Homepage Blank Da 5840 PDF Form
Article Guide

The DA Form 5840, also known as the Certificate of Acceptance as Guardian or Escort, plays a crucial role in ensuring the well-being of soldiers' children during their absence. This form is utilized under Army Regulation 600-20 and serves as a formal agreement where a designated guardian commits to caring for a soldier’s child or children. It outlines the responsibilities that come with this role, including financial, medical, educational, and subsistence support. By completing this form, the guardian acknowledges their acceptance of these duties and confirms they have received all necessary documents to fulfill them. Additionally, the form requires the guardian to be briefed on how to access military and civilian facilities, services, benefits, and entitlements for the children in their care. It's important to note that while the information requested is voluntary, failing to provide it may result in the rejection of a soldier's Family Care Plan. The DA Form 5840 is not just a bureaucratic requirement; it is a vital tool that helps ensure that military families are supported during challenging times.

Document Preview

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 Specifications

Fact Name Description
Form Title CERTIFICATE OF ACCEPTANCE AS GUARDIAN OR ESCORT
Governing Law 10 U.S.C. Section 3013, Secretary of the Army; Army Regulation 600-20
Purpose To document a guardian's agreement to care for a soldier's child(ren) during their absence.
Routine Uses None specified.
Disclosure Information Voluntary; failure to provide requested information may lead to rejection of a soldier's Family Care Plan.
Required Documents Guardian must receive necessary documents for financial, medical, educational, and subsistence support.
Notary Requirement Signature must be acknowledged by a notary public.

Da 5840: Usage Guidelines

Filling out the DA 5840 form is an important step for guardians or escorts of soldiers' children. This form serves as a certificate of acceptance, confirming the guardian's commitment to care for the child or children in the absence of the soldier. To ensure the form is completed correctly, follow these steps carefully.

  1. Obtain the Form: Download or print the DA 5840 form from a reliable source.
  2. Fill in Your Information: Start by entering your typed or printed name in the designated space.
  3. Provide Your Address: Include your full address, making sure to add the ZIP code.
  4. Sign and Date: Sign the form and write the date in the format YYYY/MM/DD.
  5. Enter Your Contact Information: Fill in your telephone number, including the area code, and your email address.
  6. List Family Members: Write the names and ages of the family members you will be responsible for.
  7. Confirm Your Agreement: Acknowledge that you accept responsibility for the family members listed.
  8. Gather Required Documents: Ensure you have all necessary documents for financial, medical, educational, and other support for the family members.
  9. Complete Notary Section: Have the notary public acknowledge your signature, including the date and their commission expiration.

After completing the form, review it for any errors or omissions. It’s essential to ensure all required information is accurate and complete before submission. This will help prevent any delays in processing your Family Care Plan.

Your Questions, Answered

What is the purpose of the DA Form 5840?

The DA Form 5840 serves as a Certificate of Acceptance as Guardian or Escort. It is used when a soldier designates someone to care for their child(ren) in their absence. This form ensures that the guardian understands their responsibilities and has received the necessary documents to provide for the family members.

Who needs to fill out the DA Form 5840?

This form must be completed by individuals who are appointed as guardians or escorts for a soldier's child(ren). The soldier must provide an original DA Form 5841 (Power of Attorney) or another legally sufficient authority to validate this appointment.

What information is required on the DA Form 5840?

The form requires the typed or printed name of the guardian, their address, signature, date, telephone number, and email address. Additionally, it includes the names and ages of the family members being cared for, as well as the name of the soldier.

What happens if I do not provide all requested information?

Failure to provide all requested information can lead to the rejection of the soldier's Family Care Plan. It is crucial to complete the form accurately to ensure that the guardian's acceptance is recognized.

Do I need a notary for the DA Form 5840?

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

If you have questions, it is advisable to consult with a legal advisor or a representative from your unit's personnel office. They can provide guidance on the form and ensure that all requirements are met.

Where can I obtain a DA Form 5840?

The DA Form 5840 can typically be obtained from your unit's administrative office or downloaded from official military websites. Ensure you are using the most current version of the form to avoid any issues.

Common mistakes

  1. Incomplete Information: One common mistake is not filling out all required fields. Ensure that every section is completed, including the names and ages of the family members. Leaving any part blank can lead to delays or rejection of the form.

  2. Incorrect Signature: It's vital to sign the form correctly. Many people forget to include their signature or sign in the wrong area. Always double-check that your signature is placed where indicated and that it matches the name printed on the form.

  3. Missing Notary Acknowledgment: The form requires notarization. Failing to have the form notarized can result in it being considered invalid. Make sure to visit a notary public and have them acknowledge your signature as required.

  4. Failure to Provide Contact Information: Another mistake is not including accurate contact information. This includes your telephone number and email address. Providing this information is essential for any follow-up communications regarding the form.

Documents used along the form

The DA Form 5840 is a crucial document for military families, specifically designed for guardians or escorts of soldiers' children. However, it often accompanies several other forms and documents that help ensure proper care and support for the family members involved. Below is a list of additional documents commonly used alongside the DA Form 5840.

  • DA Form 5841 (Power of Attorney): This form grants legal authority to the guardian or escort to make decisions on behalf of the soldier’s child(ren). It specifies the powers granted, which may include medical and financial decisions.
  • DA Form 5842 (Family Care Plan): This form outlines the soldier's plan for the care of their dependents in case of deployment or absence. It includes details about the designated guardian and the responsibilities they will assume.
  • DA Form 5305 (Family Care Plan Counseling Checklist): This checklist is used to ensure that soldiers understand the requirements and implications of their Family Care Plan. It serves as a guide for soldiers in preparing their plan.
  • DD Form 1172 (Application for Identification Card/DEERS Enrollment): This form is necessary for enrolling dependents in the Defense Enrollment Eligibility Reporting System (DEERS) and obtaining military ID cards for family members.
  • DD Form 214 (Certificate of Release or Discharge from Active Duty): While primarily used for veterans, this document can also provide important information about a soldier’s service, which may be relevant for guardianship and benefits.
  • Medical Records: These documents provide essential health information about the child(ren) and may include immunization records, allergies, and any ongoing medical treatments necessary for their care.
  • School Records: This includes transcripts, report cards, and enrollment information. They are important for the guardian to ensure the child(ren) continue their education without interruption.
  • Emergency Contact Information: A list of contacts who can be reached in case of an emergency. This document ensures that the guardian has immediate access to necessary support.
  • Financial Documents: These may include bank statements, proof of income, or other financial information that helps the guardian manage the financial needs of the child(ren).
  • Notarized Affidavit: A sworn statement that may be required to confirm the guardian’s authority and responsibility. This document adds an extra layer of legal assurance for the guardian’s role.

In conclusion, understanding the various forms and documents associated with the DA Form 5840 is essential for any guardian or escort. Each document plays a vital role in ensuring that the soldier's family members receive the support and care they need during the soldier's absence. Being well-prepared can make a significant difference in managing the responsibilities that come with guardianship.

Similar forms

The DA Form 5840 is a crucial document for military families, specifically for those who need to establish guardianship for their children in the absence of a soldier. Several other documents serve similar purposes in different contexts. Here’s a list of five such documents:

  • DA Form 5841 (Power of Attorney): This document allows a person to act on behalf of another in legal matters. Like the DA Form 5840, it designates someone to make decisions for a soldier, ensuring that the family’s needs are met during their absence.
  • Child Custody Agreement: This legal document outlines the arrangements for the care of children after a separation or divorce. It specifies who has the right to make decisions about the child's welfare, similar to how the DA Form 5840 defines guardianship responsibilities.
  • Guardianship Agreement: This is a formal arrangement where one person is appointed to care for another's minor child. It shares the same purpose as the DA Form 5840, ensuring that a responsible adult is designated to look after the child’s needs when the parent is unavailable.
  • Temporary Custody Order: Issued by a court, this document grants temporary custody of a child to someone other than the parent. Like the DA Form 5840, it provides legal authority for the caregiver to make decisions on behalf of the child.
  • Military Family Care Plan: This plan outlines how a soldier’s family will be cared for during their deployment. It includes provisions for guardianship, much like the DA Form 5840, ensuring that a soldier’s children are looked after while they serve.

Dos and Don'ts

When filling out the DA 5840 form, keep these important dos and don'ts in mind:

  • Do read the entire form carefully before starting.
  • Do provide accurate information for each section.
  • Do ensure that all names and ages of family members are correct.
  • Do sign and date the form where indicated.
  • Do include your contact information, such as phone number and email address.
  • Don't leave any sections blank; all requested information is necessary.
  • Don't use abbreviations or nicknames for names.
  • Don't forget to check for spelling errors before submitting.
  • Don't rush through the process; take your time to ensure accuracy.
  • Don't forget to have the form notarized if required.

Following these guidelines can help ensure that your form is completed correctly and accepted without delay.

Misconceptions

The DA Form 5840, known as the Certificate of Acceptance as Guardian or Escort, is an important document for military families. However, several misconceptions about this form can lead to confusion. Below are ten common misunderstandings.

  • It is mandatory for all military families. The DA Form 5840 is not required for every military family. It is specifically for those who need to designate a guardian for their children during their absence.
  • Only the soldier can fill it out. While the soldier initiates the form, the guardian must also provide their information and consent to accept the responsibilities outlined in the form.
  • The form guarantees custody of the child. The DA Form 5840 does not confer legal custody. It merely allows a designated individual to act on behalf of the soldier in specific situations.
  • It replaces a Power of Attorney. The DA Form 5840 does not replace a Power of Attorney. It serves a different purpose, focusing on guardianship rather than general legal authority.
  • Once submitted, it cannot be changed. The information on the form can be updated or changed as necessary. It is essential to keep the form current to reflect any changes in guardianship or family circumstances.
  • The form is only for children. While primarily used for children, the DA Form 5840 can also apply to other dependents, depending on the circumstances and the needs of the soldier.
  • Notarization is optional. Notarization is a crucial step in the process. It adds a layer of authenticity and ensures that the guardian's acceptance is legally recognized.
  • It is not necessary to provide supporting documents. The form requires that the guardian receives all necessary documents related to financial, medical, and educational support for the dependents.
  • Filling out the form is a quick process. Completing the DA Form 5840 can take time, as it involves gathering information and ensuring all parties understand their responsibilities.
  • Submitting the form guarantees access to benefits. While the form facilitates access to certain benefits, it does not automatically grant all entitlements. Eligibility for benefits may depend on additional criteria.

Understanding these misconceptions can help military families navigate the complexities of guardianship and ensure that their loved ones are cared for in their absence.

Key takeaways

The DA 5840 form, also known as the Certificate of Acceptance as Guardian or Escort, is an important document for military families. Here are key takeaways to understand its purpose and usage:

  • Purpose of the Form: This form is primarily used to designate a guardian for a soldier's child or children in the soldier's absence.
  • Authority: The form is authorized under Army Regulation 600-20, which outlines Army Command Policy.
  • Voluntary Disclosure: While completing the form is voluntary, not providing the requested information may lead to issues with the soldier’s Family Care Plan.
  • Responsibilities: The guardian must agree to accept responsibility for the designated family members and ensure their care.
  • Required Documents: The guardian should have all necessary documents to provide support, including financial, medical, educational, and subsistence needs.
  • Access to Services: Guardians must be briefed on how to access military and civilian facilities, services, benefits, and entitlements for the family members.
  • Notary Requirement: The form must be acknowledged by a notary public to validate the agreement and ensure legal recognition.

By understanding these key points, individuals can better navigate the responsibilities associated with the DA 5840 form, ensuring that family members receive the necessary care and support when a soldier is unavailable.