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.
| Question | Answer |
|---|---|
| Form Name | DA Form 5521 |
| Form Length | 1 page |
| Fillable? | Yes |
| Fillable fields | 32 |
| Avg. time to fill out | 6 min |
| Edition | APR 2024 |
| Proponent agency | DCS, G1 (AR 215-3) |
| Who signs | The employee and the authorizing official |
| Other names | DA Form 5521, DA 5521, DA5521, Form 5521, Record of Emergency Data and Designation of Beneficiary |
| Official source | DA Form 5521 (Rev APR 2024), DCS, G1 |