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The DA Form 5840 serves as the Certificate of Acceptance as Guardian or Escort, a vital document designed to ensure the well-being of a soldier's children during their absence. This form plays a crucial role within military families, particularly under circumstances where a soldier may be deployed or otherwise unable to fulfill their parental responsibilities. Individuals in the role of guardian must explicitly agree to care for these children and accept responsibility for their various needs, including financial, medical, educational, and subsistence support. Clear guidelines exist regarding the completion of this form, which requires the guardian to provide personal information, such as their name, signature, and contact details. Additionally, the form must be accompanied by relevant powers of attorney or similar documentation to affirm the guardian's authority. It is imperative for soldiers to complete this form accurately, as any omission or inaccuracy may jeopardize their Family Care Plan, a structured approach to ensuring their children’s welfare. The legal framework supporting the DA Form 5840 is grounded in Army Regulation 600-20 and is enforced under the authority of the Secretary of the Army. Understanding its significance and implications can enhance the stability and security of military families during challenging times.

Da 5840 Example

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

Form Characteristics

Fact Name Details
Purpose The DA 5840 form serves as a Certificate of Acceptance as Guardian or Escort for a soldier's child or children in the event of the soldier's absence.
Governing Law This form is governed under Army Regulation 600-20 and 10 U.S.C. Section 3013.
Authority The authority for this form stems from the Secretary of the Army.
Routine Uses The form does not have any routine uses associated with its submission.
Disclosure Disclosure of information requested in this form is voluntary, although failure to provide all necessary information may lead to the rejection of a soldier's Family Care Plan.
Financial Responsibility Guardians must confirm that they have received all the necessary resources to provide support for the child's financial, medical, educational, and subsistence needs.
Access to Services The guardian must be briefed on accessing military and civilian facilities, services, benefits, and entitlements on behalf of the children.
Expiration of Notary Commission The notary public must indicate their commission expiration date on the form, which is required for validity.

Guidelines on Utilizing Da 5840

Filling out the DA Form 5840 is an important step for anyone assuming guardianship or escort duties for a soldier's children. This process ensures that all necessary information is accurately captured, allowing for a smooth transition of care.

  1. Obtain a copy of the DA Form 5840. Ensure you have the latest version.
  2. Identify the soldier's child(ren) for whom you will act as guardian or escort. Fill in their names and ages in the specified section.
  3. Provide the name of the soldier you are acting for by entering it in the appropriate section.
  4. Confirm your agreement to accept responsibility for the listed family members. This is typically done by checking a box or signing a statement.
  5. Gather and review all necessary documents that relate to financial, medical, educational, quarters, and subsistence support for the children.
  6. Brief yourself on the procedures for accessing military and civilian services and benefits for the children. This ensures you are prepared to meet their needs.
  7. Fill in your typed or printed name, address (including ZIP code), telephone number (with area code), and email address in the designated fields.
  8. Sign and date the form in the appropriate section. Use the format YYYY/MM/DD for the date.
  9. Find a notary public to acknowledge your signature. Complete the notary section with the date and details as needed.

What You Should Know About This Form

What is the purpose of the DA Form 5840?

The DA Form 5840 is a Certificate of Acceptance as Guardian or Escort. Its main purpose is to document the agreement of a designated individual to assume responsibility for caring for a soldier’s child or children while the soldier is absent. This form is part of the soldier's Family Care Plan, ensuring that proper arrangements are in place for their dependents in times of need.

Who is required to fill out the DA Form 5840?

This form is typically filled out by a soldier who needs to designate a guardian or escort for their children. It is essential for soldiers who may be deployed or otherwise unable to care for their dependents. The selected guardian or escort must agree to take on this responsibility by signing the form.

What information is needed to complete the DA Form 5840?

To complete the DA Form 5840, the guardian must provide their full name, address, contact information, and the names and ages of the children they will be responsible for. Additionally, the guardian must confirm receipt of necessary documents that relate to financial, medical, educational, and other support for the children.

Is it mandatory to use the DA Form 5840?

What happens if the information is not fully provided on the DA Form 5840?

If the requested information is not fully provided, the soldier’s Family Care Plan may be rejected. This could have significant implications for both the soldier and their dependents. It is crucial for guardians to be diligent in filling out the form completely to avoid any potential issues.

Who can act as a guardian or escort on the DA Form 5840?

A guardian or escort can be any responsible adult who is willing and able to take on the responsibilities of caring for the soldier's children. This can include family members, friends, or trusted individuals who meet the soldier’s criteria for someone to act in this capacity.

Is there a notary requirement for the DA Form 5840?

Yes, the DA Form 5840 must be acknowledged by a notary public. This step adds an additional layer of verification and ensures the authenticity of the signatures on the form. The notary will confirm the identity of the guardian and the date when the form is signed.

Can the DA Form 5840 be updated or changed after submission?

If circumstances change, such as a change in guardianship, the DA Form 5840 can be updated. A new form will need to be filled out and notarized to reflect the changes accurately. It is important to keep the Family Care Plan current to ensure the best care for the dependents involved.

Common mistakes

When filling out the DA Form 5840, individuals often overlook key sections that could lead to complications. One common mistake is neglecting to provide complete information for both the guardian and the family members. This includes not only their names but also their ages. Inadequate details can result in confusion during processing and delay in establishing care.

Another frequent error involves the signature. Some applicants forget to sign the document entirely or fail to date it correctly. A missing signature or incorrect date may render the form invalid, requiring a complete resubmission to rectify the oversight. It is crucial to double-check the form for these elements before submission.

Individuals also sometimes misinterpret the requirements regarding supporting documents. The form requires certain documents to establish authority as a guardian or escort. Omitting these documents can lead to rejection of the Family Care Plan. Always ensure that you gather and attach all necessary paperwork to avoid complications.

In addition, many tend to ignore the importance of reviewing the contact information. Entering incorrect telephone numbers or email addresses can lead to missed communications from military authorities. It’s essential to provide accurate and up-to-date information for effective correspondence.

Moreover, some people fail to understand the significance of the notary section. The acknowledgment by a notary public is not merely a formality; it is a standard requirement for the form’s acceptance. Skipping this step can cause the entire form to be rejected.

Lastly, another common pitfall is not familiarizing themselves with the privacy act statement. Understanding how this form interacts with personal data can prevent unforeseen issues in the future. Ensure you read and comprehend the privacy implications before submission.

Documents used along the form

The DA Form 5840 serves as a certificate of acceptance as a guardian or escort, primarily for military personnel who are designating a guardian for their dependents during their absence. Several other forms may accompany this document to ensure that all legal and logistical aspects are appropriately addressed. Below is a list of commonly used forms and documents that may be required alongside the DA Form 5840.

  • DA Form 5841 (Power of Attorney): This form grants legal authority to another individual, allowing them to make decisions and act on behalf of the service member regarding the care and well-being of their dependents.
  • DA Form 365-4 (Family Care Plan) : This document outlines the specific care plan for a soldier's dependents. It details how the dependents will be cared for in the absence of the soldier, including the roles of guardians or escorts.
  • DD Form 1172 (Application for Uniformed Services Identification Card): This form is used to apply for military identification cards for dependents. It may be necessary for the guardian to have access to various military services and benefits.
  • DA Form 137-3 (Unit Clearance Record): This is used to document that a service member has met all requirements, including family care obligations, before leaving the duty station or being deployed.
  • Service Member's Official Orders: These documents provide evidence of a service member's deployment or assignment. They are crucial for verifying the circumstances under which a guardian has been designated.
  • Medical Consent Form: This document allows the guardian to make medical decisions on behalf of the dependents. It is essential for ensuring that the guardian can act in emergencies where medical care is required.
  • School Notification Letter: If the dependents are school-aged children, this letter informs the school of the guardian’s status and the temporary change in guardianship.
  • Social Security Forms: Depending on the situation, these forms may be required for benefits or support from the government for the dependents.
  • Emergency Contact Information: This may be a basic list of contacts, including family members and friends, that the guardian can reach out to for additional support or information.

These forms and documents collectively help create a comprehensive framework for managing a service member's family responsibilities during their absence. Ensuring that each is completed accurately can aid in smoother transitions and caretaking arrangements for dependents.

Similar forms

The DA Form 5840, Certificate of Acceptance as Guardian or Escort, serves a specific purpose in the management of family care plans for soldiers. Below are six documents that are similar to the DA 5840 form, with a brief description of how they relate.

  • DA Form 5841 (Power of Attorney): This form allows an individual to designate another person to act on their behalf. Like the DA 5840, it establishes someone’s authority to care for the soldier's dependents.
  • DA Form 5001 (Request for Family Care Plan): This form is used to request approval for a family care plan. Both documents ensure proper arrangements for soldier’s family members in their absence.
  • DD Form 1172-2 (Application for Department of Defense Benefits): This form applies to military family members. Similar to the DA 5840, it contains critical information needed for accessing military benefits.
  • DA Form 2273 (Application for Reassignment or Transfer): This document is used to apply for a change in duty station. Both forms help facilitate the soldier’s responsibilities toward their family members in different circumstances.
  • DA Form 5016 (Army Family Care Plan Counseling Checklist): This checklist outlines requirements for family care plans. It complements the DA 5840 by ensuring all necessary measures are considered.
  • DD Form 1363 (Child Custody Agreement): This form deals with legal guardianship and custody matters. It shares similarities with the DA 5840 in that both ensure the well-being of the soldier’s dependents during their absence.

Dos and Don'ts

When filling out the DA 5840 form, there are important dos and don’ts to keep in mind. Here’s a simple guide to help ensure everything goes smoothly.

  • Do provide accurate and complete information about yourself and the family members you will be caring for.
  • Do include your contact information, such as phone number and email address, for any follow-up questions.
  • Do read all instructions carefully before starting to fill out the form.
  • Do sign and date the form to confirm your agreement and acceptance of the responsibilities.
  • Do check that you have all necessary supporting documents ready to submit with the form.
  • Don’t leave any required fields blank; missing information may cause delays.
  • Don’t forget to keep a copy of the completed form for your records.
  • Don’t use illegible handwriting; ensure that all written information is clear.
  • Don’t submit the form without verifying that all information is correct.
  • Don’t delay. Submit the form as soon as it is completed to avoid complications later.

Misconceptions

The DA 5840 form, known as the Certificate of Acceptance as Guardian or Escort, is crucial for service members needing to designate someone to care for their children during their absence. However, several misconceptions about this form persist. Here are eight of them:

  • It is mandatory for all service members. Not all service members need to complete the DA 5840. This form is specifically for those who have children and are drafting a Family Care Plan.
  • Only active-duty soldiers can use this form. This form can be utilized by any service member, including reservists and National Guard members, as long as they are drafting a Family Care Plan.
  • Filling out the form guarantees custody of the children. This form does not confer legal custody. Instead, it outlines the guardian's responsibilities in the absence of the soldier.
  • The guardian has full control over medical decisions. While the guardian can provide care, they may not have the authority to make significant medical decisions unless specifically granted through a Power of Attorney.
  • Once completed, the form never needs to be updated. This is incorrect. Service members should review and update this form regularly, especially if there are changes in guardianship or family circumstances.
  • This form is filed with the child's school. The DA 5840 form is not a school document. It should be kept with the service member’s personal files and shared with relevant parties as needed.
  • A notary public is not required for this form. A notary public must acknowledge the form to ensure its authenticity and compliance with legal requirements.
  • Incomplete forms are still acceptable. Submitting an incomplete DA 5840 can lead to rejection of the Family Care Plan. It is essential that all requested information is provided.

Understanding these misconceptions is vital. Properly completing and maintaining the DA 5840 form can significantly impact the care of a service member's children during their absence and ensure their needs are met.

Key takeaways

  • Filling out the DA Form 5840 is essential for a guardian or escort who will take responsibility for a soldier’s children in their absence. This form acts as a formal agreement that shows you understand your obligations.

  • Prior to signing, ensure that you receive an original DA Form 5841 (Power of Attorney) or another legally recognized document confirming your role as guardian or escort. This documentation is crucial for legality and compliance.

  • Provide complete and accurate information. Any omissions or errors may lead to delays or rejection of the soldier’s Family Care Plan, potentially impacting their military service.

  • Be prepared to support the family members financially, medically, and educationally. The form states that you must have the necessary documents to provide this support, so gather all relevant information before applying.

  • The signature section must be filled out correctly, including your name, address, and contact details. Additionally, a notary public must acknowledge the form, lending it credibility and legal weight.