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FAMILY CARE PLAN

ARRANGEMENTS

SUPPORTING DIRECTIVE OPNAVINST 1740.4C

PRIVACY ACT STATEMENT

AUTHORITY: 44 U.S.C. Section 3101, 5 U.S.C. Section 301, 10 U.S.C. Sections 133 and 5031, E.O. 9397; and OPNAVINST 1740.4C

PRINCIPAL PURPOSE: To identify and ensure that single military members and military couples with dependents have made adequate

dependent care arrangements and to ensure the member is world-wide assignable. The information which will be solicited is intended

principally for the following purposes: (a) The personal information will facilitate combat readiness and document a plan for the care of your

family members in the event of a medium or long term absence; (b) it will be used to evaluate compliance with the DOD and Navy programs

requiring Family Care Plans.

ROUTINE USES: Will be used to document how financial support for family members will be provided while they are under someone else's

care; describe how they will get to the designated caregiver; provide important points of contact to the caregiver; provide information for the

dependent's medical care; provide contact information for your attorney and important documents such as your will, insurance policies,

family members' ID cards and your social security number; and to identify alternate caregiver information. This information may be used

also to determine overseas suitability, to conduct authorized investigations and for other lawful purposes.

DISCLOSURE IS MANDATORY: Disclosure of information concerning family members, their caregivers, and the personal arrangements

surrounding the care of family members is mandatory.

1. Financial –

(Describe how you will provide support for your family members while they are under someone else’s care. This may

include an allotment, powers of attorney (POA) or bank accounts and access).

2. Logistical –

(Describe how your family members will get to the designated caregiver. This is especially important if geographically

separated. Describe how financial support necessary to effect transportation will be provided. Also, discuss provisions for minor

arrangements for children, points of contact for your caregiver in case if emergency, and use of government services, specifically, what

directions have you given for access to the exchange, commissary, recreation, etc. Include all other arrangements that pertain to your

situation). Don’t forget to provide all prospective caregivers’ names to your child(ren)’s school or day care center as persons authorized to

pick-up child(ren) (this is particularly important in the event of your death or incapacity while the child(ren) is at school/day care).

3. Medical –

(Explain where your family member is to go for routine and emergency medical treatment. Does your caregiver know

where medical/immunization records are? Do they have names and addresses of medical providers? Have you discussed with your

caregiver any medical conditions or allergies that your family members have? Any special directions in case of a medical emergency?

Don’t forget special powers of attorney (SPOA) for medical treatment. A separate SPOA for medical treatment is not necessary if the

sample POA for Family Care Plan (enclosure (2)) is utilized).

5. TYPED OR PRINTED NAME OF MEMBER:

6. MEMBER'S SIGNATURE:

7. DATE

FOR OFFICIAL USE ONLY

NAVPERS 1740/7 (REV. 09-06)

S/N: 0106-LF-133-5900

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Family Care Plan Arrangements