DA Form 5521 PDF Details

Part B designates the beneficiary named to receive any unpaid compensations due and payable under existing law after the employee's death.

Void designation: this designation of beneficiary shall be void if none of the designated beneficiaries is living at the time of death.

Changes: the employee reserves the right to cancel or change any designation of beneficiary at any time and without knowledge or consent of the beneficiary.

Designation: it will remain in full force and effect unless or until cancelled in writing, so long as continuously employed in the above-named department or agency.

Disclosure: voluntary, however failure to provide this information may result in a delay of payment of unpaid compensation of the deceased NAF employee.

QuestionAnswer
Form NameDA Form 5521
Form Length1 page
Fillable?Yes
Fillable fields32
Avg. time to fill out6 min
EditionAPR 2024
Proponent agencyDCS, G1 (AR 215-3)
Who signsThe employee and the authorizing official
Other namesDA Form 5521, DA 5521, DA5521, Form 5521, Record of Emergency Data and Designation of Beneficiary
Official sourceDA Form 5521 (Rev APR 2024), DCS, G1