DD Form 3054. Exceptional Family Member Program (EFMP) Family Needs Assessment

DD Form 3054, dated March 2019, is designed for use by EFMP Family Support Staff to identify the specific needs of military families with exceptional family members. The information collected on this form helps staff understand the unique requirements of these families and provides a basis for delivering appropriate services and support.

Key Sections and Fields:

Staff Information:

• Section 1: Identifies the current installation's Family Support Staff, including their name, phone number, email, and branch (Air Force, Army, Marine Corps, or Navy).

Sponsor Demographic Information:

• Section 2: Gathers information about the service member (sponsor), including their name, contact details, rank/grade, branch, status, and dual military status.

Spouse Information:

• Section 3: Gathers information about the spouse of the service member, including their name, contact details, rank/grade, branch, and status.

EFMP Status:

• Section 4: Determines if the family is enrolled in the EFMP and the date of enrollment if applicable.

Case Number:

• Section 5: Includes a space for the case number, if applicable.

Permanent Change of Station (PCS) or Transition Out of Service Status:

• Section 6: Indicates if the family is expecting a PCS in the next six months and provides details about the prospective installation.

Family Member(s) in Household:

• Section 7: Lists all family members, their special needs, relationship to the sponsor, gender, and date of birth.

Family Needs Assessment:

• Section 8: Asks the reason for the family's visit, actions taken to address concerns, and the outcomes of those actions.

Questions or Concerns:

• Section 10: Provides space for any additional questions or concerns the family may have.

Next Steps Discussed with Family:

• Section 11: Records the actions to be taken, such as information and referral, services plan development, or follow-up.

Additional Notes:

• Section 12: Offers space for staff to explain selections and provide additional information.

Family Services Plan (Addendum 1):

• Section 14: Documents family goals, steps to achieve goals, points of contact, and achieved services. It also notes the agreed-upon frequency of follow-up contact.

Inter-Services Transfer Summary (Addendum 2):

• Sections 17 to 21: Captures information related to a family's transfer between installations, including current family support, pending action items, additional notes, staff member details, and gaining installation staff member acknowledgement.

Privacy Act Statement: Informs respondents about the authority and purpose of collecting this information and assures them that participation is voluntary.

OMB Approval: Displays the OMB approval number and expiration date for the form.

Public Reporting Burden: Provides information about the estimated time required to complete the form and where to send comments regarding the burden estimate.

DISCLOSURE: Reminds respondents that participation is voluntary and failure to provide information may impact their ability to utilize certain program opportunities.

This form is a crucial tool in the EFMP to ensure that military families with exceptional members receive the support and services they require during transitions, assignments, or life events. It helps EFMP Family Support Staff tailor their assistance to meet the specific needs of each family.