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The DA Form 5840 is an essential document within the U.S. Army framework, specifically designed to ensure the well-being of soldiers' children in the absence of their guardians. This form serves as a Certificate of Acceptance as Guardian or Escort, which is crucial for soldiers who need to designate someone to care for their children while they fulfill their military duties. The form is governed by Army Regulation 600-20, which outlines the Army's command policy regarding family care plans. By completing the DA Form 5840, a guardian formally agrees to take responsibility for the child or children of a soldier, ensuring that they receive necessary support in areas such as financial, medical, and educational needs. The document requires the guardian to acknowledge that they have received all pertinent information and documents, which empowers them to access military and civilian services on behalf of the children. It is important to note that while the information requested on the form is voluntary, omitting details could result in complications with the soldier's Family Care Plan. The form also includes sections for personal details, such as the guardian's name, address, and contact information, along with a notary section to validate the agreement. Understanding the DA Form 5840 is vital for both soldiers and their designated guardians, as it lays the groundwork for a supportive and structured environment for children during a parent's deployment.

Sample - Da 5840 Form

CERTIFICATE OF ACCEPTANCE AS GUARDIAN OR ESCORT

For use of this form, see AR 600-20; the proponent agency is DCS, G-1.

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:

PRIVACY ACT STATEMENT

10 U.S.C. Section 3013, Secretary of the Army: Army Regulation 600-20, Army Command Policy.

Guardian's agreement to care for a soldier's child(ren) in his or her absence.

None.

Voluntary; However, failure to provide all the requested information could lead to rejection of a soldier's Family Care Plan.

I

 

was provided an original DA Form 5841

(Power of Attorney) or other legally sufficient authority naming me as guardian/escort for:

NAME (s) / AGE (s) OF FAMILY MEMBERS

family members of:

NAME (s)

I agree to accept responsibility for these family members. I have received all necessary documents required to provide financial, medical, educational, quarters, and subsistence support for these family members. I have been briefed on procedures for accessing military/civilian facilities, services, benefits, and entitlements on behalf of these family members.

TYPED OR PRINTED NAME OF GUARDIAN

ADDRESS (Include ZIP Code)

SIGNATURE

DATE (YYYY/MM/DD)

TELEPHONE NUMBER (Include Area Code)

E-MAIL ADDRESS

NOTARY:

STATE OF

COUNTY OF

Acknowledged before me this

 

day of

,

 

.

 

 

 

 

 

 

 

(Notary Public)

My commission expires:

DA FORM 5840, JUN 2010

PREVIOUS EDITIONS ARE OBSOLETE.

APD PE v1.00ES

File Specs

Fact Name Details
Form Title CERTIFICATE OF ACCEPTANCE AS GUARDIAN OR ESCORT
Governing Law 10 U.S.C. Section 3013, Secretary of the Army
Regulation Reference Army Regulation 600-20, Army Command Policy
Main Purpose To confirm a guardian's agreement to care for a soldier's child(ren) during their absence.
Routine Uses None specified.
Disclosure Information Providing information is voluntary; failure to do so may result in rejection of the Family Care Plan.
Last Revision Date June 2010

Da 5840 - Usage Guidelines

Filling out the DA 5840 form is a straightforward process. This form is essential for establishing a guardian or escort for a soldier's child or children in their absence. Ensure that you have all necessary information and documents ready before you start. Follow these steps to complete the form accurately.

  1. Begin by obtaining a blank DA 5840 form.
  2. In the first section, provide the name(s) and age(s) of the family members you will be responsible for.
  3. Next, fill in the name(s) of the soldier whose family members you are caring for.
  4. Indicate your agreement to accept responsibility for these family members by checking the appropriate box or signing where indicated.
  5. Confirm that you have received all necessary documents for financial, medical, educational, quarters, and subsistence support.
  6. Briefly acknowledge that you have been informed about accessing military or civilian facilities and services for these family members.
  7. Print or type your name in the designated area.
  8. Provide your complete address, including ZIP code.
  9. Sign the form in the specified area and date it using the format YYYY/MM/DD.
  10. Include your telephone number with area code and e-mail address.
  11. In the notary section, provide the state and county where the form is being notarized.
  12. Have the notary public acknowledge your signature on the form.
  13. Ensure the notary includes their commission expiration date.

After completing the form, review it carefully for accuracy. Once verified, submit the DA 5840 form as instructed. This ensures that all parties involved are aware of their responsibilities and obligations.

Your Questions, Answered

What is the DA Form 5840?

The DA Form 5840 is a Certificate of Acceptance as Guardian or Escort. It is used to document a guardian's agreement to care for a soldier's child or children in the soldier's absence. This form ensures that the guardian is aware of their responsibilities and has received necessary information regarding support for the children.

Who needs to complete the DA Form 5840?

The form must be completed by individuals who have been designated as guardians or escorts for a soldier's children. This designation is typically made through a Power of Attorney or other legal authority. The soldier must ensure that the guardian understands their responsibilities before completing the form.

What information is required on the DA Form 5840?

The form requires the guardian's name, address, signature, and contact information. Additionally, the names and ages of the children being cared for must be included. The guardian must also acknowledge receipt of necessary documents for providing support and benefits for the children.

Is the DA Form 5840 mandatory?

While the DA Form 5840 is not mandatory by itself, it is a crucial component of a soldier's Family Care Plan. Failure to provide the requested information on this form may lead to the rejection of the Family Care Plan, which can impact the soldier's ability to fulfill their duties.

What happens if the DA Form 5840 is not completed?

If the DA Form 5840 is not completed, the soldier may face challenges in securing care for their children during their absence. This could result in complications regarding the children's welfare and the soldier's ability to focus on their military responsibilities.

Can the DA Form 5840 be revoked?

Yes, the DA Form 5840 can be revoked. If circumstances change or if the soldier wishes to designate a different guardian, they must complete a new form and inform the current guardian of the change. Proper documentation should be maintained to ensure clarity in guardianship.

What is the role of the notary on the DA Form 5840?

The notary public's role is to verify the identity of the guardian and witness the signing of the form. This adds a layer of authenticity and legal recognition to the agreement, ensuring that the guardian's acceptance of responsibility is valid and acknowledged.

How does the Privacy Act apply to the DA Form 5840?

The Privacy Act statement included with the DA Form 5840 indicates that the information collected is voluntary. However, not providing complete information could affect the soldier's Family Care Plan. The information is used solely for the purpose of establishing guardianship and is protected under privacy regulations.

When was the DA Form 5840 last revised?

The DA Form 5840 was last revised in June 2010. It is important to use the most current version of the form to ensure compliance with regulations and policies.

Where can I obtain the DA Form 5840?

The DA Form 5840 can be obtained through military administrative offices or downloaded from official Army websites. It is advisable to ensure that the latest version is being used to avoid any issues with processing.

Common mistakes

  1. Incomplete Information: Many people forget to fill out all required fields. Leaving out even one piece of information can lead to delays or rejection of the form.

  2. Incorrect Names or Ages: It's crucial to double-check the names and ages of the family members listed. Any errors can cause confusion and might complicate the acceptance process.

  3. Signature Issues: Some individuals neglect to sign the form or forget to date it. An unsigned or undated form is not valid and will not be processed.

  4. Notary Requirements: Failing to have the form notarized can lead to rejection. Ensure that a notary public acknowledges the document properly.

  5. Missing Contact Information: Providing a telephone number and email address is essential. If the reviewing authority cannot reach you, it may slow down the process.

Documents used along the form

The DA Form 5840 serves as a vital document for guardians or escorts of soldiers' children, ensuring that the necessary legal framework is in place for their care. When filling out this form, it is often accompanied by other important documents that help solidify the guardian's role and responsibilities. Below is a list of forms and documents that are commonly used alongside the DA Form 5840.

  • DA Form 5841 (Power of Attorney): This document grants a designated individual the authority to act on behalf of another person, particularly in legal or financial matters. It is essential for establishing the guardian's legal standing in the absence of the soldier.
  • DA Form 5842 (Family Care Plan): This form outlines the soldier's plan for the care of their family members when they are deployed or otherwise unavailable. It includes details about the guardian, as well as any specific needs of the children.
  • DD Form 1172-2 (Application for DEERS Enrollment): This application is used to enroll eligible family members in the Defense Enrollment Eligibility Reporting System (DEERS). It ensures that the guardian can access military benefits and services on behalf of the children.
  • DA Form 7652 (Child Custody Agreement): This form may be necessary if there are legal custody arrangements already in place. It clarifies the rights and responsibilities of the guardian concerning the child's welfare.
  • Medical Power of Attorney: This document allows the guardian to make medical decisions for the child in the event that the soldier is unable to do so. It is crucial for ensuring that medical needs are met promptly and effectively.
  • Emergency Contact Information: While not a formal document, having a list of emergency contacts is essential. This should include names, phone numbers, and relationships of individuals who can be reached in case of an emergency involving the child.

Utilizing these forms and documents in conjunction with the DA Form 5840 provides a comprehensive framework for the care of a soldier's children. Each piece plays a critical role in ensuring that guardians are prepared to take on their responsibilities effectively, safeguarding the well-being of the children in their care.

Similar forms

The DA Form 5840, which serves as a Certificate of Acceptance as Guardian or Escort, shares similarities with the Child Custody Agreement. Both documents establish a legal framework for the care of children in the absence of their parents. A Child Custody Agreement outlines the responsibilities and rights of each parent or guardian regarding the child’s upbringing, education, and welfare. Like the DA Form 5840, it requires the guardian to acknowledge their responsibilities and can be essential in ensuring the child's needs are met during the absence of the parents.

Another document comparable to the DA Form 5840 is the Power of Attorney (POA). This legal instrument allows one person to make decisions on behalf of another. The DA Form 5840 requires the guardian to possess a Power of Attorney or similar authority, which grants them the legal rights to act in the best interest of the soldier's children. Both documents emphasize the importance of trust and responsibility in caretaking, ensuring that the designated individual can manage the child's affairs effectively.

The Family Care Plan is also similar to the DA Form 5840. This plan outlines how a soldier will ensure their family is cared for when they are deployed or absent. The DA Form 5840 is often a component of this plan, as it formally designates a guardian. Both documents require detailed information about the family members involved and emphasize the importance of having a reliable support system in place during a soldier's absence.

The Temporary Guardianship Agreement is another document that resembles the DA Form 5840. This agreement allows a parent to appoint someone to care for their child temporarily. Like the DA Form 5840, it establishes the responsibilities of the guardian and is often used in situations where a parent cannot be present. Both documents provide a clear understanding of the guardian's duties and ensure that the child's needs are prioritized during the parent's absence.

Lastly, the Medical Consent Form is akin to the DA Form 5840 in that it grants a guardian the authority to make medical decisions for a child. This form is essential when a parent is unavailable to provide consent for medical treatment. Similar to the DA Form 5840, it requires the guardian to acknowledge their responsibilities and ensures that the child receives necessary medical care without delay. Both documents aim to protect the welfare of the child by designating a trusted individual to act on their behalf in critical situations.

Dos and Don'ts

When filling out the DA 5840 form, it's crucial to be thorough and accurate. Here are some essential do's and don'ts to keep in mind:

  • Do read the instructions carefully before starting the form.
  • Do provide complete and accurate information about the family members you are responsible for.
  • Do ensure your signature and date are clearly written.
  • Don't leave any required fields blank; incomplete forms may be rejected.
  • Don't forget to include your contact information, such as phone number and email address.
  • Don't rush the process; take your time to review the form before submission.

Following these guidelines will help ensure that your form is processed smoothly and efficiently. Remember, the accuracy of your information is vital for the well-being of the family members you are agreeing to care for.

Misconceptions

The DA Form 5840 is often misunderstood. Here are five common misconceptions regarding this form:

  • It is mandatory for all soldiers. Many believe that every soldier must complete the DA Form 5840. In reality, it is only required if a soldier has dependents and needs to establish a guardian or escort for their children in their absence.
  • It replaces a Power of Attorney. Some think that the DA Form 5840 serves as a substitute for a Power of Attorney. However, it is meant to complement a Power of Attorney, which may be necessary for legal authority over the dependents.
  • Only military personnel can serve as guardians. There is a misconception that only active-duty members can be designated as guardians. In fact, civilians can also be appointed as guardians, provided they meet the necessary requirements and the soldier designates them appropriately.
  • Completing the form guarantees approval. Many assume that submitting the DA Form 5840 will automatically lead to acceptance of the Family Care Plan. Approval is contingent upon meeting all requirements and providing complete information; incomplete submissions may be rejected.
  • It does not require notarization. Some individuals believe that notarization is optional. In truth, the form must be notarized to confirm the guardian's acceptance and ensure legal validity.

Understanding these misconceptions can help clarify the purpose and requirements of the DA Form 5840. Proper completion and submission of the form are essential for ensuring the well-being of dependents in a soldier's absence.

Key takeaways

Filling out the DA 5840 form is a crucial step for anyone assuming the role of guardian or escort for a soldier's children. Here are some key takeaways to keep in mind:

  • Understand the Purpose: This form serves as a certificate of acceptance for guardianship. It formalizes your agreement to care for the soldier's child(ren) during their absence.
  • Provide Complete Information: Ensure that all requested details are filled out accurately. Incomplete forms may lead to rejection of the soldier's Family Care Plan.
  • Documentation is Essential: You must receive all necessary documents that support your responsibilities, including financial, medical, and educational information for the children.
  • Access to Services: Familiarize yourself with the procedures for accessing military and civilian facilities, as well as benefits and entitlements available for the children.
  • Notary Requirement: The form must be notarized to validate your acceptance as a guardian. Ensure that this step is completed to avoid any delays.

By following these guidelines, you can help ensure a smooth process in fulfilling your responsibilities as a guardian or escort.