Family Member Deployment Screening Sheet - Da Form 5888

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FAMILY MEMBER DEPLOYMENT SCREENING SHEET
For use of this form, see AR 608-75; the proponent agency is OACSIM
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, USC Section 3013.
AUTHORITY:
PRINCIPAL PURPOSE:
Personnel support.
ROUTINE USES:
To validate family member deployment screening, and to provide gaining command with data to assist in
making an assignment decision.
The provision of requested information is mandatory. Failure to respond may preclude successful
DISCLOSURE:
processing of an application for family member travel/command sponsorship and may lead to appropriate
administrative or disciplinary action against the soldier.
PART A - SOLDIER/FAMILY MEMBER DATA
1. NAME OF SOLDIER (Last, first, MI)
2. SOCIAL SECURITY NUMBER
3a. RANK
3b. MOS/BRANCH
4a. HOME ADDRESS
5a. DUTY ADDRESS
6. DATE OF EDAS
CYCLE OR RFO
(0FF) DATE
4b. HOME PHONE NO. (Include Area Code)
5b. DUTY PHONE NO. a. DSN
b. COMMERCIAL (Include area code)
7. FAMILY MEMBERS
a. NAME
b. RELATIONSHIP
c. DOB (YYYYMMDD)
d. HOME ADDRESS
8. AUTHENTICATION
c. RANK (Grade)
d. SIGNATURE
a. MILITARY PERSONNEL DIVISION/PERSONNEL
SERVICE COMPANY REPRESENTATIVE'S NAME
b. TITLE
e. DATE (YYYYMMDD)
PART B - FAMILY MEMBER SCREENING RESULTS
EXCEPTIONAL FAMILY MEMBER PROGRAM (EFMP) ENROLLMENT (Check one)
b. CONSIDERATION
9. NAME
c. SUBSTANTIAL CHANGE SINCE ENROLLMENT
a. NOT
WARRANTED (Date
WARRANTED
sent for Coding)
NO
YES
DATE SENT FOR CODING
10. ARMY MEDICAL TREATMENT FACILITY (MTF) EFMP MEDICAL PRACTITIONER COMPLETING THIS FORM
a. PRINTED NAME OF MEDICAL PRACTITIONER
b. SIGNATURE
c. DATE (YYYYMMDD)
d. ADDRESS
e. PHONE NUMBER (Include Commercial and DSN)
11. ARMY MTF EFMP PHYSICIAN'S AUTHENTICATION
(To be signed when a medical practitioner other than a physician completes this form.)
a. TYPED OR PRINTED NAME OF PHYSICIAN
b. TITLE
c. RANK
d. SIGNATURE
e. DATE (YYYYMMDD)
DA FORM 5888, SEP 2002
EDITION OF AUG 1995 IS OBSOLETE
USAPA V1.00ES

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