Free Da 5840 Form in PDF

Instructions on Writing Da 5840

Filling out the DA Form 5840 is a critical step for a guardian or escort who has agreed to care for a soldier's child or children during their absence. Completing this form accurately is necessary to ensure the guardian can provide for the needs of the children, including financial, medical, educational, quarters, and subsistence support. This form also serves as an acknowledgment of the guardian's acceptance of responsibility and an understanding of how to access military and civilian facilities and services on behalf of the family members. It's vital to follow these steps methodically to ensure the form is correctly filled out.

1. Start by reading the Privacy Act Statement to understand the authority, purpose, routine uses, and disclosure information related to the form.
2. Enter the name(s) and age(s) of the family member(s) you are agreeing to care for in the space provided.
3. Fill in your name as the guardian or escort, indicating your acceptance of this responsibility.
4. Confirm that you have received all necessary documents required to provide support to the family members. These documents might include but are not limited to financial records, medical records, and educational reports.
5. Document that you have been briefed on the procedures for accessing military and civilian facilities, services, benefits, and entitlements on behalf of these family members.
6. Type or print your name clearly in the space provided for the "TYPED OR PRINTED NAME OF GUARDIAN".
7. Write your complete address, including the ZIP Code, in the respective field.
8. Sign and date the form in the "SIGNATURE" and "DATE (YYYY/MM/DD)" fields respectively.
9. Provide your telephone number, including the area code, and your email address in the designated spaces.
10. The notary section should be completed by a notary public. Present the form to a notary to witness your signature. They will fill in the state and county, acknowledge the date, their name, and stamp/seal the document. Be mindful of the expiration date of the notary's commission, which they will also fill in.

After completing these steps, review the form to ensure all information is correct and complete. Any missing or inaccurate information might delay or prevent the acceptance of the DA Form 5840, impacting the care and support of the family members. Once finalized, submit the form to the appropriate authority as directed by Army Regulation 600-20 or other guidelines provided to you. This form is a crucial document that supports the soldier's Family Care Plan, providing peace of mind that their family members are in responsible hands during their absence.

What is the DA Form 5840?

The DA Form 5840 is a "Certificate of Acceptance as Guardian or Escort." It's a document used by the United States Army for a soldier to designate an individual as the guardian or escort for their child(ren) in the soldier's absence. This form is part of a soldier's Family Care Plan, which ensures family members are taken care of during the soldier’s deployment, training, or any other periods of absence.

Why is the DA Form 5840 required?

This form is required as it provides a formal agreement where the designated guardian accepts responsibility for caring for the soldier's child(ren) during the soldier's absence. It's a critical component of the Army's Family Care Plan, aiming to ensure that soldiers can perform their duties without worrying about the welfare of their family members back home.

What information is needed to complete the DA Form 5840?

To complete the DA Form 5840, you need the name(s) and age(s) of the family member(s) being cared for, the name(s) of the guardian or escort, their address, telephone number, and e-mail address. The guardian or escort also needs to provide a signature, which must be notarized. Additionally, the form indicates that the guardian should have received necessary documents to provide comprehensive care and been briefed on accessing military and civilian support services on behalf of the family members.

Can anyone be designated as a guardian or escort on the DA Form 5840?

Not just anyone can be designated as a guardian or escort. The chosen individual must be someone the soldier trusts deeply to care for their family members. Furthermore, the designated guardian must be willing to accept the responsibility formally through the DA Form 5840 and must be capable of providing for the soldier's family members in terms of financial, medical, education, quarters, and subsistence support.

Is it mandatory to have the DA Form 5840 notarized?

Yes, it is mandatory. After the guardian or escort completes the DA Form 5840, including their signature, the document must be notarized. This step adds a level of legal verification, ensuring that the guardian's acceptance of responsibility is formally recognized and binding.

What happens if a soldier fails to complete the DA Form 5840?

If a soldier fails to complete the DA Form 5840 or any other part of the Family Care Plan, they may face challenges in ensuring the well-being of their family members during their absence. In some cases, failure to provide a fully executed Family Care Plan, including the DA Form 5840, could result in administrative actions or impact the soldier's ability to deploy. It's crucial for soldiers to fulfill their Family Care Plan requirements to avoid any potential complications.

Where can I find the DA Form 5840?

The DA Form 5840 can usually be obtained through the soldier’s unit or the base's legal assistance office. It's also accessible online through various official U.S. Army websites and portals. Soldiers are encouraged to seek assistance from their unit's administrative personnel or legal office to ensure the form is completed correctly.

Filling out the DA Form 5840, the Certificate of Acceptance as Guardian or Escort, is a crucial step for soldiers preparing a Family Care Plan. However, mistakes in this process can create unnecessary complications. One common error individuals make is failing to provide all requested information. The form stipulates that completing it is voluntary, but failure to provide all requested information could lead to the rejection of a soldier's Family Care Plan. This rejection can delay deployments or result in administrative actions, indicating the importance of attentiveness to detail when filling out the form.

Another frequent mistake involves the notarization section of the form. Some individuals overlook the necessity for the form to be acknowledged before a Notary Public, with a clearly marked expiration date of the notary's commission. This oversight can invalidate the document, forcing the process to start over. Given the time-sensitive nature of military preparations, such delays can add stress and complication to what is already a stressful time for soldiers and their families.

Additionally, there's often confusion about the document's requirements concerning the guardian or escort's capacity to provide for the soldier's child(ren) in their absence. The form requires the guardian to confirm receipt of all necessary documents for financial, medical, educational, quarters, and subsistence support for these family members. Some individuals mistakenly believe mere verbal agreements with the soldier are sufficient and fail to secure the formal documents that prove their capability to support the soldier's family members, a misconception that could lead to legal complications.

Last but certainly not least, an easily overlooked but critical detail is the accurate representation of family members for whom the guardian is responsible. Mistakes in the NAME(s) / AGE(s) OF FAMILY MEMBERS section can cause significant confusion, potentially impacting the benefits and support the guardian can access on their behalf. It's crucial for guardians to double-check this information for accuracy to ensure they can fully support the soldier's family as intended.

When preparing for deployment or any extended period away from family, military personnel often have to ensure that all legal and administrative matters are in order. The DA Form 5840 is a critical document used by soldiers to designate a guardian for their children in their absence. However, this form is just one piece of the puzzle. There are several other essential documents and forms that are frequently used in conjunction with the DA Form 5840 to ensure all aspects of care, legal authority, and support are comprehensively covered. Here is a list and brief description of these documents.

• DA Form 5841: A Power of Attorney form that grants the guardian authority to make decisions and perform specific acts on behalf of the soldier's family. It is crucial for handling financial, medical, and educational matters.
• DD Form 1172-2: Application for Identification Card/DEERS Enrollment. This form is required to register family members in the Defense Enrollment Eligibility Reporting System (DEERS) for military benefits access.
• DD Form 2656: Data for Payment of Retired Personnel. This document is used to apply for retired pay benefits, crucial for ensuring continued financial support for a soldier's family.
• DA Form 7666: Parental Consent. This form is required when the non-custodial parent is granting permission for the guardian to make decisions in their stead.
• DD Form 2558: Authorization to Start, Stop or Change an Allotment. This is used to arrange for a portion of the soldier's pay to be automatically directed to the guardian for the child's care.
• DA Form 3349: Physical Profile. Contains information about the soldier's medical condition and limitations. Important for the guardian to understand any medical needs of the soldier that may impact their care.
• DFAS Form 702: Defense Finance and Accounting Service Pay Adjustment Authorization. This form allows for adjustments to be made to pay for allowances, garnishments, or child support.
• SSA-3288: Social Security Benefit Application. Used to apply for or modify social security benefits for dependents, ensuring additional financial support.
• Healthcare Power of Attorney: A legal document granting the guardian the right to make healthcare decisions on behalf of the children, if necessary.

Together, these documents form a comprehensive set that addresses the financial, legal, medical, and educational needs of soldier's dependents in their absence. It is essential for service members to prepare these forms with thoroughness and foresight to ensure the well-being of their families while away. Being proactive in gathering and completing these forms can significantly ease the stress on both the soldier and their designated guardian or escort.

The DA Form 5840, while unique to the U.S. Army, shares similarities with several other legal documents centered around guardianship, responsibilities, and consent. One such document is a civilian Power of Attorney (POA). A POA grants an individual the authority to make decisions on behalf of another, typically covering financial, legal, or health-related matters. Both the DA Form 5840 and a Power of Attorney necessitate a formal acceptance by the individual who is taking on the responsibility, requiring it to be acknowledged legally, often in front of a notary public.

Another document that bears resemblance to the DA Form 5840 is the Child Care Authorization form. This form is used by parents or guardians to authorize a caregiver to make decisions regarding the health and safety of their child(ren) in their absence. Similar to the DA Form 5840, the Child Care Authorization form provides a legal framework that allows someone else to care for and make decisions regarding the minor(s), including medical treatment or educational matters.

A Medical Consent Form for Minors is also akin to the DA Form 5840 in that it involves the delegation of decision-making authority concerning a minor's medical care. Parents or legal guardians can authorize a designated individual to consent to medical treatment for the minor when they are not available to do so themselves. The DA Form 5840 encapsulates a broader scope, encompassing not just medical, but also financial, educational, and subsistence support for the family members under the guardian or escort's care.

The Emergency Contact Form, commonly used in schools and daycare centers, shares a functional similarity with the DA Form 5840. It collects contact information and authorizes specific individuals to be contacted and to act on behalf of the parent or guardian in case of an emergency. While it doesn't confer as broad a range of responsibilities as the DA Form 5840, it creates a framework for temporary guardianship and decision-making authority in urgent situations.

When filling out the DA 5840 form, a Certificate of Acceptance as Guardian or Escort, understanding and adhering to precise instructions ensures the document is properly processed without delay. Observing what you should and shouldn't do is vital for a seamless submission.

Things You Should Do

1. Ensure all fields are completed with accurate information to reflect your agreement to become a guardian or escort, adhering to Army Regulation 600-20.

2. Review the Army Regulation 600-20 and the Privacy Act Statement for a clear understanding of your responsibilities and the form's legal implications.

3. Input the name(s) and age(s) of the family member(s) you are agreeing to be responsible for in your care.

4. Verify that you have received all necessary documents to support the family members financially, medically, educationally, and in terms of quarters and subsistence.

5. Confirm that you have been briefed on how to access military and civilian facilities, services, benefits, and entitlements for the family members.

6. Provide a current, typed or legibly printed name, along with your address, telephone number, and email address, ensuring all contact information is up to date.

7. Sign the document in the presence of a notary public to authenticate the form.

8. Check that the notary fills out their section completely, including their acknowledgment, signature, and the expiration of their commission.

9. Retain a copy of the completed form for your records and provide another to the relevant military personnel.

10. Submit the form within the required timeline to avoid any delays in the acceptance of your guardian or escort status.

Things You Shouldn't Do

1. Do not leave any required fields blank, as this might result in the rejection of the form.

2. Avoid providing outdated or incorrect information, particularly relating to your contact details and the names and ages of the family members.

3. Don't sign the form without a notary present, as an un-notarized form could be deemed invalid.

4. Never falsify information or documents required for support, as this could lead to legal consequences.

5. Do not overlook the importance of being fully briefed on accessing support services and entitlements for your charges.

6. Don't assume completion of the DA 5840 form alone is sufficient; review all associated documents for accuracy and completeness.

7. Avoid processing delays by forgetting to review and double-check all entered information before submission.

8. Do not use previous editions of the form; always ensure you are completing the most current version, labeled as DA FORM 5840, JUN 2010.

9. Resist the urge to withhold your signature or any personal contact information, as both are required to validate your commitment.

10. Do not ignore the guidelines set out in Army Regulation 600-20; understanding your obligations is essential for the form's acceptance.

When discussing the DA Form 5840, or the Certificate of Acceptance as Guardian or Escort, several misconceptions commonly arise. Understanding the truth behind these misconceptions is crucial for individuals involved in the process, ensuring a smooth and compliant experience within Army regulations.

• Misconception 1: The belief that the DA Form 5840 serves as a Power of Attorney.

  This form does not grant Power of Attorney. It merely documents the guardian's acceptance of responsibility for a soldier’s family members in the soldier's absence. A DA Form 5841 or similar document is required for Power of Attorney.

• Misconception 2: Completing the DA Form 5840 alone is sufficient for a Family Care Plan.

  While crucial, the DA Form 5840 is only part of a comprehensive Family Care Plan. The plan also requires other documentation, including medical, financial, and legal arrangements to ensure the family's well-being.

• Misconception 3: Any family member can be listed as a guardian on the DA Form 5840.

  The designated guardian must be someone who the soldier trusts and who agrees to take on the responsibilities outlined in the form. Not every family member may be suitable or willing to fulfill this role.

• Misconception 4: Filling out and submitting the DA Form 5840 is voluntary.

  While it may seem optional, submitting a completed DA Form 5840 is mandatory for soldiers required to have a Family Care Plan. Failure to provide all the requested information can lead to rejection of the plan.

• Misconception 5: The form is only used during a soldier’s deployment.

  Though commonly associated with deployment, the DA Form 5840 is also essential during the soldier’s training periods or any other time they are unable to care for their family members due to military obligations.

• Misconception 6: There are no privacy concerns with the DA Form 5840.

  The form contains personal information, and proper handling is essential to protect privacy. While its primary use within the Army limits routine external uses, safeguarding this information is a shared responsibility.

• Misconception 7: The guardian must use military services for the family member's needs.

  While the guardian has access to military/civilian facilities, services, benefits, and entitlements to support the family members, they are not restricted to using only military services and may utilize civilian services as necessary.

Clarifying these misconceptions ensures that soldiers and their chosen guardians are better informed and can proceed with confidence in establishing a reliable and comprehensive Family Care Plan.

Filling out and using the DA Form 5840, Certificate of Acceptance as Guardian or Escort, is crucial for soldiers planning for the care of their dependents in their absence. Here are key takeaways to ensure accuracy and completeness:

• Understand the Purpose: The DA Form 5840 serves as a guardian's formal agreement to care for a soldier's child(ren) while the soldier is away. This form is an integral part of a Family Care Plan.
• Legal Authority Requirement: A DA Form 5841 (Power of Attorney) or equivalent legal document must accompany the DA 5840, authorizing the named individual to act as a guardian.
• Comprehensive Information: The form requires detailed information about the guardian and the children, including names, addresses, and contact details. Ensuring this information is accurate and up-to-date is critical.
• Financial and Care Responsibilities: The guardian commits to providing comprehensive care — financial, medical, educational, housing, and subsistence — for the named dependents.
• Military and Civilian Access: The guardian agrees to be briefed and understand how to access military and civilian facilities, services, benefits, and entitlements for the dependents.
• Voluntary Disclosure: Completing and submitting the form is voluntary. However, a soldier's Family Care Plan may be considered incomplete or rejected if the form is not properly filled out and submitted.
• Privacy Act Considerations: Given the personal information required on the form, understanding privacy implications is important. The Privacy Act Statement outlines how the information will be used and protected.
• Notarization: A Notary Public must acknowledge the form once completed, adding an extra layer of legal validation to the guardian's commitment.
• Stay Updated: Army regulations and policies concerning family care plans can evolve. Guardians and soldiers should stay informed about any changes to the requirements or procedures related to the DA Form 5840.

Properly completing the DA Form 5840 is a significant responsibility, ensuring that soldiers can fulfill their duties with the peace of mind that their loved ones are cared for in their absence. It's a document that underscores the importance of planning and commitment within the military community.