Download the form
DA Form 5189 handles one job: application for respite care for children and adults with disabilities. The official title is APPLICATION FOR RESPITE CARE FOR CHILDREN AND ADULTS WITH DISABILITIES. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is 02/01/2026, status ACTIVE, running 1 page(s) with about 123 fields to complete. This edition is superseded — pull the newer one unless your record was already executed on this version.
Authority sits in two places. TSG owns the form, AR 608-75 says when it is raised and where it goes. Routine cases need neither read in full — the page itself carries the sequence. The entries are completed by their subject or by unit administrative staff working from what that person supplies.
PDF, XFDL are available and the decision takes one second. Type your entries: fillable pdf. Write them: printable pdf. The published layout is common to both, so the format governs your method and nothing more.
Use a full pdf reader, not the browser viewer. Browser viewers display fields they cannot always save, and the loss shows up only when you reopen the file — type one entry, save, reopen, verify, then fill the rest. The xfdl file is IBM Lotus Forms, used inside Army systems, and opens in the Lotus Forms Viewer alone — no pdf reader, no word processor.
Nothing is charged and no sign-up applies. Files are served as published, without changes to the page image.
What the form asks for
- ADDRESS
- ALLERGIES
- BIRTH_DAY
- CAN_DOA
- CAN_DOA_1
- CAN_DOA_2
- CAN_DOA_3
- CAN_DOA_4
- CAN_DOA_5
- CAN_DOB
- CAN_DOB_1
- CAN_DOB_2
- CAN_DOB_3
- CAN_DOB_4
- CAN_DOB_5
- CHRONIC
- ContentArea1
- DISABILITY
- Dentist
- EMER_AVAIL
- Emergency_Contact
- HEIGHT
- MEDICATION
- MEDICATION_1
The heading entries carry more weight than the body. Name spelled as in official records, identification number, organisation, date prepared. Retrieval runs on those values, so a transposed digit or a casual spelling costs someone a file search. Fill them before anything else.
Tab through the fields rather than clicking. The tab order was fixed when the form was built and generally follows the page, which catches boxes a mouse skips past. Check boxes and option buttons take a click, and an exclusive group clears the previous selection when you make a new one. Single-line fields do not wrap — text past the field width prints truncated while still showing in full on screen, which is why the loss is discovered after printing. Overflow goes to remarks or a continuation sheet. A field that does not apply gets the mark meaning none; blank space reads as an omission.
The signature closes the form and nothing precedes it. Draft status holds until it is applied, by hand or by an accepted electronic method. Countersignatures go in printed order, each dated at signing. Then one final read from the top, looking for the four recurring defects: empty mandatory fields, swapped digits in identification numbers, day-month inversion in dates, and residue from a reused file that goes forward as though intended.
Read the Privacy Act statement at the point it appears. Authority, purpose, routine uses, mandatory or voluntary — four facts, and they govern what you are about to enter. A completed copy holds personal data and takes the handling rules that attach to it.
Routing follows AR 608-75 and nothing else — a named office, the unit administrative channel, or the individual's file, according to why the form was raised. Copy it before it leaves. Retention is fixed by the records schedule for the series, which local practice does not shorten or extend.
Companion documents come from the same series and number scheme. Within the DA series, a shared proponent or a shared directive usually means shared use, and a form cited on the face of another accompanies it. Gather the whole package first — continuation sheets, cover sheets, transmittals.
A stored file goes stale silently. The proponent revises, a new edition date is published, and your copy says nothing about it — so compare the printed date against the edition in force before typing into it again. Completed submissions on an earlier edition are not reopened.
What is distributed here are reproductions of published Department of the Army documents. Independent site, no official standing, no forms of its own. Nothing on the page constitutes legal advice, and acceptance by any office is outside what can be stated. Put questions about entries, requirements or eligibility to TSG or your servicing administrative office.
Questions and answers
- What is DA Form 5189?
- APPLICATION FOR RESPITE CARE FOR CHILDREN AND ADULTS WITH DISABILITIES
- Which edition is current?
- 02/01/2026
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, XFDL, PDF