. Basis for Substantiation or Unsubstantiation: In summary form, provide the facts and behavioral
dynamics that caused the FAS to substantiate or unsubstantiated the allegations.
19. Case Management Plan: Provide the plan for services. Indicate the provider(s) being used and
describe the programs the victim and offender will be utilizing.
20. Authenticating Official: Incident reports are prepared by the FAS and signed by the FAS. By
signing this report, the FAS is making a determination of suspected, substantiated or
unsubstantiated. If the finding is substantiated, the FAS has determined abuse, neglect and/or
maltreatment is/are present and the family is in need of CGFAP services.
21. Command Signature: The substantiated incident report is forwarded to the involved member's
command for the purpose of command notification of the finding and recommended Case
Management Plan. Signature by the command indicates the appropriate official is aware of the
finding and the recommended Case Management Plan. The Command can concur or not concur
with the Case Management Plan.
2
Previous Page
