Content Navigation

The DA Form 5840, also known as the Certificate of Acceptance as Guardian or Escort, plays a vital role in ensuring the welfare of a soldier's family members during their absence. This form is utilized under the authority of Army Regulation 600-20, which outlines the policies regarding family care in the military. It serves as a formal agreement in which a designated guardian commits to caring for a soldier’s children, ensuring they receive the necessary support in areas such as financial, medical, and educational needs. The form requires the guardian to acknowledge their responsibilities and confirm they have been briefed on how to access military and civilian services for the family members in their care. While the completion of this form is voluntary, it is crucial for soldiers to provide accurate information to avoid complications with their Family Care Plan. The DA Form 5840 includes spaces for the guardian's personal details, signatures, and even a notary section to validate the agreement. This comprehensive approach ensures that the responsibilities and expectations of guardianship are clearly understood and legally recognized, thereby safeguarding the well-being of the soldier's dependents.

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

File Breakdown

Fact Name Description
Purpose The DA Form 5840 serves as a Certificate of Acceptance as Guardian or Escort, allowing a designated individual to care for a soldier's child(ren) during the soldier's absence.
Governing Law This form is governed by 10 U.S.C. Section 3013 and Army Regulation 600-20, which outlines the Army Command Policy.
Privacy Act Statement Disclosure of information on the form is voluntary. However, failing to provide requested information may result in the rejection of a soldier's Family Care Plan.
Notary Requirement The form must be acknowledged before a notary public, which adds a layer of legal validation to the guardian's acceptance of responsibility.

Guide to Using Da 5840

Completing the DA Form 5840 is a crucial step for anyone assuming the role of guardian or escort for a soldier's child or children. This form ensures that all necessary information is accurately captured, which is vital for the soldier's Family Care Plan. Below are the steps to fill out the form correctly.

  1. Begin by entering the name(s) and age(s) of the family members you will be responsible for in the designated section.
  2. Next, provide the name(s) of the soldier whose family members you are caring for.
  3. In the agreement section, confirm your acceptance of responsibility for the family members by checking the appropriate box or signing where indicated.
  4. Ensure that you have received all necessary documents required for financial, medical, educational, quarters, and subsistence support. This is essential for providing adequate care.
  5. Indicate that you have been briefed on the procedures for accessing military and civilian facilities, services, benefits, and entitlements on behalf of the family members.
  6. Type or print your name in the section provided for the guardian.
  7. Fill in your complete address, including the ZIP code.
  8. Sign and date the form, using the format YYYY/MM/DD for the date.
  9. Include your telephone number with the area code and your email address in the respective fields.
  10. Lastly, if required, have the form notarized. The notary will fill in the state, county, and date, and provide their commission expiration date.

Get Answers on Da 5840

What is the purpose of the DA Form 5840?

The DA Form 5840, also known as the Certificate of Acceptance as Guardian or Escort, serves a crucial role in the Army. Its primary purpose is to formalize a guardian's agreement to care for a soldier's child or children during the soldier's absence. This ensures that the child’s needs are met and that there is a responsible adult designated to provide support.

Who should use the DA Form 5840?

This form is intended for soldiers who need to designate a guardian or escort for their dependents. Typically, this situation arises when a soldier is deployed or otherwise unable to care for their children. The guardian must be someone who can provide for the child’s financial, medical, educational, and daily needs.

What information is required on the DA Form 5840?

When filling out the DA Form 5840, several key pieces of information are necessary:

  1. The name(s) and age(s) of the family members for whom the guardian is responsible.
  2. The name of the soldier who is designating the guardian.
  3. The guardian's contact information, including address, telephone number, and email address.
  4. The guardian's signature and the date of signing.

Additionally, the guardian must acknowledge receipt of necessary documents and information regarding support services for the family members.

Is the DA Form 5840 mandatory?

While the DA Form 5840 is not legally required in all situations, it is highly recommended. Completing this form helps ensure that the soldier's Family Care Plan is accepted and effective. Failure to provide the requested information could lead to complications in the soldier's Family Care Plan, potentially affecting the well-being of the dependents.

What happens if the information on the DA Form 5840 is incomplete?

If the DA Form 5840 is submitted with incomplete information, it may be rejected. This rejection can delay the establishment of a Family Care Plan, which is essential for ensuring that the soldier's dependents are cared for appropriately. It is crucial to provide all necessary details to avoid any issues.

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

The Privacy Act governs the collection, maintenance, and dissemination of personal information contained in the DA Form 5840. The information provided is considered sensitive, and the Army is obligated to protect it. The form specifies that disclosure is voluntary, but providing complete and accurate information is vital for the Family Care Plan's success.

What should I do if I have questions about completing the DA Form 5840?

If you have questions or need assistance with the DA Form 5840, consider reaching out to your unit's administrative office or legal assistance office. They can provide guidance on the form and ensure that you understand the responsibilities associated with being a guardian or escort.

Common mistakes

Filling out the DA 5840 form can be a straightforward process, but many individuals make common mistakes that can lead to complications. One frequent error is failing to provide complete information. Every section of the form is essential. Omitting details such as the names and ages of family members can result in rejection of the Family Care Plan.

Another common mistake involves not signing the form. A signature is crucial to validate the guardian's acceptance of responsibility. Without it, the form is incomplete and cannot be processed. Additionally, the date must be filled out correctly. Using the wrong format or leaving the date blank can cause delays in approval.

Many people also overlook the importance of the notary section. This part requires a notary public to acknowledge the guardian's signature. Neglecting to have this section completed can render the form invalid. It is essential to ensure that the notary's details, including their commission expiration date, are correctly filled in.

Providing incorrect contact information is another mistake that can hinder communication. The form requires a valid telephone number and email address. If these details are inaccurate or missing, it may lead to difficulties in accessing necessary services for the family members.

Some individuals fail to review the entire form before submission. Double-checking for errors or omissions can save time and prevent rejections. Taking a moment to ensure that all sections are filled out accurately can make a significant difference.

Lastly, misunderstanding the requirements for supporting documents is a common pitfall. The form states that guardians must receive all necessary documents for financial, medical, and educational support. Without these documents, the guardian may struggle to provide adequate care, which could lead to further complications.

Documents used along the form

The DA Form 5840 is important for establishing a guardian or escort for a soldier's child or children. Along with this form, several other documents may be necessary to ensure all legal and procedural requirements are met. Below are some commonly used forms and documents that often accompany the DA Form 5840.

  • DA Form 5841 (Power of Attorney): This form allows a soldier to designate a person to act on their behalf in legal matters. It grants the guardian the authority to make decisions regarding the soldier's family members while they are away.
  • DA Form 5305 (Family Care Plan): This form outlines the arrangements made for a soldier's dependents during their absence. It includes details about guardianship, living arrangements, and support for the dependents.
  • DA Form 2823 (Sworn Statement): This document is a written statement made under oath. It can be used to provide additional information or clarification regarding the guardian's responsibilities or the family situation.
  • DD Form 1172 (Application for Uniformed Services Identification Card): This form is used to apply for an ID card for dependents of military personnel. It helps ensure that family members can access benefits and services while the soldier is away.

These documents work together to create a comprehensive plan for the care and support of a soldier's family members. It is essential to ensure that all forms are completed accurately to avoid any issues during the absence of the soldier.

Similar forms

The DA 5840 form, which serves as a certificate of acceptance as guardian or escort, shares similarities with several other documents. Each of these documents plays a role in establishing legal responsibilities and rights regarding the care of individuals, particularly children. Below is a list of documents that are similar to the DA 5840 form:

  • DA Form 5841 (Power of Attorney): This document grants someone the authority to act on behalf of another person. Like the DA 5840, it is essential for managing the affairs of a soldier's family during their absence.
  • Child Custody Agreement: This legal document outlines the arrangements for the care of a child. It specifies who has the right to make decisions for the child, similar to how the DA 5840 assigns guardianship responsibilities.
  • Temporary Guardianship Form: This form allows a parent to designate someone to take care of their child for a limited time. It parallels the DA 5840 in establishing temporary care arrangements.
  • Foster Care Agreement: This document is used when a child is placed in foster care. It shares the same goal of ensuring the child's welfare, much like the responsibilities outlined in the DA 5840.
  • Medical Power of Attorney: This form allows an individual to make medical decisions for another person. It is similar to the DA 5840 in that it grants authority to care for someone else's well-being.
  • Educational Power of Attorney: This document permits someone to make educational decisions for a child. Like the DA 5840, it ensures that the child's educational needs are met in the absence of the parent.
  • Declaration of Guardian: This legal declaration appoints a guardian for a child in case of emergencies. It is similar to the DA 5840 in its intent to ensure the child's safety and care.
  • Family Care Plan: This plan outlines how a soldier's family will be cared for in their absence. It is closely related to the DA 5840 as it emphasizes the importance of planning for family needs.
  • Notarized Affidavit of Guardianship: This document is used to affirm someone's role as a guardian. It is akin to the DA 5840 in formalizing the guardian's responsibilities.

Understanding these documents can help ensure that the necessary legal protections and responsibilities are in place for the care of family members. Each serves a specific purpose, but they all share the common goal of safeguarding the well-being of those in need.

Dos and Don'ts

When filling out the DA 5840 form, it is essential to follow specific guidelines to ensure your submission is accurate and complete. Here’s a list of things you should and shouldn’t do:

  • Do read the instructions carefully before starting to fill out the form.
  • Do provide all required information, including the names and ages of family members.
  • Do ensure that your contact information is accurate, including your phone number and email address.
  • Do sign and date the form where indicated.
  • Do keep a copy of the completed form for your records.
  • Don't leave any sections blank unless instructed to do so.
  • Don't use nicknames; always use full legal names.
  • Don't forget to check for spelling errors before submitting the form.
  • Don't submit the form without a notary signature if required.
  • Don't rush through the process; take your time to ensure accuracy.

Misconceptions

Understanding the DA 5840 form is crucial for those involved in military family care planning. Unfortunately, there are several misconceptions surrounding this form that can lead to confusion. Here are six common misconceptions explained:

  • The DA 5840 form is only for active-duty soldiers. This form is applicable to any soldier who has family care responsibilities, including reservists and National Guard members.
  • Completing the DA 5840 form guarantees approval of the Family Care Plan. While the form is necessary for the plan, approval depends on meeting all requirements set forth by military regulations.
  • The DA 5840 form does not require notarization. In fact, notarization is often required to validate the guardian's acceptance and ensure the form's legality.
  • Only one guardian can be named on the DA 5840 form. Multiple guardians can be designated, allowing for flexibility in care arrangements for the soldier's family members.
  • The DA 5840 form is a one-time requirement. This form may need to be updated or resubmitted if there are changes in circumstances, such as a change in the guardian or the soldier's deployment status.
  • Filling out the DA 5840 form is optional. While it may seem voluntary, not completing this form can lead to complications in the soldier's Family Care Plan and may affect the soldier's readiness and benefits.

It is essential to approach the completion of the DA 5840 form with a clear understanding of its purpose and requirements. By dispelling these misconceptions, individuals can ensure they are better prepared to fulfill their responsibilities as guardians or escorts for military family members.

Key takeaways

When filling out the DA 5840 form, which serves as a Certificate of Acceptance as Guardian or Escort, it is essential to understand its purpose and requirements. Here are some key takeaways to keep in mind:

  • Understand the Purpose: This form is used to designate a guardian for a soldier's child(ren) during their absence.
  • Legal Authority: The form is governed by Army Regulation 600-20, which outlines the policies regarding family care plans.
  • Voluntary Disclosure: While providing information is voluntary, incomplete submissions may lead to the rejection of the Family Care Plan.
  • Required Documentation: Ensure you have the original DA Form 5841 (Power of Attorney) or equivalent legal documents to establish your role as guardian.
  • Responsibility Acknowledgment: By signing the form, you agree to take on the responsibility for the specified family members.
  • Support Services: Familiarize yourself with the necessary documents to provide support in areas such as financial, medical, educational, and subsistence needs.
  • Access to Benefits: Understand the procedures for accessing military and civilian facilities, services, benefits, and entitlements for the family members.
  • Complete Contact Information: Provide your typed or printed name, address, phone number, and email address accurately.
  • Notarization Requirement: The form must be notarized, confirming your identity and the authenticity of your signature.

Filling out the DA 5840 form accurately and completely is crucial for ensuring that the soldier's family members receive the necessary support in their absence. Taking the time to understand each section will facilitate a smoother process.