DA Form 5304-R – Fill Out and Use This PDF

The DA Form 5304-R is the Family Care Plan Counseling Checklist required by U.S. Army regulations. It helps single parents, dual-military couples, and pregnant soldiers arrange care for dependents during duty or deployment. The checklist covers guardian selection, power of attorney, and emergency provisions. Related forms include the DA Form 5304 and DA Form 5305-R. Click the button below to fill out Form 5304-R online for free.

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5304 R Form PDF Details

The DA Form 5304-R is issued under Army Regulation AR 600-20 and applies to all Army soldiers who have dependents. It is required for single parents, pregnant soldiers, and dual-military couples who need a documented guardian plan before deployment or extended duty.

The form covers three main parts. Part I is for the soldier and the commanding officer to sign, confirming guardian details and acknowledgment of responsibilities. Part II covers entitlements and assignment policies for Active Army and Reserve Component soldiers. Part III is the military spouse acknowledgment, if applicable.

Key information needed to complete the form includes the full name and contact details of the designated guardian, confirmation of a current will on file, and written acknowledgment of all duties outlined in AR 600-20. The family care plan must be updated whenever family circumstances change, such as a new assignment, new dependent, or change in guardian availability. For related planning documents, see the military power of attorney form and the DA Form 5305-R.

Question	Answer
Form Name	DA Form 5304-R
Official Title	Family Care Plan Counseling Checklist
Issuing Authority	U.S. Army
Applicable Regulation	AR 600-20
Form Length	4 pages
Fillable?	No (use FormsPal editor to complete online)
Fillable fields	0
Avg. time to fill out	1 min
Other names	form da 5304 r, form 5304 r, checklist dcsper planning, form da 5304 r fillable

How to Edit 5304 R Form Online for Free

Who Needs the DA Form 5304-R?

Any Army soldier with dependent family members must complete the DA Form 5304-R before deployment or extended duty. This includes single parents, dual-military couples, and pregnant soldiers. The form ensures dependents have a named guardian who can act on their behalf. For the companion form, see the DA Form 5304.

How to Fill Out Form 5304-R Online

Fill out the family care plan checklist using FormsPal's online PDF editor. No software download is needed. Follow the steps below.

Step 1: Open the form editor. Click the orange "Get Form" button above. The editor opens instantly in your browser.

Opening DA Form 5304-R in the online editor

Step 2: Complete Part I. Enter your name, unit, and guardian details. Both soldier and commander must sign this section to confirm all duties under AR 600-20.

Completing Part I of DA Form 5304-R - soldier and commander section

Step 3: Complete Part II. Review the entitlement and assignment policies for Active Army and RC soldiers. Check all applicable boxes in this section.

Completing Part II of DA Form 5304-R - entitlements section

Step 4: Complete Part III. If applicable, your military spouse signs this section to confirm the agreed-upon care arrangement.

Part III military spouse acknowledgment in DA Form 5304-R

Step 5: Review and save. Re-read all completed sections and confirm no fields are blank. Click "Done" to save. You can download, print, or share the completed form from your FormsPal account.

Related Army Forms

The DA Form 5304-R is part of a series of Army family care documents. You may also need the DA Form 5305-R for your designated guardian. A military power of attorney is often submitted alongside the family care plan. See also Army Risk Assessment forms for deployment preparation.