Download the form
DA Form 5521 handles one job: record of emergency data and designation of beneficiary for unpaid compensation of deceased naf employee. The official title is RECORD OF EMERGENCY DATA AND DESIGNATION OF BENEFICIARY FOR UNPAID COMPENSATION OF DECEASED NAF EMPLOYEE. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is 04/01/2024, status ACTIVE, running 1 page(s) with about 112 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 This edition is superseded — pull the newer one unless your record was already executed on this version.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. G-1 owns the form, AR 215-3 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.
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.
No charge, no account, no email address. The file is the published document, distributed unaltered.
What the form asks for
- AddA
- AddB
- Auth
- BenA
- BenB
- ContentArea1
- DOB
- DateA
- DateB
- Design
- EmpAct
- Name
- Notify
- Page1
- PercentA
- PercentB
- PhoneA
- PhoneB
- PhoneC
- R100
- R101
- R102
- R103
- R104
Start at the top and get the header exactly right. Official spelling of the name, identification number, unit, date. Everything downstream finds the record through those entries; nothing else on the page has that consequence.
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.
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.
Send it where the directive says: the office it names, the unit administrative channel, or the individual's file. Take your copy before submission. How long the record is held comes from the schedule for the series, not from the office holding it.
Look for associated forms by series and number. In the DA series, documents sharing a proponent or a governing directive tend to travel together, and anything referenced on the page normally submits alongside. Collect continuations, covers and transmittals in advance of sending.
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 G-1 or your servicing administrative office.
Questions and answers
- What is DA Form 5521?
- RECORD OF EMERGENCY DATA AND DESIGNATION OF BENEFICIARY FOR UNPAID COMPENSATION OF DECEASED NAF EMPLOYEE
- Which edition is current?
- 04/01/2024
- Who is responsible for this form?
- G-1
- In which formats can it be downloaded?
- PDF, XFDL, PDF