Enclosure (1) to COMDTINST 1754.7A
COAST GUARD SPECIAL NEEDS ENROLLMENT AND ASSESSMENT FORM
PRIVACY ACT STATEMENT:
Data required by the Privacy Act of 1974 (5 U.S.C. 552a)
AUTHORITY:
14 U.S.C. 632.
PRINCIPAL PURPOSES:
To obtain family information needed to
evaluate and document the needs of family
members for special education and/or health
related services. Information will be used
by personnel, Commandant (G-PWL-2), to
evaluate and document the health related
needs of family members and to document the
special education needs of school age
family members. This information will
enable assignment personnel to match needs
of family members against the availability
of special education and health related
services by assignment location, service-
wide.
ROUTINE USES:
Provide information to Federal Government
agencies for coordination of special needs
programs, medical care, mental health
treatment, and monitoring and tracking of
special needs families. Provide
information to individuals or organizations
providing family support program care under
contract to the Federal Government.
DISCLOSURE:
The provision of requested information is
mandatory from active duty military
personnel. Failure to respond may preclude
processing requests or consideration for
out-of-CONUS assignments. Proper medical
and educational evaluations of family
members cannot be made without completion
of this form.
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