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 |