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Outline

The DA Form 5840, also known as the Certificate of Acceptance as Guardian or Escort, plays a crucial role in the lives of military families. This form is designed for guardians who agree to care for a soldier’s children during the soldier's absence. It is important to understand that this agreement is not merely a formality; it carries significant responsibilities and implications for both the guardian and the soldier. The form requires the guardian to acknowledge their acceptance of this role, providing essential details such as the names and ages of the children they will care for. Additionally, the guardian must confirm that they have received all necessary documents to support the children in areas such as finances, medical care, and education. This ensures that the children’s needs are met comprehensively. Furthermore, the form also includes a section for notary acknowledgment, which adds a layer of legal validation to the agreement. It is vital for guardians to complete this form accurately and thoroughly, as any omissions could jeopardize the soldier’s Family Care Plan. The DA Form 5840 is governed by Army Regulation 600-20, ensuring that it aligns with military policies and procedures. Understanding the significance and requirements of this form is essential for anyone stepping into the role of a guardian or escort for military family members.

Sample - Da 5840 Form

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.

Form Information

Fact Name Details
Form Title Certificate of Acceptance as Guardian or Escort
Governing Law 10 U.S.C. Section 3013, Secretary of the Army
Regulation Reference Army Regulation 600-20, Army Command Policy
Main Purpose To document a guardian's agreement to care for a soldier's child(ren) during their absence.
Routine Uses None specified for this form.
Disclosure Voluntary; however, incomplete information may lead to rejection of the soldier's Family Care Plan.
Required Documents Guardian must have received all necessary documents for support of family members.
Notary Requirement The form must be acknowledged by a Notary Public.

Detailed Guide for Filling Out Da 5840

Filling out the DA 5840 form is an important step in establishing your role as a guardian or escort for a soldier's children. After completing this form, you will be able to provide the necessary care and support for the family members in the soldier's absence. Here are the steps to fill out the form correctly:

  1. Begin by writing your typed or printed name in the designated space at the top of the form.
  2. Provide your complete address, including the ZIP code, below your name.
  3. In the section labeled NAME(s) / AGE(s) OF FAMILY MEMBERS, list the names and ages of the children you will be caring for.
  4. Next, write the NAME(s) of the soldier you are representing in the form.
  5. Sign the form in the SIGNATURE section to indicate your agreement to accept responsibility for the family members.
  6. Enter the date in the format YYYY/MM/DD to document when you signed the form.
  7. Provide your telephone number, including the area code, for contact purposes.
  8. Include your e-mail address in the appropriate section for additional communication.
  9. Find a notary public to acknowledge your signature. They will fill in the STATE OF and COUNTY OF sections, along with the date of acknowledgment.
  10. Finally, the notary will indicate their commission expiration date to complete the notarization process.

Once you have completed the DA 5840 form, ensure that all information is accurate and legible. This will help prevent any delays or issues with the soldier's Family Care Plan. Keep a copy for your records before submitting it as required.

Obtain Answers on Da 5840

  1. What is the purpose of the DA 5840 form?

    The DA 5840 form, officially 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 is essential for ensuring that the soldier's family is taken care of while they are away, whether due to deployment or other military obligations.

  2. Who needs to fill out the DA 5840 form?

    This form must be completed by individuals who are designated as guardians or escorts for the children of soldiers. Typically, this includes family members, friends, or other trusted individuals who have been given the responsibility of caring for the soldier's dependents. It is important that the guardian has the legal authority to act on behalf of the soldier's family, often supported by a DA Form 5841 (Power of Attorney) or other legal documents.

  3. What information is required on the DA 5840 form?

    The form requires several key pieces of information to ensure clarity and legal compliance:

    • The name(s) and age(s) of the family members being cared for.
    • The name of the soldier whose children are under the guardian's care.
    • The guardian's contact information, including address, telephone number, and email address.
    • A signature from the guardian, affirming their acceptance of responsibility.
    • Notary acknowledgment to validate the form.

    Providing complete and accurate information is vital, as any missing details could lead to complications with the soldier's Family Care Plan.

  4. Is the DA 5840 form mandatory?

    While filling out the DA 5840 form is voluntary, it is highly recommended for soldiers who have dependents. Not completing the form or providing incomplete information could result in the rejection of the soldier's Family Care Plan. This could create significant challenges for the soldier and their family during their absence. Therefore, it is in the best interest of the soldier to ensure that this form is accurately completed and submitted.

Common mistakes

Filling out the DA 5840 form, which is essential for establishing a guardian or escort for a soldier's child, requires attention to detail. One common mistake is neglecting to include the full names and ages of all family members. This information is crucial for the acceptance of the form. Omitting any details can lead to delays or rejection.

Another frequent error is failing to provide a complete address for the guardian. The form requires a full address, including the ZIP code. Incomplete address information can hinder communication and verification processes.

Some individuals forget to sign and date the form. This step is mandatory. Without a signature and date, the form is considered incomplete and will not be processed. Always double-check to ensure these critical elements are present.

Additionally, many people overlook the importance of providing a valid telephone number and email address. These contact details are necessary for any follow-up or clarification needed by the authorities. Missing this information can lead to unnecessary complications.

Another mistake is not including the necessary documentation that proves the guardian's authority. The form requires an original DA Form 5841 or another legally sufficient authority. Without this documentation, the form cannot be accepted.

Some guardians may not fully understand their responsibilities, leading to incomplete information about the support they can provide. It is vital to be aware of the financial, medical, and educational responsibilities that come with being a guardian. Lack of clarity on this can result in issues later on.

People sometimes misinterpret the notary section. It is essential to have the form notarized correctly. If the notary's information is incomplete or inaccurate, it can invalidate the form.

Lastly, individuals often rush through the process, which can lead to errors in typing or printing their names. Careful attention to detail in this section is necessary to ensure that all information is accurate and legible. Mistakes here can also lead to processing delays.

Documents used along the form

The DA Form 5840 serves as a crucial document for guardians or escorts of soldiers' children. When utilizing this form, several other documents may be required to ensure a comprehensive Family Care Plan. Below are five forms and documents often used in conjunction with 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 children. It outlines the scope of authority, including financial, medical, and educational decisions.
  • DA Form 5305 (Family Care Plan): This document outlines the soldier's plan for the care of their dependents during their absence. It includes details about the guardian, the children, and any special needs the children may have.
  • DD Form 1172-2 (Application for Uniformed Services Identification Card): This form is used to apply for identification cards for family members. It ensures that guardians can access military benefits and services on behalf of the children.
  • DA Form 7696 (Child Care Provider Agreement): This agreement is between the soldier and the chosen child care provider. It establishes the terms of care and outlines the responsibilities of both parties.
  • DA Form 4856 (Developmental Counseling Form): This form is used to document counseling sessions related to the Family Care Plan. It can help track the progress and any issues that may arise regarding the children's care.

Each of these documents plays a vital role in ensuring that the soldier's family is well cared for during their absence. Properly completing and submitting these forms can prevent complications and ensure that all necessary support is in place.

Similar forms

The DA Form 5840 is a Certificate of Acceptance as Guardian or Escort, primarily used to designate someone responsible for a soldier's child or family member in their absence. Several other documents serve similar purposes, either in terms of guardianship, power of attorney, or family care plans. Here’s a look at eight documents that share similarities with the DA Form 5840:

  • DA Form 5841 (Power of Attorney): This document allows an individual to grant another person the authority to act on their behalf in legal or financial matters, similar to how the DA Form 5840 designates a guardian for a child.
  • DA Form 5305 (Family Care Plan): This form outlines a soldier's plan for the care of their dependents during their absence, much like the DA Form 5840, which ensures that a guardian is prepared to take over responsibilities.
  • DA Form 5888 (Family Care Plan Counseling Checklist): This document provides a checklist to ensure that soldiers understand their responsibilities regarding family care, paralleling the acceptance of guardianship in the DA Form 5840.
  • DA Form 4080 (Application for Family Care Plan): Similar to the DA Form 5840, this form is used to apply for a family care plan, emphasizing the need for designated guardianship.
  • DD Form 1172 (Application for Department of Defense Common Access Card (CAC) and DEERS Enrollment): This form allows for the enrollment of dependents in military benefits, which ties into the responsibilities outlined in the DA Form 5840.
  • DD Form 214 (Certificate of Release or Discharge from Active Duty): While primarily a discharge document, it often includes information about dependents, similar to how the DA Form 5840 addresses family responsibilities.
  • State Guardianship Forms: Various states have their own guardianship forms that establish legal guardianship, akin to the DA Form 5840's purpose of confirming a guardian's acceptance.
  • Power of Attorney Documents (State-Specific): These documents grant authority for specific actions, much like the DA Form 5840, which confirms a guardian's responsibilities for a soldier's dependents.

Understanding these documents can help ensure that military families have the necessary arrangements in place for the care of their loved ones during absences. Each serves a unique function while sharing common themes of responsibility and guardianship.

Dos and Don'ts

When filling out the DA 5840 form, it is important to follow specific guidelines to ensure accuracy and completeness. Below is a list of things you should and shouldn't do.

  • Do read the entire form carefully before starting.
  • Do provide accurate information about the family members you will be responsible for.
  • Do ensure your signature matches the name printed on the form.
  • Do include a valid telephone number and email address for contact purposes.
  • Don't leave any required fields blank.
  • Don't submit the form without checking for errors.
  • Don't forget to have the form notarized, if required.
  • Don't use outdated versions of the form; always use the latest edition.

Misconceptions

The DA Form 5840, known as the Certificate of Acceptance as Guardian or Escort, is often misunderstood. Here are five common misconceptions surrounding this form, along with clarifications to help you understand its purpose and requirements.

  • It is mandatory for all soldiers to complete the DA Form 5840. Many believe that every soldier must fill out this form. In reality, it is only necessary when a soldier has children and needs to designate a guardian in their absence.
  • The form can be completed without any legal authority. Some think they can fill out the form without proper documentation. However, the guardian must have a legally sufficient authority, such as a Power of Attorney, to take on the responsibilities outlined in the form.
  • Providing personal information is optional. There is a misconception that filling out personal details is not important. While the disclosure of information is voluntary, failing to provide complete and accurate information may result in the rejection of the soldier's Family Care Plan.
  • Once the form is signed, the guardian has unlimited authority. Some individuals believe that signing the DA Form 5840 grants them unrestricted power over the children. In fact, the authority is limited to the responsibilities outlined in the document and is subject to military regulations.
  • The form does not require a notary. It is often assumed that notarization is unnecessary. However, the form must be acknowledged by a notary public to validate the guardian's acceptance and commitment.

Understanding these misconceptions can help ensure that soldiers and their families navigate the process more effectively and with greater confidence.

Key takeaways

When filling out and using the DA 5840 form, it is important to keep the following key points in mind:

  • Purpose: The form serves as a certificate of acceptance for guardianship or escort responsibilities for a soldier's child or children.
  • Authority: It is governed by Army Regulation 600-20, which outlines Army Command Policy.
  • Information Required: Complete and accurate information is necessary to avoid rejection of a soldier's Family Care Plan.
  • Documentation: Ensure that you have received all necessary documents related to financial, medical, educational, and subsistence support for the family members.
  • Briefing: A briefing on how to access military and civilian facilities, services, benefits, and entitlements is essential.
  • Signature: The guardian must sign and date the form to confirm acceptance of responsibilities.
  • Notary Requirement: The form needs to be acknowledged by a notary public, adding a layer of authenticity.
  • Contact Information: Include a valid address, telephone number, and email address for communication purposes.