Da 5840 Template

Guidelines on Filling in Da 5840

Tackling the DA Form 5840 can seem daunting at first glance, but it’s an important document that ensures the well-being of a soldier's family in their absence. This form serves as a Certificate of Acceptance as Guardian or Escort, a crucial part of a Family Care Plan. By completing it, you're stepping up to care for a soldier's child or children, acknowledging the responsibility that comes with it. Here’s how to confidently fill out the form, ensuring that all necessary information is accurately provided.

1. Begin with the Privacy Act Statement. Understanding this section is essential as it explains the legal basis and the purpose of the form. Though it doesn’t require any input from you, it’s important to acknowledge the significance of your consent and the impact of the information you're about to provide.
2. Under the section marked CERTIFICATE OF ACCEPTANCE AS GUARDIAN OR ESCORT, start by listing the NAME(s) / AGE(s) OF FAMILY MEMBERS you are agreeing to care for. Ensure this is filled out clearly to avoid any confusion about your responsibilities.
3. Next, input the NAME(s) of the family members’ soldier(s) to establish the connection between the guardian or escort and the military personnel.
4. Confirm your acceptance by stating, "I agree to accept responsibility for these family members". No need for additional commentary here—the statement is a straightforward commitment.
5. Indicate that you have received all necessary documents required to provide proper care by filling in the following sections about financial, medical, educational, quarters, and subsistence support.
6. Confirm your briefing on procedures for accessing military/civilian facilities, services, benefits, and entitlements. This acknowledgment is crucial for the seamless provision of care.
7. Provide your TYPED OR PRINTED NAME OF GUARDIAN, ensuring that your name is legible and matches other legal documents to avoid any identification issues.
8. Enter your complete ADDRESS (Including ZIP Code) to ensure all related correspondence reaches you without any hitches.
9. Sign and date the form in the designated areas. Ensure the date format follows the YYYY/MM/DD format for consistency with military standards.
10. Include your TELEPHONE NUMBER and E-MAIL ADDRESS for easy communication. Make sure these are current contact details.
11. The last section is for the Notary Public to complete, so leave this part blank. Your responsibility is to present the filled form to a Notary Public for acknowledgment.

After completing the DA Form 5840, the next steps involve ensuring the document is notarized and then submitted to the appropriate military personnel or department as part of the Family Care Plan. Remember, this form is a legal document, so accuracy and honesty are paramount throughout the process. Taking on the role of a guardian or escort is a significant commitment, reflecting both trust and responsibility, so approach this task with the seriousness it deserves.

What is the DA Form 5840?

The DA Form 5840 is a document used by the United States Army known as the Certificate of Acceptance as Guardian or Escort. It serves as an agreement from a guardian to take responsibility for a soldier's child or children during the soldier’s absence. This form is a key component of a soldier's Family Care Plan, ensuring their dependents are cared for in their absence.

Why is the DA Form 5840 necessary?

This form is required for soldiers to validate their Family Care Plan. Its primary purpose is to establish a legal agreement with a guardian who will care for the soldier's dependents, thereby allowing soldiers to fulfill their duty without worry about the welfare of their family members. It records the guardian's commitment to provide all necessary support—financial, medical, educational, and otherwise—for the dependents.

What information is required on the DA Form 5840?

To complete the DA Form 5840, the following information is needed:

• The names and ages of the family members to be cared for.
• The name and contact details of the guardian or escort.
• A statement of acceptance from the guardian or escort, alongside their signature.
• Confirmation that the guardian has received all necessary documents and briefings related to caring for the dependents.

What is the authority behind the DA Form 5840?

The authority for the DA Form 5840 comes from 10 U.S.C. Section 3013, Secretary of the Army, and is further regulated by the Army Regulation 600-20, Army Command Policy. This legislative backing ensures the form’s compliance and adherence to military standards for family care arrangements.

Who needs to fill out the DA Form 5840?

The DA Form 5840 must be filled out by the individual who agrees to be the guardian or escort for a soldier’s dependents. This person commits to taking on all responsibilities outlined in the document in the soldier's absence. The process requires thoughtful consideration as it involves a significant commitment to the well-being of the soldier's family members.

Is the completion of the DA Form 5840 optional?

Completion of the DA Form 5840 is voluntary; however, it's crucial for soldiers who have dependents and are preparing a Family Care Plan. Failure to provide all the requested information on this form could lead to the rejection of a soldier's Family Care Plan, potentially impacting their military duties and responsibilities.

What happens after submitting the DA Form 5840?

After the DA Form 5840 is completed and notarized, it should be submitted as part of the soldier's Family Care Plan. The accepting military command will review the form along with the rest of the Family Care Plan. If approved, it allows the soldier to deploy or fulfill duties knowing their dependents are legally and properly cared for during their absence. Periodically, the Family Care Plan may be reviewed or updated to ensure continuing compliance and adequacy of care arrangements.

1. Failing to provide complete information: This form serves a critical function in establishing a legal guardian or escort for a soldier's dependents in the soldier's absence. Omitting details can invalidate the form or delay its processing. Every field, including names, ages of family members, and contact information, needs to be accurately and fully filled out.

2. Not including a legally sufficient authority: The DA Form 5840 requires an accompanying DA Form 5841 (Power of Attorney) or similar legal document. This oversight is a common error that stems from misunderstanding the requirements. The guardian or escort must have legal authority to act on behalf of the soldier's dependents, and this authority must be documented and attached.

3. Incorrect or outdated information: Given the importance of the information for military and civilian facilities access, benefits, and entitlements, providing outdated or incorrect details can severely impact the welfare of the family members. Always double-check for the most current and accurate information.

4. Incompletely briefing the guardian or escort: The guardian or escort must be fully informed about their responsibilities and how to access necessary military/civilian facilities and services. Failing to brief them thoroughly can lead to complications in the caretaking of the dependents. This briefing is crucial for the seamless provision of financial, medical, educational, and subsistence support.

5. Forgetting to sign and date the form: An unsigned or undated form is incomplete and cannot be processed. The signature of the guardian or escort, along with the correct date, is a necessary step in affirming the commitment to take responsibility for the soldier’s family members.

6. Neglecting the notarization requirement: This form must be notarized to have legal effect. Skipping this step can render the document invalid. It is an essential part of the process, confirming the identity of the guardian or escort and their agreement to the responsibility.

7. Failure to consult with legal counsel: Legal documents such as the DA Form 5840 can be complex. Understanding every aspect of the obligations it entails is crucial. Failure to seek legal advice can lead to misunderstandings about the responsibilities being undertaken. For soldiers and potential guardians or escorts, consulting with a legal advisor can clarify duties and process, ensuring the family's needs will be adequately met.

When handling the responsibilities that come with being a designated guardian or escort, as outlined in the DA Form 5840, there are several other forms and documents often required to fully establish this role and ensure all legal and administrative bases are covered. These documents collectively facilitate the guardian's ability to provide comprehensive care and support for the service member's family members in their absence, enabling access to various services, benefits, and entitlements.

• DA Form 5841: Power of Attorney (POA) - Essential for granting the guardian the legal authority to make decisions and carry out specific actions on behalf of the service member's children or dependents.
• DD Form 1172-2: Application for Identification Card/DEERS Enrollment - Necessary for enrolling dependents in the Defense Enrollment Eligibility Reporting System (DEERS) to obtain military ID cards for accessing military services and benefits.
• DA Form 31: Request and Authority for Leave - Service members use this form to request leave, which can be relevant for guardians to understand the timing and duration of the service member's absence.
• DD Form 2656: Data for Payment of Retired Personnel - Although primarily used for retired personnel, it is relevant in preparing for any financial support arrangements made for dependents.
• DA Form 5305: Family Care Plan - This comprehensive form is used by service members to outline care arrangements for dependents, supporting the DA 5840 in ensuring all aspects of care are addressed.
• DA Form 7666: Parental Consent - Required for certain actions concerning minors, ensuring that both parents or legal guardians agree on decisions, especially relevant in dual-military families or when non-custodial guardians are appointed.
• SSA-1696: Appointment of Representative - May be necessary if the guardian needs to handle issues with Social Security benefits on behalf of the dependents.
• Medical Consent Forms: Needed for granting the guardian the authority to make medical decisions, accompany children to doctor visits, and access medical records.
• School Enrollment Forms: Required for enrolling children in school, which may include documentation proving guardianship authorized by the DA 5840 and DA 5841 forms.

Together, these forms ensure that guardians can fully execute their duties, providing for the welfare, medical care, educational needs, and overall well-being of the service member's dependents. Understanding each form's purpose and properly completing them creates a strong legal and logistical foundation for the care of military family members during the service member's deployment, training, or absence for any reason.

• DA Form 5841 (Power of Attorney): This document is closely related to the DA Form 5840 as it may be provided to the guardian or escort as evidence of their legal authority. Both forms function together within the Family Care Plan framework, ensuring a soldier's child(ren) are cared for in the soldier's absence. The DA Form 5841 specifically grants the guardian or escort the necessary legal powers to act on behalf of the service member's family members.

• DD Form 1172-2 (Application for Identification Card/DEERS Enrollment): This form is similar to the DA Form 5840 in its function related to the military family's welfare. When a guardian or escort is appointed through DA Form 5840, they might need to complete the DD Form 1172-2 to ensure access to military benefits, medical care, and services for the dependents under their care. Both forms facilitate the process of providing for the needs of military dependents.

• DA Form 5305 (Family Care Plan): This form is integral to the same process as DA Form 5840, establishing a comprehensive care plan for military dependents. The DA Form 5840 serves as part of executing the Family Care Plan, where a guardian or escort agrees to take responsibility for a service member's dependents. The DA Form 5305 outlines the overall plan and requirements, while the DA Form 5840 serves as acceptance of that responsibility.

• Healthcare Power of Attorney: While not a standardized military form like the DA Form 5840, a Healthcare Power of Attorney shares a similar purpose in granting authority to make medical decisions. When a guardian or escort is appointed through DA Form 5840, they may also be granted healthcare decision-making powers, similar to a Healthcare Power of Attorney, to ensure the well-being of the service member's dependents in their absence.

When filling out the DA 5840 form, which is a Certificate of Acceptance as Guardian or Escort, navigating the complexities and ensuring all the necessary information is accurately provided can be crucial. This form plays a crucial role in establishing a guardian or escort's commitment to caring for a soldier's child or children during the soldier's absence. Understanding what to do and what to avoid can help in completing the form effectively and avoid any potential issues that may affect the implementation of a soldier's Family Care Plan.

Things You Should Do:

1. Verify the accuracy of all personal information. Double-check the names, ages of family members, and your contact information to ensure everything is correct.
2. Ensure you have all the necessary documents before signing the form. This includes having the original DA Form 5841 (Power of Attorney) or another legally sufficient authority document that names you as the guardian or escort.
3. Include comprehensive contact information. Make sure to provide a complete address, telephone number, and email address to facilitate easy communication.
4. Gain a full understanding of your responsibilities. Before signing, make sure you are fully briefed on how to access military and civilian facilities, services, benefits, and entitlements for the family members under your care.

Things You Shouldn't Do:

• Avoid leaving sections incomplete. Failing to provide all the requested information can lead to the rejection of the Family Care Plan. Ensure every section is filled out.
• Don’t rush through reading the form. Take your time to read and understand each section, especially the Privacy Act Statement, to understand the implications of your agreement.
• Refrain from signing without the notary present. The form requires acknowledgment before a notary public, and your signature must be done in their presence.
• Don’t underestimate the importance of this document. This form is legally binding and confirms your role and responsibilities as a guardian or escort. Understand the magnitude of your commitment.

Understanding the DA Form 5840 can sometimes be challenging due to several misconceptions surrounding its use and purpose. Below are four common misunderstandings that deserve clarification to ensure accurate comprehension and handling of this form.

• It's only necessary for deployment situations. While it's often associated with deployment, the DA Form 5840 is crucial in any scenario where a soldier might be absent and unable to care for their dependents. This form is a vital component of a Family Care Plan, designed to provide care arrangements not only during deployments but also for field exercises, unaccompanied tours, or any military obligation that could separate soldiers from their families.
• Completing the form is the only step needed. Simply filling out and submitting the DA Form 5840 isn't enough. It's part of a larger process that includes creating a comprehensive Family Care Plan. This plan requires detailed arrangements for the well-being of the dependents, including financial, medical, educational, and housing provisions. The soldier must also submit a DA Form 5841 (Power of Attorney), granting the guardian legal authority to make decisions on behalf of the dependents.
• Any Guardian can be nominated. While soldiers have the freedom to select a guardian for their dependents, the choice is not without constraints. The nominated guardian must be thoroughly briefed on the responsibilities involved, including understanding how to access military/civilian facilities, services, benefits, and entitlements. The guardian’s acceptance and preparedness to take on these responsibilities are formally acknowledged through the DA Form 5840.
• Privacy and disclosure are not concerns. The privacy act statement on the DA Form 5840 emphasizes voluntary disclosure. However, it also highlights potential consequences if all requested information is not provided, which could lead to the rejection of the Family Care Plan. It's imperative to understand that while the form does collect personal information, its main purpose is to ensure the welfare of family members, and the information is handled with confidentiality and respect for privacy.

Correcting these misconceptions ensures that military personnel can prepare their Family Care Plans with a clear understanding of the DA Form 5840’s purpose and requirements. It's a vital step in making sure that the dependents of military members are well cared for in their absence.

Here are key takeaways regarding the completion and use of the DA Form 5840, Certificate of Acceptance as Guardian or Escort:

• The DA Form 5840 is used to formally acknowledge someone's acceptance of responsibility as a guardian or escort for a soldier's child(ren) during the soldier's absence.
• This form serves as part of a soldier's Family Care Plan, as outlined in Army Regulation 600-20.
• The authority for the form comes from 10 U.S.C. Section 3013, under the Secretary of the Army.
• The primary purpose of the DA Form 5840 is to ensure there is an agreement in place for the care of a soldier's child(ren) in his or her absence, covering financial, medical, educational, housing, and sustenance needs.
• Completion and submission of the form are voluntary, but failure to provide all requested information might result in the rejection of the soldier's Family Care Plan.
• Guardians or escorts need to be provided with, or have access to, the necessary documents such as the DA Form 5841 (Power of Attorney) or other legally sufficient authority that designates them as the guardian/escort.
• Before signing the document, guardians/escorts should ensure they understand the procedures for accessing military and civilian facilities, services, benefits, and entitlements on behalf of the family members they are responsible for.
• The form requires the guardian/escort's printed name, signature, address (including ZIP Code), telephone number, and email address.
• A notary public must acknowledge the form for it to be considered legally binding. The section for notarization includes space for the state, county, date, and the notary's commission expiration date.
• It is important to use the most current version of the form, which as of the last known update is dated June 2010 (DA FORM 5840, JUN 2010).

Proper completion and submission of the DA Form 5840 are crucial steps in establishing a legally recognized plan for the care of soldiers' dependents during periods of the soldier's absence, ensuring their well-being is safeguarded.