DA Form 5305 – Fill Out and Use This PDF

Line A, INITIALS: enter the date after "I was counseled on". "I understand that I must arrange for care of my family members, remain available for deployment and training, and report for duty as required without interference of responsibility for family members."

Line B: "I have made and will maintain arrangements for the care of my family members during all the following:" Duty, Exercises/field duty, Permanent Change of Station, Alerts, Annual Training, Temporary Duty, Unit Training Assembly, Active Duty Training, Unaccompanied Tours, Mobilization, Deployment, Other Military Duty, Emergencies, Leave/non-duty Time.

Line C: "I understand the importance of ensuring the proper care for my family members, and ensuring my own readiness and deployability as well."

Line C1: Failure to make and maintain adequate family member care arrangements in accordance with the Army's policy is grounds for disciplinary action or separation.

Line C2: Nonavailability for worldwide assignment and/or unit deployment may lead to my separation from the Army.

Line C3: If arrangements for the care of my family members fail to work, I am not automatically excused from prescribed duties, unit deployment, or reassignment.

Line C4: If I fail to maintain a Family Care Plan or provide false information regarding my plan, I am subject to separation, administrative action, or disciplinary action under UCMJ.

Line C5: I must maintain an up-to-date Family Care Plan and revise my Plan when circumstances change. I understand that Family Care Plans may be tested at the discretion of the commander.

Line C6: I will receive no special consideration in duty assignments or duty stations based on my responsibilities for my family members unless enrolled in the Exceptional Family Member Program (EFMP) in accordance with AR 600-75.

Line D: "I have made all necessary arrangements (legal, educational, financial, religious, special, etc.) to ensure a smooth, rapid turnover of family member care responsibilities in case this plan is implemented."

Line E: I have arranged for necessary travel required to transfer my family members to a designated person. If my principal designee is not in the local area, I have arranged with a nonmilitary person in the local area to assume temporary guardianship of my family members until they are transferred to my principal care designee, or that designee arrives to assume responsibility for their care.

Line F: A copy of DA Form 5841 (Power of Attorney) or equivalent documents and a copy of DA Form 5840 (Certificate of Acceptance as Guardian or Escort) for each escort or guardian whether temporary or long-term is attached to this plan.

Line G: The following additional required documents are completed, included in this plan, and will be put into effect as part of the Family Care Plan.

Line G1: DD Form 1172 (Application for Uniformed Services Identification Card - DEERS Enrollment) for each family member whether they have a currently valid ID card or not.

Line G2: DD Form 2558 (Authorization to Start, Stop or Change an Allotment) or other proof of financial support for expenses incurred by guardian and family members.

Line G3: Copies of Letters of Instruction (which have been forwarded to designated escorts or guardians along with powers of attorney and other pertinent documents), outlining all special instructions concerning the care of family members have also been included in the Family Care Plan.

Line H: "I have thoroughly briefed escorts and guardians on the full extent of their responsibilities and on procedures for gaining access to military/civilian facilities, services, entitlements and benefits on behalf of my family members."

Line I: "I am confident that my Family Care Plan is workable, and to the best of my knowledge, the guardian (s) and escort (s) I have designated will be both willing and able to carry out the responsibilities of caring for my family members."

Part II line A designates the temporary guardian to care for the family member (s) until responsibility is transferred to escort or principal (long-term) guardian.

Enter the typed or printed name, the complete address (Including Street, Apartment Number, P.O. Box Number, Rural Route Number, City, State, and ZIP + 4 where applicable), the telephone number (Include Area Code) and the e-mail address.

Part II line B designates the principal long-term guardian(s) for the family member(s). The designated guardian(s) reside in the continental United States or United States territories.

Part II line C designates the individual(s) as escort for the family member(s) if evacuation from OCONUS becomes necessary (applies only to persons assigned OCONUS).

Part III is for dual military couples only: military spouse and commander certification.

Spouse: have made arrangements and will maintain arrangements for the care of family member(s) in all circumstances required by commitment to the military and family.

Sign Signature of Spouse, enter the Date (YYYY/MM/DD) and the Typed or Printed Name of Spouse.

Commander: "I have counseled the military spouse assigned to my unit, reviewed the Family Care Plan, and I am satisfied that the members have made adequate family care arrangements."

Sign Signature of Commander, then enter the Unit Address, the Date and the Typed or Printed Name of Commander.

Soldier: have made arrangements and will maintain arrangements for the care of family member(s) in all circumstances required by commitment to the military and family.

Sign Signature of Soldier, enter the Date (YYYY/MM/DD) and the Typed or Printed Name of Soldier.

Commander: "I have reviewed the Family Care Plan, and I am satisfied that the members have made adequate family care arrangements that will allow for a full range of military duties and for worldwide availability as defined here."

Enter the Unit Address, the Date and the Typed or Printed Name of Commander, and sign Signature of Commander.

Recertification: a. INIT. b. INIT. c. INIT. d. INIT. e. INIT. DATE.

(a) Completed and approved within 30 days for RA Soldiers and 60 days for ARNG and USAR Soldiers from the date of counseling.⁠^[2]