Article Guide
The DA Form 5841 is a significant legal document utilized by service members in the United States Armed Forces to establish a special power of attorney (POA) for the care of their children during periods of absence. This form designates a trusted individual to assume guardianship responsibilities, ensuring that a child’s health, education, and welfare are attended to seamlessly in the parent's absence. It is crucial to note that using this particular POA is not mandatory for your Family Care Plan; alternatives can be pursued. Moreover, the effectiveness of this POA may be influenced by state laws and specific circumstances related to where the child will reside. Parents should seek legal advice to understand how the DA Form 5841 interacts with the custodial rights of others, including non-custodial parents. When executing the form, parents should be prepared to present it to various institutions, such as schools and health care providers, to confirm its acceptance and validity. By doing so, guardians can ensure they are equipped to make necessary decisions on behalf of the children. Ultimately, understanding the nuances of the DA Form 5841 empowers parents to make informed choices while fulfilling their responsibilities toward their children's care.
Form Sample
SPECIAL INSTRUCTIONS RELATED TO EXECUTION OF POWERS OF ATTORNEY
The DA Form 5841 is a special power of attorney (POA) that may be used to authorize a person to take care
of your child(ren) in your absence. It is important that you understand that you are not required to use this POA for your Family Care Plan. You may seek legal assistance to have a different POA drafted that better provides for your family members if you so desire. You must also understand that depending on the law or other requirements where your child (ren) will be living, a POA may not always be effective for your designated guardian to care for your child (ren) under any or all
circumstances. You may seek legal assistance to advise you about the effectiveness of DA Form 5841, other POAs or any other matters in your Family Care Plan.
It is very important that the following persons be shown the POA or other appropriate documentation for the purpose of determining whether they will honor it:
Doctors, dentists, and hospital officials or other health care providers who may be called upon to treat your child (ren).
Any school officials or other officials who may need your permission to provide services for your child (ren) or register your child (ren) in school.
If the persons identified above will not honor the POA, you must ask to be provided powers of attorney or other documents that will be honored. You should show this POA or other documentation to all facilities, institutions, and individuals to ensure they will recognize it for the purposes you have intended.
You must understand that a POA will not prevent another person, such as a
DA FORM 5841, DEC 2005 |
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POWER OF ATTORNEY
For use of this form, see AR
PRIVACY ACT STATEMENT
AUTHORITY:10 U.S.C. Section 3013, Secretary of the Army: Army Regulation
PRINCIPAL PURPOSE: To designate a guardian to care for your child (ren) in your absence.
ROUTINE USES: |
None. |
DISCLOSURE:Mandatory; failure to maintain a Family Care Plan could subject you to separation, administrative action, or. disciplinary action under the UCMJ.
KNOW ALL PERSONS BY THESE PRESENTS:
That I, |
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member of the United States Armed Forces, currently residing in
, pursuant to Military Orders, do hereby appoint , presently residing at
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following acts or things in my name and in my behalf: To assume and maintain guardianship of my child (ren),
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to do all acts necessary or desirable for maintaining health, education, and welfare; and to maintain customary living standards, including, but not limited to, provision of living quarters, food, clothing, medical, surgical and dental care, entertainment and other customary matters; and, specifically, to approve and authorize any and all medical treatment deemed necessary by a duly licensed physician and to execute any consent, release or waiver of liability required by medical or dental authorities incident to the provision of medical, surgical or dental care to any of them by qualified medical or dental personnel.
I hereby give and grant individually unto my said attorney full power and authority to do and perform all and any act, deed, matter and thing whatsoever in and about any of the aforementioned specified particulars as fully and effectually to all intents and purposes as I might and could do in my own person if personally present; and in addition thereto. I do hereby ratify and confirm each of the acts of my aforesaid attorneys lawfully done pursuant to the authority herein above conferred.
I HEREBY AUTHORIZED MY ATTORNEY TO INDEMNIFY AND HOLD HARMLESS ANY THIRD PARTY WHO ACCEPTS AND ACTS UNDER OR IN ACCORDANCE WITH THIS POWER OF ATTORNEY.
I intend for this to be a DURABLE Power of Attorney. This Power of Attorney will continue to be effective if I become disabled, incapacitated, or incompetent.
I authorize by
DA FORM 5841, DEC 2005 |
DA FORM |
APD PE v1.01 |
I HEREBY RATIFY ALL THAT MY ATTORNEY SHALL LAWFULLY DO OR CAUSE TO BE DONE BY THIS DOCUMENT.
This Power of Attorney shall become effective when I sign and execute it below. Further, unless sooner revoked or terminated by me, this Power of Attorney shall become NULL and VOID on
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Notwithstanding my inclusion of a specific expiration date herein, if on the
or during the sixty (60) day period preceding that specified expiration date, I should be or have been determined by the United States Government to be in a military status of "missing," "missing in action," or "prisoner of war," then this Power of Attorney shall remain valid and in full effect until sixty (60) days after I have returned to United States military control following termination of such status UNLESS OTHERWISE REVOKED OR TERMINATED BY ME.
IN WITNESS WHEREOF, I sign, seal, declare, publish, make and constitute this as and for my Power of |
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Attorney in the presence of the Notary Public witnessing it at my request this date |
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I, the undersigned, certify that I am a fully commissioned, qualified, and authorized notary public. Before
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me personally, within the territorial limits of my warrant of authority, appeared
, who is known by me to be the person who is
described herein, whose name is subscribed to, and who signed the Power of Attorney as grantor, and who, having been duly sworn, acknowledged that this instrument was executed after its contents were read and duly explained, and that such execution was a free and voluntary act and deed for the uses and purposes herein set forth.
IN WITNESS WHEREOF, i have hereunto set my hand and affix my seal this |
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GRANTOR'S SIGNATURE
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ACKNOWLEDGMENT |
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STATE OF |
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COUNTY OF |
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Acknowledged before me this |
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(Notary Public)
My commission expires:
PAGE 2, DA FORM 5841, DEC 2005 |
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Document Specifications
| Fact Name | Details |
|---|---|
| Purpose | The DA Form 5841 is used to grant a person the authority to act on behalf of a parent regarding the care of their child or children in the parent's absence. |
| Family Care Plan | Usage of DA Form 5841 is not mandated for a Family Care Plan. A parent may opt for a different type of power of attorney to better suit their family's needs. |
| Legal Effectiveness | The effectiveness of this form may vary based on the laws and regulations of the state where the child resides, which should be considered carefully. |
| Healthcare Authorization | This document allows the appointed guardian to authorize necessary medical treatments and make decisions regarding the child's health, education, and welfare. |
| Limitations | A power of attorney does not prevent others, such as non-custodial parents, from pursuing custody rights through the courts. |
| Durability | The DA Form 5841 is intended to be a durable power of attorney, remaining effective even if the granting parent becomes incapacitated or disabled. |
| Revocation | This power of attorney can be revoked or will automatically terminate if specified conditions are met, such as returning to military control. |
| Governing Law | This form is governed by the Army Regulation 600-20 and is authorized under 10 U.S.C. Section 3013. |
Steps to Filling Out Da 5841 R
Filling out the DA Form 5841 can seem like a daunting task, but it ensures that your wishes regarding the care of your child or children are clearly communicated during your absence. Carefully follow the steps below to complete the form accurately.
- Obtain the Form: Download or request the DA Form 5841 from your military legal office or the appropriate website.
- Provide Your Information: In the first section, enter your full name, Social Security Number, and current state of residence.
- Specify Military Status: Mention your rank and the branch of the military you are serving in.
- Designate Your Attorney-in-Fact: Fill in the name and address of the person you wish to appoint as your attorney-in-fact. This person will act on your behalf regarding matters related to your children.
- List Your Children: Clearly state the names of your child or children who will be under the care of the designated attorney-in-fact.
- Outlining Powers: In the section that details the powers given to the attorney-in-fact, make sure to be specific about the responsibilities and rights you wish to grant them, such as health, education, and welfare decisions.
- Durability Clause: Confirm that this is intended to be a durable power of attorney by marking the appropriate section. This ensures that it remains valid even if you become incapacitated.
- Signature and Date: Sign and date the form. This signals your intent for the powers granted in the form to take effect.
- Notarization: Have the form notarized. The notary public will confirm your identity and that you are signing the document voluntarily.
- Distribute Copies: Make copies of the signed and notarized form. Provide them to your attorney-in-fact and any other parties who may need to recognize it, such as schools or healthcare providers.
Once you have completed these steps, your DA Form 5841 is ready for use. Keep the original in a safe place and ensure that your attorney-in-fact is aware of their responsibilities and has access to the document when needed. Remember, keeping communication open with all parties involved will help facilitate a smooth process in your absence.
More About Da 5841 R
What is DA Form 5841 R?
DA Form 5841 is a special power of attorney that allows you to designate a person to take care of your children in your absence. This form grants specific authority for the appointed individual to manage responsibilities related to your child's health, education, and welfare.
Is using DA Form 5841 R required for my Family Care Plan?
No, you are not required to use DA Form 5841 for your Family Care Plan. While it serves a purpose, you have the option to seek legal assistance to create a different power of attorney that may suit your family's needs better.
Will the powers granted in DA Form 5841 R be honored everywhere?
The effectiveness of a power of attorney can vary based on local laws. It is crucial to check with doctors, schools, and other relevant parties to ensure they will recognize and honor the authority given in the DA Form 5841.
Who should I show the DA Form 5841 R to for it to be effective?
You should provide the DA Form 5841 to any relevant parties such as medical professionals, school officials, and other individuals who may need to honor this document. This ensures that they accept the responsibilities and authority you intend to delegate.
Can someone override the authority given in DA Form 5841 R?
Yes, a non-custodial parent or relative may still petition the court for custody of your children. While the DA Form 5841 grants authority to the designated guardian, it does not prevent legal actions from other family members under certain circumstances.
What happens if the designated attorney-in-fact does not fulfill their duties?
If the individual you have appointed does not adequately perform the responsibilities outlined in the DA Form 5841, it may require legal intervention. You should consider appointing someone trustworthy and capable of managing the responsibilities of childcare.
What should I do if the DA Form 5841 R is not accepted by certain institutions?
If specific institutions or individuals are unwilling to accept the DA Form 5841, request clarification from them about what they need in order to honor a power of attorney. You may need to obtain different documentation or legal assistance to ensure the best arrangements for your children.
Does DA Form 5841 R remain valid if I become incapacitated?
Yes, the DA Form 5841 is categorized as a durable power of attorney, meaning it remains effective even if you become disabled, incapacitated, or incompetent. This feature ensures your designated guardian can still act on behalf of your children when necessary.
What is the process for revoking the DA Form 5841 R?
You can revoke the DA Form 5841 at any time. To do this, you should notify the designated attorney-in-fact and any relevant institutions in writing. It’s advisable to consult with legal assistance to make sure the revocation is processed correctly and recognized by all parties involved.
Common mistakes
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Failing to provide complete personal information. Applicants must include full names, Social Security numbers, and addresses for all parties involved. Incomplete information can lead to issues in executing the Power of Attorney.
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Not specifying the duration for which the Power of Attorney will be effective. It is essential to include an expiration date or indicate if the document is intended to be durable.
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Overlooking the necessity for notarization. A Power of Attorney typically requires the signature of a notary public to ensure its validity. Without notarization, the document may not be honored.
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Neglecting to inform relevant individuals and institutions about the Power of Attorney. It is crucial to ensure that doctors, schools, and other entities are aware of the document's existence and will recognize it.
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Using outdated forms or versions of the DA Form 5841. Make sure to use the most recent version of the form. Outdated documents may not comply with current regulations.
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Not seeking legal advice when necessary. Individuals should understand their rights and responsibilities. Consulting a legal expert can provide clarity and safeguard against potential issues.
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Assigning a guardian without evaluating their suitability. Before designating a guardian, it’s essential to consider their ability to care for the child effectively.
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Failing to revoke the Power of Attorney if circumstances change. If personal situations evolve, it is important to formally revoke the existing Power of Attorney to prevent future misunderstandings.
Documents used along the form
The DA Form 5841 serves as a crucial document for military families, allowing parents to designate guardians for their children during their absence. Several other forms and documents can complement this power of attorney, ensuring comprehensive care and support for children. Understanding these documents can help you make informed decisions that best serve your family’s needs.
- DA Form 1746: This form is used to apply for residency at an installation and may include the request to establish a Family Care Plan. It ensures that the necessary arrangements are made for your dependents while you are away on duty.
- DA Form 5305: This is the Family Care Plan, which outlines where your children will be cared for in your absence. It details all essential information that caregivers will need to ensure your child's well-being, including emergency contacts and a list of medical needs.
- DA Form 602: This form is known as the Application for Family Care Plan Counseling and serves to document the need for a Family Care Plan. It makes a formal request for assistance in creating or revising a plan that includes custody arrangements.
- State-Specific Power of Attorney Forms: Various states offer their own versions of power of attorney forms. These may provide additional or alternative options tailored to the laws of your state, ensuring your designated guardian has the necessary authority to care for your child.
Gathering and understanding these forms can help ensure your children's needs are met while you fulfill your military duties. It is always advisable to consult with a legal professional to ensure that all documentation aligns with current laws and regulations, assuring peace of mind for you and your family.
Similar forms
The DA Form 5841 R is similar to the General Power of Attorney (GPOA), which is a document that allows an individual to appoint another person to handle a wide array of legal and financial matters. Like the DA Form 5841 R, the GPOA grants broad authority to the agent, allowing them to make decisions in the best interest of the principal. However, the primary distinction lies in the specific context of the DA Form 5841 R, which is designed specifically for issues related to child care during a service member's absence.
Another document comparable to the DA Form 5841 R is the Special Power of Attorney (SPOA). This document is often tailored to grant specific powers to an agent for particular functions, such as managing day-to-day decisions for a child, similar to the child care designation in the DA Form 5841 R. Both documents empower another individual to act on behalf of the principal, but the context of use differs, with DA Form 5841 R primarily focusing on child guardianship.
The Child Guardianship Agreement serves a purpose akin to the DA Form 5841 R, emphasizing the establishment of guardianship rights for a minor child. This agreement outlines the rights and responsibilities of the guardian, ensuring that the child's welfare is prioritized in the absence of the parent. While both documents assign guardianship, the Child Guardianship Agreement is generally not a legally recognized form until it is sanctioned by a court, unlike the DA Form 5841 R, which may not require legal intervention depending on the situation.
The Medical Power of Attorney (MPOA) is similarly aligned with the DA Form 5841 R, specifically in the healthcare domain. The MPOA designates an individual to make medical decisions on behalf of another person in case of incapacity. Just like the DA Form 5841 R grants authority for medical decisions regarding the children, the MPOA permits an agent to make vital healthcare choices, but it does not encompass guardianship responsibilities outside of medical matters.
The Caregiver Agreement, much like the DA Form 5841 R, formalizes the caregiving arrangement for a child or dependent. This document allows parents to outline essential care duties and responsibilities for the appointed caregiver. However, unlike the DA Form 5841 R, which is recognized by various institutions, a Caregiver Agreement may not have the same legal standing and recognition unless it is validated by a court or other legal authority.
The Adoption Power of Attorney functions similarly to the DA Form 5841 R in that it allows a designated individual to act on behalf of a child's needs. This document grants authority specifically concerning adoption proceedings. While the DA Form 5841 R focuses on temporary guardianship in the absence of a parent, the Adoption Power of Attorney is a more permanent arrangement aimed explicitly at transferring parental rights for adoption purposes.
Finally, the Temporary Custody Agreement shares a relationship with the DA Form 5841 R by allowing for a temporary arrangement regarding the care of children. This document is often used between parents and third parties to establish custodial rights for a specified period. While the DA Form 5841 R is designed for short-term use related to military obligations, the Temporary Custody Agreement may involve more complex arrangements, such as custody during divorce proceedings or other family matters.
Dos and Don'ts
When filling out the DA 5841 R form, there are several important guidelines to follow. Below is a list of things you should and shouldn't do:
- Do ensure that all personal information is accurate, including names and addresses.
- Do retain copies of the completed form for your records.
- Do consult with legal assistance if you have questions about the power of attorney.
- Do share the signed form with relevant individuals, such as teachers and healthcare providers.
- Don't assume that a power of attorney will be recognized everywhere; confirm its validity with potential guardians.
- Don't leave any sections of the form blank, as incomplete information may cause issues.
- Don't forget to have the form notarized to ensure its validity.
Misconceptions
- Misconception 1: The DA 5841 R form is mandatory for all military families.
- Misconception 2: This power of attorney grants unrestricted authority to the designated guardian.
- Misconception 3: A power of attorney guarantees that all parties will recognize it.
- Misconception 4: The DA 5841 R form is effective in all states.
- Misconception 5: This form prevents non-custodial parents from seeking custody.
- Misconception 6: Once the DA 5841 is signed, it cannot be changed.
- Misconception 7: The power of attorney ceases to be effective if the parent becomes incapacitated.
In reality, the DA 5841 is just one option for establishing a power of attorney. Parents are not required to use this specific form and may choose to create a different power of attorney if they wish.
The form does provide significant powers to the guardian, but it does not allow them to override legal requirements or make decisions beyond what is necessary for the child’s health and welfare.
Not all entities are required to honor this form. It’s crucial to present the DA 5841 to doctors, schools, and other relevant institutions beforehand to ensure they will accept it.
The effectiveness of a power of attorney can vary based on state laws. It is advisable to confirm that the form complies with local regulations to ensure it is legally binding.
Even with the DA 5841 in place, non-custodial parents or relatives can still petition for custody through the courts. The power of attorney does not interfere with these rights.
Parents can revoke or update the DA 5841 whenever necessary. Keeping this document aligned with current circumstances is key to ensuring the child's welfare.
This form is designed to be a durable power of attorney, meaning it remains valid even if the parent becomes incapacitated. This can provide peace of mind in challenging situations.
Key takeaways
Here are the key takeaways for filling out and using the DA Form 5841 R:
- Purpose: The DA Form 5841 is designed to appoint someone to care for your child(ren) in your absence.
- Not Mandatory: You are not required to use this form for your Family Care Plan.
- Legal Advice: Consider seeking legal assistance for drafting a different POA that meets your specific needs.
- Effectiveness: A POA may not be valid in all situations, depending on local laws where your child(ren) will live.
- Disclosure: It is mandatory to provide a Family Care Plan, as failure can lead to disciplinary actions.
- Inform Key Parties: Show the POA to doctors, school officials, and others who need to recognize it for your child(ren) to receive care.
- Recognition: Always verify that institutions will accept the POA before relying on it.
- Other Custodial Rights: A POA does not prevent others, like non-custodial parents, from seeking custody through the court.
- Durable Power: This is a durable power of attorney, remaining effective even if you become incapacitated.
- Expiration: Specify an expiration date, but understand it may remain valid if you're declared missing or detained by military authorities.