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The DA 5840 form, known as the Certificate of Acceptance as Guardian or Escort, plays a crucial role in the Army's Family Care Plan. This form is essential for soldiers who need to designate a guardian for their children during their absence, ensuring that their family members receive the necessary care and support. It is governed by Army Regulation 600-20, which outlines the policies related to family care within the military. The DA 5840 requires the guardian to acknowledge their responsibilities, including providing financial, medical, educational, and subsistence support for the designated family members. Additionally, the form collects vital information such as the names and ages of the children, as well as the guardian's contact details. By signing this document, the guardian agrees to accept the responsibilities laid out and confirms that they have received all necessary information to access military and civilian services on behalf of the children. Notarization of the form adds an extra layer of authenticity, ensuring that the commitment is legally recognized. Understanding the importance and requirements of the DA 5840 is essential for any soldier looking to establish a reliable Family Care Plan.

Form Sample

TELEPHONE NUMBER
(Include Area Code)
TYPED OR PRINTED NAME OF GUARDIAN
SIGNATURE DATE
(YYYY/MM/DD)
A
DDRESS
(Include ZIP Code)
E-MAIL ADDRESS
NOTARY:
STATE OF
COUNTY O
F
A
cknowledged before me this
My commission expires:
NAME
(s)
/ AGE
(s)
OF FAMILY MEMBERS
CERTIFICATE OF ACCEPTANCE AS GUARDIAN OR ESCORT
For use of this form, see AR 600-20; the proponent agency is DCS, G-1.
I
(Power of Attorney)
or other legally sufficient authority naming me as guardian/escort for:
was provided an original DA Form 5841
NAME
(s)
day of
family members of:
(Notary Public)
,.
DA FORM 5840, JUN 2010
PREVIOUS EDITIONS ARE OBSOLETE.
APD PE v1.00ES
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.
PRIVACY ACT STATEMENT
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:
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.

Document Specifications

Fact Name Description
Purpose This form serves as a certificate of acceptance for a guardian or escort who agrees to care for a soldier's child or children during the soldier's absence.
Governing Law The DA Form 5840 is governed by 10 U.S.C. Section 3013, which pertains to the authority of the Secretary of the Army, as well as Army Regulation 600-20, which outlines Army Command Policy.
Privacy Statement Disclosure of information is voluntary. However, failing to provide all requested details may result in the rejection of a soldier's Family Care Plan.
Validity The form must be signed and dated by the guardian, and it requires notarization to ensure its legal validity.

Steps to Filling Out Da 5840

Completing the DA Form 5840 is an important step in establishing your role as a guardian or escort for a soldier's child or children. It is essential to provide accurate and complete information to ensure the acceptance of your responsibilities. Follow these steps carefully to fill out the form correctly.

  1. Begin by obtaining a copy of the DA Form 5840.
  2. Fill in the guardian's name in the designated space.
  3. Provide the address of the guardian, including the ZIP code.
  4. List the names and ages of the family members you will be responsible for.
  5. Indicate the name(s) of the soldier whose family members you are caring for.
  6. Confirm your agreement to accept responsibility by checking the appropriate box.
  7. Ensure you have received all necessary documents for support, and check the box to acknowledge this.
  8. Indicate that you have been briefed on accessing military and civilian services by checking the box.
  9. Sign and date the form, using the format YYYY/MM/DD.
  10. Provide your telephone number and email address.
  11. Have the form notarized by a Notary Public, who will fill in the state, county, and date.

More About Da 5840

What is the purpose of the DA 5840 form?

The DA 5840 form, known as the Certificate of Acceptance as Guardian or Escort, serves a crucial role in the military community. It is primarily used to document a guardian's agreement to care for a soldier's child or children during the soldier's absence. This form ensures that the guardian understands their responsibilities and has received all necessary information to provide adequate support for the child or children, including financial, medical, and educational needs.

Who needs to fill out the DA 5840 form?

What information is required on the DA 5840 form?

The DA 5840 form requires several key pieces of information. First, it asks for the names and ages of the family members for whom the guardian will be responsible. The soldier's name must also be included. Additionally, the guardian must provide their typed or printed name, address, signature, date, telephone number, and email address. This information is essential to ensure that all parties are clearly identified and that the guardian is fully aware of their obligations.

What happens if the DA 5840 form is not completed correctly?

Completing the DA 5840 form accurately is vital. If the form is not filled out correctly or if any required information is missing, it could lead to the rejection of the soldier's Family Care Plan. This could create complications for the soldier and the guardian, potentially impacting the care of the children involved. Therefore, it is important to review the form carefully and ensure that all information is provided before submission.

Common mistakes

  1. Incomplete Information: One of the most common mistakes is failing to fill out all required fields. Each section must be completed to avoid delays in processing.

  2. Incorrect Names: Providing the wrong names of the family members can lead to significant issues. Ensure that names are spelled correctly and match official documents.

  3. Missing Signatures: A signature is mandatory. Omitting this can result in the form being deemed invalid.

  4. Failure to Date the Form: Not dating the form can create confusion regarding the timeline of the agreement. Always include the date in the specified format.

  5. Notary Section Errors: Errors in the notary section, such as an incomplete acknowledgment or missing notary signature, can invalidate the document.

  6. Providing Outdated Information: Ensure that all contact information, including telephone numbers and email addresses, is current. Outdated information can hinder communication.

  7. Ignoring Privacy Act Statement: Not understanding the implications of the Privacy Act Statement can lead to unintentional breaches of confidentiality. Familiarize yourself with the statement before submission.

Documents used along the form

The DA Form 5840 is an important document used in military contexts, specifically for designating a guardian or escort for a soldier's children during their absence. Alongside this form, several other documents may be required to ensure comprehensive care and legal authority. Below is a list of forms and documents often used in conjunction with the DA Form 5840, along with brief descriptions of each.

  • DA Form 5841 (Power of Attorney): This form grants legal authority to another person, allowing them to make decisions on behalf of the soldier. It is essential for ensuring that the guardian can manage financial, medical, and educational matters for the soldier's children.
  • DA Form 5410 (Family Care Plan): This document outlines the soldier's plan for the care of their dependents in case of deployment or absence. It includes details about the guardian, as well as provisions for the children's well-being.
  • DA Form 3685 (Child Care Certificate): This form certifies that the designated guardian has been approved to provide care for the soldier's children. It is often required by childcare facilities or schools to ensure that the guardian is recognized as the responsible adult.
  • DD Form 1172 (Application for Uniformed Services Identification Card): This form is used to apply for an ID card for dependents. It is crucial for accessing military benefits and services, and it may be needed by the guardian to ensure the children receive necessary support.
  • DA Form 7425 (Child Custody Agreement): This document outlines the custody arrangements for the soldier's children. It is particularly important if there are multiple guardians or if the soldier is divorced, as it clarifies the roles and responsibilities of each guardian.

These forms and documents work together to create a comprehensive framework for the care and support of a soldier's children during their absence. Proper completion and understanding of each document can facilitate a smoother transition and ensure that all legal and practical needs are met.

Similar forms

The DA Form 5840, Certificate of Acceptance as Guardian or Escort, shares similarities with the DA Form 5841, Power of Attorney. Both documents serve to designate a responsible party for a soldier's dependents. The DA Form 5841 grants legal authority to act on behalf of another, particularly concerning financial and medical decisions. While the DA Form 5840 focuses on the acceptance of guardianship, the DA Form 5841 empowers the designated individual to make decisions in various aspects of care, ensuring that the needs of the soldier's family are met in their absence.

Another document that resembles the DA Form 5840 is the DA Form 5305, Family Care Plan. This form is essential for soldiers with dependents, outlining a comprehensive plan for their care during deployment or absence. Like the DA Form 5840, it emphasizes the importance of having a responsible adult in place to provide for the needs of children. Both documents require the soldier’s input and agreement, ensuring that the chosen guardian is fully aware of their responsibilities.

The DA Form 5888, Family Care Plan Counseling Checklist, also parallels the DA Form 5840. This checklist serves as a guide for soldiers in creating a Family Care Plan. It highlights the responsibilities of the guardian and ensures that all necessary arrangements are made. While the DA Form 5840 confirms the guardian’s acceptance, the DA Form 5888 helps soldiers systematically address the various aspects of their family’s care, reinforcing the need for a thoughtful approach to guardianship.

Similar to the DA Form 5840, the DA Form 7425, Family Care Plan Review, plays a role in the ongoing management of a soldier's family care arrangements. This review form is used to evaluate the effectiveness of the existing Family Care Plan and to ensure that the designated guardian remains suitable for the role. Both documents prioritize the welfare of the soldier's dependents, requiring regular updates and confirmations to adapt to changing circumstances.

The DA Form 2656, Application for Retired Pay Benefits, is another document that bears resemblance to the DA Form 5840 in terms of its focus on family. While it primarily addresses retirement benefits, it also includes provisions for dependent care and support. Both forms reflect the military's commitment to ensuring that service members' families are cared for, whether through guardianship or financial support, and underscore the importance of planning for the future.

The DA Form 7453, Survivor Benefit Plan (SBP) Election, shares a thematic connection with the DA Form 5840. It allows service members to designate beneficiaries for their survivor benefits, ensuring that their loved ones are financially supported after their passing. Both documents highlight the importance of making informed decisions regarding family welfare, whether through guardianship or financial provisions, and require the service member's active participation in the process.

The DD Form 1172-2, Application for Department of Defense (DoD) Common Access Card (CAC) and DEERS Enrollment, is another form that aligns with the DA Form 5840. This document is used to establish eligibility for military benefits and services for dependents. Both forms emphasize the need for proper documentation and authorization, ensuring that family members receive the necessary support while the service member is away.

Lastly, the SF 1179, Request for Waiver of Overpayment, has similarities with the DA Form 5840 in that it addresses the financial responsibilities of service members. While the SF 1179 deals with the repayment of overpaid benefits, it also requires a clear understanding of the soldier's obligations toward their dependents. Both documents reflect the military's commitment to accountability and the importance of maintaining financial stability for families during times of transition.

Dos and Don'ts

When filling out the DA 5840 form, it is important to follow specific guidelines to ensure the process goes smoothly. Here are five things you should and shouldn't do:

  • Do read the instructions carefully before starting the form.
  • Do provide accurate and complete information for all required fields.
  • Do ensure that your signature is included and that the date is correct.
  • Don't leave any sections blank unless instructed to do so.
  • Don't submit the form without double-checking for any errors or omissions.

Misconceptions

The DA 5840 form, known as the Certificate of Acceptance as Guardian or Escort, is often misunderstood. Here are six common misconceptions about this important document:

  • It is mandatory for all soldiers. Many believe that every soldier must fill out this form. In reality, it is only required if a soldier has children and needs to designate a guardian in their absence.
  • It grants legal custody of the children. Some think that signing the DA 5840 gives the guardian legal custody. However, this form merely allows the guardian to care for the child temporarily and does not transfer custody rights.
  • It covers all financial responsibilities. There is a misconception that the DA 5840 includes comprehensive financial support for the child. While it does allow access to certain benefits, it does not guarantee all financial responsibilities are covered.
  • It can be filled out without any supporting documents. Some individuals believe they can submit the DA 5840 without additional paperwork. In fact, the guardian must provide necessary documents to ensure proper support for the child.
  • It is a one-time form. Many assume that once the DA 5840 is filled out, it remains valid indefinitely. This is not true; the form may need to be updated or renewed as circumstances change.
  • Notarization is optional. Some think that notarizing the form is not necessary. In truth, notarization is a required step to validate the agreement and ensure its legal standing.

Understanding these misconceptions can help ensure that soldiers and their families are better prepared when using the DA 5840 form.

Key takeaways

Understanding the DA Form 5840 is essential for guardians or escorts of military family members. Here are key takeaways to consider:

  • Purpose: The DA Form 5840 serves as a certificate of acceptance for guardians or escorts responsible for a soldier's child(ren) during their absence.
  • Authority: The form is governed by Army Regulation 600-20, which outlines Army Command Policy.
  • Voluntary Disclosure: Providing information on this form is voluntary, but incomplete submissions may result in the rejection of a soldier's Family Care Plan.
  • Documentation: Guardians must have an original DA Form 5841 (Power of Attorney) or another legally sufficient document naming them as the guardian or escort.
  • Responsibility: By signing the form, the guardian agrees to take full responsibility for the designated family members.
  • Support Requirements: Guardians must confirm they have received all necessary documents to provide support, including financial, medical, educational, quarters, and subsistence.
  • Access to Services: The guardian should be briefed on how to access military and civilian facilities, services, benefits, and entitlements for the family members.
  • Contact Information: The form requires the guardian to provide their typed or printed name, address, telephone number, and email address.
  • Notary Requirement: The form must be acknowledged by a notary public, confirming the guardian's identity and agreement.
  • Obsolete Editions: The current version of the DA Form 5840 is from June 2010, and previous editions are considered obsolete.

Filling out the DA Form 5840 accurately ensures that guardians can effectively support military families when needed.