Download the form
DA Form 5221-R handles one job: child development services (cds) family child care (fcc) certification, denial/revocation (lra). The official title is CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) CERTIFICATION DENIAL/REVOCATION. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is July 1989, status not stated, running 1 page(s) with about 82 fields to complete.
ACSIM is the proponent, AR 608-10 the prescribing authority. Read the directive only if something about your situation departs from the standard case. Otherwise the form is filled by the individual it describes, or by the records clerk keeping the file, and reviewed through the printed signature blocks.
Pick by how you will enter data: PDF, XFDL on offer. Typing means fillable pdf, where the boxes accept keystrokes and hold them on save. Handwriting means printable pdf, a flat page image sent straight to a printer. Neither version changes what appears on the page.
A standalone reader is the safe choice for fillable work. Browser viewers vary in whether entered data survives the session, and there is no warning when it does not; a one-field save test settles it in seconds. Xfdl means IBM Lotus Forms. The Lotus Forms Viewer opens it; pdf readers and word processors do not.
Free, unregistered, unmodified. What arrives is what the publisher released.
What the form asks for
- ATNDTRAIN
- ContentArea1
- FROM
- MUSTPROVD
- NONDISCSVC
- NOTIFIED
- OTHER
- PROGSVC
- Page1
- R72
- R73
- R74
- R75
- R76
- R77
- R78
- R79
- R80
- R81
- R82
- R83
- R84
- R85
- R86
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.
Move between fields with tab; the build-time order follows the page and misses nothing. Click check boxes and option buttons, and expect an exclusive group to release the old choice when you set a new one. The trap is field width. Single-line fields do not wrap, so an overlong entry displays complete on screen and prints cut at the margin — put it in remarks or on a continuation instead. Mark inapplicable fields rather than leaving them blank, since an empty box carries no information about whether the question was read.
Sign last. An unsigned form is a draft whatever else is on it, and additional signatures — reviewer, approver, witness — follow printed block order with each signer dating the day they sign, not the day of preparation. Four faults account for most returns: a blank mandatory field, transposed digits in an identification number, day and month reversed in a date, and leftover entries in a working copy reused instead of a fresh blank. Read the form once from the top before releasing it.
Privacy Act statement first, personal entries second. The notice covers who is authorised to collect, why, who else routinely sees it, and whether you must answer. After completion the file carries personal data and is stored and sent under the corresponding safeguards.
Routing follows AR 608-10 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.
Related forms are found by series and number. DA series documents under the same proponent or the same prescribing directive are commonly required as a set, and any form named on the face of this one goes forward with it. Assemble continuations, covers and transmittals before submitting, not after the query comes back.
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.
The files are copies of published Department of the Army forms. This site has no official connection, no authority to issue anything, and no basis for saying whether an office will accept a given submission. None of the text is legal advice. Real questions — entry, requirement, eligibility — belong with ACSIM or the administrative office servicing your unit.
Questions and answers
- What is DA Form 5221-R?
- CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) CERTIFICATION DENIAL/REVOCATION
- Which edition is current?
- July 1989
- Who is responsible for this form?
- ACSIM
- In which formats can it be downloaded?
- PDF, XFDL