AF 1175 Legal Assistance Record

PRIVACY ACT STATEMENT Authority: Primarily 10 U.S.C. § 9013, Secretary of the Air Force; 10 U.S.C. § 9037, Judge Advocate General, Deputy Judge Advocate General: Appointment and duties; 10 USCS § 1044, Legal Assistance; Air Force Instruction 51-304, Legal Assistance, Notary, Preventive Law, and Tax Programs. Purpose(s): To collect data on the number and types of legal assistance cases handled and to help lawyers recall type of legal problems previously discussed. Routine Uses: Information may be disclosed for any of the Standard Routine Uses. Disclosure: Disclosure is voluntary, however, non-disclosure of requested personal information may result in the inability of JACG personnel to provide appropriate legal assistance System of Records Notice: https://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569886/f051-afja-g/ .

OMB CONTROL NUMBER: 0701-0161 EXPIRATION DATE: XX-XX-XXXX

NAME OF CLIENT (Last, First, Middle Initial)

CLIENT'S GRADE AND STATUS

CLIENT'S DOD ID No.

NAME AND RANK OF MILITARY SPONSOR(If applicable)

ORGANIZATION

WORK TELEPHONE NO.

HOME OR MAILING ADDRESS

HOME TELEPHONE NO.

PRIVILEGED INFORMATION - Information placed on this card is privileged. Neither the lawyer nor such paralegal assistants or clerical personnel that may assist in the case will disclose this information to anyone without the express consent of the client. Furthermore, disclosure may not be ordered by superior military authority.

DATE

LAWYER/ PARALEGAL

SUBJECT CODE

DOCUMENT CODE

REMARKS

TIME SPENT 1/10th hrs

CONFLICT?

SUBJECT CODES ADOPTION/CHANGE OF NAME AUTOMOBILE CHILD CUSTODY CONSUMER AFFAIRS DEPENDENT NON-SUPPORT DOMESTIC RELATIONS IDENTITY THEFT IMMIGRATION/NATURALIZATION LANDLORD-TENANT

NEGLIGENCE/TORTS PATERNITY PERSONAL FINANCE/DEBTS REAL ESTATE RESIDENCE/DOMICILE SPECIAL NEEDS/EFMP SCRA TAXATION USERRA WILLS AND ESTATES OTHER

DOCUMENT CODES ADVANCED MEDICAL DIRECTIVE AFFIDAVIT BILL OF SALE CONTRACT DEED/DEED OF TRUST LEASE LETTER POA (GENERAL) POA (SPECIAL)

POA (HEALTH) PROMISSORY NOTE WILL DRAFTED OTHER

SPECIAL INTEREST IDENTIFIER

AF FORM 1175, 2025 LEGAL ASSISTANCE RECORD

DISCLOSURE: The public reporting burden for this collection of information, 0701-0161, is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mcalex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
DATE	LAWYER/ PARALEGAL	SUBJECT CODE	DOCUMENT CODE	REMARKS	TIME SPENT 1/10th hrs	CONFLICT?

AF FORM 1175, 2025 (Reverse)