You need DA Form 5221, and this page gets you to the file and through it. Start with what the form is: CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) CERTIFICATION DENIAL/REVOCATION, used to CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) CERTIFICATION DENIAL/REVOCATION. Check next that you have the right version — the edition dated 01/01/2026 is the one published here, and its status is ACTIVE. Then look at the size before you begin, because unknown page(s) and roughly unknown fields tell you how long this will take.
Then work out your role. If the entries describe you, you fill them in and someone in the administrative section checks the result. If you handle records for others, you enter what they supply and pass the form along. In both cases the same two references govern you: G-1 maintains the form, and AR 608-10 sets out the trigger for using it and the route it takes. Read that directive before you start when anything about your case is unusual.
Begin with the first block and follow the printed order. You will enter your name first, exactly as your official records show it, followed by your identification number, your organisation, and the date of preparation. Resist the urge to jump to the substantive blocks and return to the header later. Those first entries are the index for the whole record, and an error there costs you the ability to retrieve it.
In the body of the form, tab from field to field instead of clicking around. The tab order follows how the form was constructed, which keeps you from missing a box. For check boxes and option buttons, click them. If you find a set where the choices are exclusive, expect your new selection to clear the previous one. Keep an eye on long entries as you type: fields built for one line will not wrap, and what overflows the width will print truncated even though your screen shows all of it. At that point move the text into remarks or onto a continuation. And when something does not apply to you, say so in the field — write the entry that means "none" rather than leaving white space a reviewer has to interpret.
Sign at the end and not before. Use ink or the electronic method your office accepts; whatever the state of the entries, an unsigned form is still a draft. When a reviewer, approver or witness has to sign as well, collect those signatures in printed block order and make sure each one is dated the day it was applied, not the day you started. Then read the form through once from the beginning. Three faults account for most rejections: a required field left blank, an identification number with two digits swapped, and a date whose day and month are reversed. Add a fourth if you began from an old working copy — data left over from the last time will travel forward untouched.
Read the Privacy Act statement when it appears on the page, before you fill in the personal details it covers. It sets out the authority for collecting the information, the purpose behind it, the routine uses it may be put to, and whether your disclosure is required or voluntary. Then keep in mind what you have created — a completed copy carries personal data, and you handle and store it under the rules that apply to such records.
Download the form
Now pick your file. You have PDF to choose from, and the choice depends on one thing: whether you will type the entries or write them by hand. Choose the fillable pdf when you want to type, tab between fields and keep a clean copy on your computer. Choose the printable pdf when you intend to print the blank first and write on paper. The pages look identical either way, so you are not giving anything up by picking the wrong one — you are only choosing how you work.
After you download, open the file the right way. Double-click a pdf and your browser may take it, which is fine for reading but risky for filling: some browser viewers show you the fields, let you type, and then lose the text when you close the tab. Save the file to your computer first, then open it in a full pdf reader, and check that your entries survive a save before you type the whole form.
One last point before you move on: every format is free. No registration stands between you and the file, and what you download is the published form, unaltered.
Once you have signed, route the form. The prescribing directive names the destination: an office, your unit administrative channel, or your personal file, according to the case. Make yourself a copy first, because you will not get the original back. After that, retention is out of your hands — the applicable records schedule fixes how long the document is kept, whatever the practice in a particular office.
When another document has to travel with this one, find it by series and number. Forms in the DA series sharing a proponent or a governing directive are commonly used in combination, and anything cited on the face of your form generally goes with it. Assemble continuation sheets, covers and transmittals before you send the package rather than in response to a query.
Before you reuse a saved copy, look at the edition date printed on it. The proponent revises the form from time to time, and your stored file will not tell you when that happens — you compare its date against the current edition yourself. If a revision has come out since you last filed one of these, leave the earlier submission alone; the change does not reach backwards.
Read this before you go. The file you download is a reproduction of a published Department of the Army document, offered as it was published. We are an independent site with no connection to the Department of the Army and no authority to issue anything, and we make no statement about whether your completed form will be accepted anywhere. Treat what you read here as information, not legal advice. Take real questions — about an entry, a requirement, or your eligibility — to G-1 or to your servicing administrative office.
Questions and answers
- What is DA Form 5221?
- CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) CERTIFICATION DENIAL/REVOCATION
- Which edition is current?
- 01/01/2026
- Who is responsible for this form?
- G-1
- In which formats can it be downloaded?