How to Fill Out DA Form 5304: Parts I and II, Signatures, and Updates

To fill out DA Form 5304, the Family Care Plan Counseling Checklist, you and your commander sit down together, work through the two-part form, and initial each responsibility you’re accepting as a Soldier with dependent care obligations. Part I captures identifying information about you and your dependents. Part II is the substance: a checklist of duties — guardian selection, financial support, transportation, availability for duty — that you acknowledge line by line, with your commander initialing alongside you. Both of you then sign, and the form is submitted as part of a larger Family Care Plan packet within 30 days for Active Army or 60 days for Reserve Component Soldiers.¹ The authority is AR 600-20, Chapter 5.²

Use the July 2020 version of the form, available through the Army Publishing Directorate. Older editions can slow approval.

Gather the Packet Before You Sit Down

The 5304 is the counseling checklist, but it doesn’t stand alone. Bring the other packet materials to the counseling session so you’re not making repeat trips. The Army Recruiting Command checklist lists what belongs in a complete packet:³

DA Form 5305, the Family Care Plan itself, where you name your guardians and attach supporting paperwork.⁴
DA Form 5841, the special power of attorney giving your guardian authority to make medical, educational, and legal decisions for your children.⁵
DA Form 5840, the Certificate of Acceptance as Guardian or Escort, signed by each guardian and notarized.
DA Form 7666, parental consent from any non-custodial parent or other person with a legal interest in the child’s custody.
DA Form 7667, the preliminary screening form used earlier in the process.
DD Form 1172-2 for each family member, so DEERS enrollment and TRICARE access stay current.⁶
DD Form 2558 to set up a discretionary allotment supporting your guardian from your pay. It can remain unsigned until deployment, but prepare it and include it. If you plan to support your dependents another way, explain that in your letter of instruction.⁷
A letter of instruction to each guardian and escort covering school schedules, medical histories, medications, special needs, religious preferences, and anything else a caregiver needs to run daily life.¹

The checklist also flags an updated will that specifies your custody wishes. It’s not a required packet form, but it’s expected, and installation legal assistance offices will draft one at no cost.¹

Part I: Identifying Information

Part I is administrative. Enter your name, rank, unit, and the details for every dependent covered by the plan. Have DEERS records nearby so names, dates of birth, and relationships match exactly. Discrepancies between the 5304 and DEERS are among the easiest mistakes to make and the most common reason a packet gets kicked back.

Part II: The Responsibilities You Initial

Part II is where the counseling actually happens. Each item on the checklist is a responsibility you accept, and you initial each one as your commander walks through it. Your commander initials the same lines, confirming the counseling took place. Read every item; don’t initial ahead. The obligations you’re acknowledging are:¹

You will arrange care so you remain available for duty whenever and wherever the Army requires, including duty hours, alerts, field exercises, TDY, deployments, annual training, MUTAs, ADT, and hospitalization.
You will select temporary and long-term guardians who are qualified, reliable, and stable, and who are willing and able to assume full responsibility for your dependents during any absence.
You will fully inform those guardians of their responsibilities and how to access military and civilian facilities, services, entitlements, and benefits.
You will make all necessary arrangements — housing, education, legal documents, transportation, finances, religious needs, and special requirements — and execute the DA Form 5841 power of attorney so your guardian can act on your behalf.
You bear full responsibility for the cost and logistics of moving your family members to and from guardians.
You will not receive preferential treatment in duty assignments or station selection based on family responsibilities, unless enrolled in the Exceptional Family Member Program.
You understand that failing to maintain a workable plan can result in separation, administrative action, or disciplinary action under the UCMJ.

If any line reflects something you cannot actually do — a guardian who lives too far away to arrive on short notice, a financial arrangement that doesn’t add up — say so during the counseling. Initialing an obligation you can’t meet doesn’t make the plan workable; it just delays the moment the gap gets discovered.

Signatures, Deadlines, and Version

Once Part II is complete, both you and the commander (or a designated representative) sign the form. The commander’s signature sets the clock: you have 30 days to submit the full packet if you’re Active Army, or 60 days if you’re in the Reserve Component. The same deadlines apply when you arrive at a new unit or experience a qualifying change in family status.¹

When you submit, the commander reviews the packet for completeness and viability: guardian certificates signed and notarized, power of attorney properly executed, financial support arrangements realistic, letter of instruction detailed enough to guide the caregiver. If something is missing or unworkable, the commander documents the deficiency during counseling and gives you a reasonable window to fix it before any escalation.⁸ When the commander is satisfied, they sign off certifying you deployable, and the packet is filed in your personnel records.

Keeping the Form Current After Submission

The 5304 isn’t a one-and-done. Your commander must recertify the plan at least annually, and you’re required to update it whenever your situation changes — a new guardian, a change in custody, a PCS, a spouse joining the military, the birth of a child.¹ Commanders can also require more frequent reviews depending on unit mission tempo.

Recertification is also when you catch DEERS drift. If a dependent’s enrollment has lapsed or their record is outdated, they can lose TRICARE access, which defeats the plan.⁹ Verify each dependent’s DD Form 1172-2 every time you resubmit.

If You’re Stationed OCONUS

Soldiers assigned outside the continental United States have to designate an escort for dependents in the event of a Noncombatant Evacuation Operation, which makes the DA Form 5840 for an escort part of your packet rather than optional. The escort must be a U.S. citizen or hold a valid U.S. immigrant visa, have base access through all force protection levels, and be able to physically reach your dependents when you cannot.¹⁰ Your letter of instruction to that escort should cover where to report, what documents to carry, how to access military transportation, and any medical or special-needs information the escort will need during an evacuation.

1
U.S. Army Japan. DA Form 5304 – Family Care Plan Counseling Checklist
2
United States Army. AR 600-20 – Army Command Policy
3
U.S. Army Recruiting Command. Family Care Plan Checklist
4
U.S. Army Japan. DA Form 5305 – Family Care Plan
5
Mississippi National Guard. DA Form 5841-R – Power of Attorney
6
Washington Headquarters Services. DD Form 1172-2 – Application for Identification Card/DEERS Enrollment
7
Washington Headquarters Services. DD Form 2558 – Authorization to Start, Stop or Change an Allotment
8
U.S. Army Fort Knox. Involuntary Separation Due to Parenthood – Chapter 5-8, AR 635-200
9
TRICARE. Defense Enrollment Eligibility Reporting System
10
United States Forces Korea. USFK Pamphlet 600-300 – Non-Combatant Emergency Evacuation Instructions