Official Department of the Army Forms

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DA4400_to_DA4999
Form Number Date Title Version XFDL PDF
DA 4430 MAY 10 DEPARTMENT OF THE ARMY REPORT OF RESULT OF TRIAL V1.00ES XFDL PDF
DA 4441 SEP 02 UNITED STATES ARMY TRIAL DEFENSE SERVICE V1.00 XFDL PDF-F
DA 4449 AUG 10 CLEMENCY ACTION RECORD V1.00ES XFDL PDF
DA 4450-R PDF ONLY MAY 92 BALLISTIC DENSITY OF TEMPERATURE

PDF
DA 4459 AUG 10 PAROLE ACTION RECORD V1.00ES XFDL PDF
DA 4460-R JUL 80 ARMY LAW LIBRARY SHELF LIST V1.00 XFDL PDF
DA 4465 NOV 01 PATIENT INTAKE/SCREENING RECORD (PIR) V2.00ES XFDL PDF
DA 4466 NOV 01 PATIENT PROGRESS REPORT (PPR) V1.00ES XFDL PDF
DA 4469-R MAY 92 WIND COMPUTATION (ELECTRONIC OR VISUAL) V1.00 XFDL PDF
DA 4474 AUG 10 REQUEST FOR ACCELERATED PAYMENT OF SRB - HARDSHIP OR COMPASSIONATE V1.00 XFDL PDF
DA 4475 MAR 06 DATA REQUIRED BY THE PRIVACY ACT OF 1974 PERSONAL INFORMATION FROM THE NOK OF A DECEASED SERVICE MEMBER V1.00 XFDL PDF-F
DA 4497 MAR 02 INTERIM (ABBREVIATED) FLYING DUTY MEDICAL EXAMINATION V1.01ES XFDL PDF
DA 4502-R DEC 82 WORKSHEET FOR CALCULATING COST OF MANAGEMENT INFORMATION REQUIREMENTS/PRODUCTS V1.00 XFDL PDF-F
DA 4503-1-R MAY 86 ADP PRODUCT REVIEW EVALUATION V1.00 XFDL PDF
DA 4504 OCT 78 RECORD OF FIRE V1.00 XFDL PDF
DA 4505 MAY 76 155mm NUCLEAR COMPUTATION-MET CORRECTION TECHNIQUE V1.00 XFDL PDF-F
DA 4507-1-R DEC 09 MANEUVER/PROCEDURE GRADE SLIP V1.00 XFDL PDF
DA 4507-2-R DEC 09 CONTINUATION COMMENT SLIP v1.00 XFDL PDF
DA 4507-R DEC 09 CREW MEMBER GRADE SLIP V1.00 XFDL PDF
DA 4511 JUL 00 REQUEST FOR LOGISTICS CATALOG DATA AND/OR INFORMATION V1.00 XFDL PDF
DA 4513 MAY 76 RECORD OF MISSIONS FIRED V1.00 XFDL PDF
DA 4524-R PDF ONLY MAY 92 BALLISTIC DENSITY FROM SURFACE DATA

PDF
DA 4538 JUL 02 ABSTRACT OF ISSUES/SALES V1.00 XFDL PDF
DA 4550-R APR 82 MEAL CARD VERIFICATION FORM V1.01 XFDL PDF
DA 4552 JUL 02 KITCHEN REQUISITION V1.01ES XFDL PDF
DA 4560-R DEC 82 APPLICATION FOR APPROVAL OF ADP PRODUCT V1.00 XFDL PDF
DA 4570 APR 99 REGISTER OF PRINTING/DUPLICATING REQUISITIONS V1.01 XFDL PDF
DA 4570-1 APR 99 COMMERCIAL PRINTING RECORD V1.01 XFDL PDF
DA 4571-R NOV 83 DATA REQUIRED BY THE PRIVACY ACT OF 1974 (ELIGIBILITY FOR AMEDD OFFICER PROCUREMENT PROGRAMS - MISCELLANEOUS DOCUMENTATION) V1.00 XFDL PDF
DA 4572 OCT 09 STATEMENT OF UNDERSTANDING FOR APPOINTMENT AS A COMMISSIONED OFFICER V1.00ES XFDL PDF
DA 4573 MAR 82 DOCUMENT CONTROL AND DESTRUCTION CERTIFICATE V1.01 XFDL PDF
DA 4574-R NOV 76 RADIOPHARMACEUTICAL STOCK RECORD V1.00 XFDL PDF
DA 4591 AUG 10 RETENTION DATA WORKSHEET V1.00ES XFDL PDF
DA 4598-R DEC 82 INSTALLATION CASH TRANSFER REQUEST V1.00 XFDL PDF
DA 4601-R MAR 77 REPORT OF MANPOWER AND FISCAL RESOURCES IN SUPPORT OF THE CIVILIAN EQUAL EMPLOYMENT OPPORTUNITY PROGRAM V1.00 XFDL PDF
DA 4604 SEP 06 SECURITY CONSTRUCTION STATEMENT V1.00 XFDL PDF
DA 4605-R PDF ONLY AUG 90 DEPARTMENT OF THE ARMY MUNITIONS CONTROL CASE PROCESSING WORKSHEET

PDF
DA 4612-R OCT 93 NUMBER AND TYPES OF DECORATIONS APPROVED V1.00 XFDL PDF
DA 4620-R JUN 77 SPECIAL C-E AUTHORIZATION REQUEST V1.01 XFDL PDF
DA 4644-R DEC 82 ARMY RESERVE REENLISTMENT DATA V1.00 XFDL PDF
DA 4651 AUG 05 REQUEST FOR RESERVE COMPONENT ASSIGNMENT OR ATTACHMENT V1.00ES XFDL PDF-F
DA 4655-R AUG 13 TARGET LIST WORKSHEET V1.00 XFDL PDF
DA 4656-R JAN 83 SCHEDULING WORK SHEET V1.00 XFDL PDF-F
DA 4657 AUG 10 STATEMENT OF RETIREMENT - ELIGIBLE SOLDIER - REMAINING SERVICE OBLIGATION v1.00ES XFDL PDF
DA 4658 AUG 10 STATEMENT OF RETIREMENT - ELIGIBLE SOLDIER - NOT ELIGIBLE TO REENLIST v1.00ES XFDL PDF
DA 4664-1-R JUN 83 TEMPEST INSPECTION REPORT SUPPLEMENT - FACILITY PROFILE V1.00 XFDL PDF
DA 4664-R JUN 83 TEMPEST INSPECTION REPORT V1.00 XFDL PDF
DA 4665 MAR 00 PATIENT'S TRUST FUND--DAILY SUMMARY RECORD V1.01ES XFDL PDF
DA 4669-R AUG 90 COMSEC MATERIAL VOUCHER CONTROL REGISTER V1.00 XFDL PDF
DA 4677 OCT 78 THERAPEUTIC DOCUMENTATION CARE PLAN (NON-MEDICATION) V1.00 XFDL PDF
DA 4678 FEB 79 THERAPEUTIC DOCUMENTATION CARE PLAN (MEDICATIONS) V1.01 XFDL PDF
DA 4691 FEB 04 INITIAL APPLICATION FOR CLINICAL PRIVILEGES AND STAFF APPOINTMENT V1.00 XFDL PDF
DA 4691-1 FEB 04 APPLICATION FOR RENEWAL OF CLINICAL PRIVILEGES AND STAFF APPOINTMENT V1.01 XFDL PDF
DA 4700 FEB 03 MEDICAL RECORD-SUPPLEMENTAL MEDICAL DATA V1.00 XFDL PDF
DA 4701-R APR 85 REQUEST FOR AVFUELS IDENTAPLATES V1.00 XFDL PDF
DA 4702-R APR 85 MONTHLY BULK PETROLEUM ACCOUNTING SUMMARY V2.01 XFDL PDF
DA 4707 JUL 78 ENTRANCE PHYSICAL STANDARDS BOARD (EPSBD) PROCEEDINGS V1.01 XFDL PDF
DA 4708 SEP 78 QUANTITY CHANGE FOR SUBSTITUTE IN PROPERTY BOOK V1.00 XFDL PDF-F
DA 4711 MAR 07 STATEMENT OF LAW VIOLATIONS V1.00 XFDL PDF
DA 4713 MAR 13 VOLUNTEER DAILY TIME RECORD V1.00 XFDL PDF
DA 4719 JUN 09 CHILD DEVELOPMENT SERVICES (CDS) REGISTRATION CARD V1.00ES XFDL PDF
DA 4727 PDF ONLY SEP 78 FIELD RECORD AND COMPUTATIONS - TELLUROMENTER

PDF
DA 4730 JUN 05 CERTIFICATE FOR PERFORMANCE OF HAZARDOUS DUTY V1.01 XFDL PDF
DA 4734-R OCT 78 DEPARTMENT OF THE ARMY UNITED STATES OF AMERICA INVENTION DISCLOSURE V1.00 XFDL PDF
DA 4753 OCT 78 NOTICE OF UNSAFE OR UNHEALTHFUL WORKING CONDITION V2.01 XFDL PDF-F
DA 4754 OCT 78 VIOLATION INVENTORY LOG V2.00 XFDL PDF
DA 4755 OCT 78 EMPLOYEE REPORT OF ALLEGED UNSAFE OR UNHEALTHFUL WORKING CONDITIONS V2.01 XFDL PDF
DA 4756 OCT 78 INSTALLATION HAZARD ABATEMENT PLAN V2.00 XFDL PDF-F
DA 4757 SEP 84 REGISTRATION/SPECIAL CORRECTION WORK SHEET V2.00 XFDL PDF
DA 4762 JUN 04 ATHLETE'S APPLICATION V1.01 XFDL PDF
DA 4787 MAR 07 REASSIGNMENT PROCESSING V1.01 XFDL PDF
DA 4789 JUN 79 STATEMENT OF ENTITLEMENT TO SELECTIVE REENLISTMENT BONUS V1.00 XFDL PDF
DA 4790 NOV 06 CERTIFICATION FOR DISTRIBUTION OF PUBLICATION(S) IN SUPPORT OF GOVERNMENT CONTRACT V1.00 XFDL PDF
DA 4797 FILE 1/2 JAN 04 INTERNATIONAL STANDARDIZATION AGREEMENT RATIFICATION-IMPLEMENTATION DATA SHEET V1.02 XFDL PDF
DA 4797 FILE 2/2 JAN 04 INTERNATIONAL STANDARDIZATION AGREEMENT RATIFICATION-IMPLEMENTATION DATA SHEET V1.01
PDF
DA 4797-1 JAN 04 INTERNATIONAL STANDARDIZATION AGREEMENT REVIEW DATA SHEET V1.01 XFDL PDF
DA 4799-R PDF ONLY AUG 79 PROBATIONARY AGENT MONTHLY EVALUATION REPORT

PDF
DA 4809-R APR 82 MEAL CARD CONTROL REGISTER V1.00 XFDL PDF-F
DA 4815 APR 99 FORMS CONTROL REGISTER V1.00 XFDL PDF
DA 4817-R PDF ONLY DEC 85 CONSENT/NONCONSENT TO DISCLOSE PERSONAL INFORMATION

PDF
DA 4824 APR 05 ADDENDUM TO CERTIFICATE AND ACKNOWLEDGEMENT OF SERVICE REQUIREMENTS (DA FORM 3540) FOR ALL PERSONNEL APPLYING FOR PARTICPATION IN THE RESERVE OFFICER TRAINING CORPS (ROTC)/SIMULTANEOUS MEMBERSHIP PROGRAM (SMP) V2.00 XFDL PDF
DA 4826 APR 05 ADDENDUM TO CERTIFICATE AND ACKNOWLEDGEMENT OF SERVICE REQUIREMENTS (DA FORM 3540) FOR ENLISTMENT UNDER THE ALTERNATE TRAINING PROGRAM V1.00ES XFDL PDF-F
DA 4831-R FILE 1/2 NOV 79 CALIBRATION AND REPAIR PROGRAM REPORT V1.01 XFDL PDF
DA 4831-R FILE 2/2 NOV 79 CALIBRATION AND REPAIR PROGRAM REPORT V1.00
PDF
DA 4833 MAR 14 COMMANDER’S REPORT OF DISCIPLINARY OR ADMINISTRATIVE ACTION V1.02ES XFDL PDF
DA 4836 AUG 10 OATH OF EXTENSION OF ENLISTMENT OR REENLISTMENT v1.01ES XFDL PDF
DA 4838-R JAN 80 MAINTENANCE PROCESS ANALYSIS WORKSHEET V1.00 XFDL PDF
DA 4839 JAN 80 CIVILIAN CAREER INTERN PROGRAM CERTIFICATE OF ACHIEVEMENT
XFDL PDF-F
DA 4841-R JUL 89 CHILD DEVELOPMENT SERVICES (CDS) PROGRAM/FACILITY REPORT V1.00 XFDL PDF
DA 4843 AUG 12 GUEST/ATTENDANCE SHEET V1.00 XFDL PDF
DA 4850-1-R DEC 94 NONAPPROPRIATED FUNDS TIME AND ATTENDANCE SUPPLEMENT REPORT

PDF
DA 4856 JUL 14 DEVELOPMENTAL COUNSELING FORM V1.02ES XFDL PDF-F
DA 4876 APR 10 REQUEST AND RELEASE OF MEDICAL INFORMATION TO COMMUNICATIONS MEDIA V1.00ES XFDL PDF
DA 4878 JUN 04 ARMY CHESS TOURNAMENT APPLICATION V1.00 XFDL PDF-F
DA 4880-R MAY 80 SUPPLEMENTAL CONTRACTOR COST REPORT V1.00 XFDL PDF-F
DA 4881 JUL 04 AGREEMENT FOR THE LOAN OF US ARMY MATERIEL V1.00 XFDL PDF
DA 4881-1 JUL 04 AGREEMENT FOR THE LOAN OF US ARMY MATERIEL CERTIFICATE FOR SIGNATURE BY AN ALTERNATE V1.00 XFDL PDF-F
DA 4881-2 JUL 04 MILITARY PROPERTY OF THE UNITED STATES - EXHIBIT 1 V1.00 XFDL PDF-F
DA 4881-3 JUL 04 SURETY BOND FOR SAFEKEEPING OF PUBLIC PROPERTY AND GUARANTEEING REIMBURSEMENT TO THE GOVERNMENT FOR EXPENSES INCIDENT TO THE LOAN OF ARMY MATERIEL - EXHIBIT II V1.00 XFDL PDF
DA 4881-4 JUL 04 POWER OF ATTORNEY V1.00 XFDL PDF
DA 4881-5 JUL 04 AGREEMENT FOR THE LEASE OF US ARMY MATERIEL V1.00 XFDL PDF
DA 4881-6 JUL 04 REQUEST AND APPROVAL FOR LOAN OR LEASE OF EQUIPMENT AND LOAN OR LEASE AGREEMENT V1.00 XFDL PDF
DA 4884-R PDF ONLY MAY 92 WEATHER DATA FOR SOUND RANGING

PDF
DA 4886 JUL 14 ISSUE-IN-KIND-PERSONAL CLOTHING RECORD V1.00 XFDL PDF-F
DA 4888-R OCT 04 C-12 TAKEOFF AND LANDING DATA (TOLD) V1.000 XFDL PDF
DA 4908 SEP 12 ARMY EMERGENCY RELIEF ANNUAL FUND CAMPAIGN V1.00ES XFDL PDF
DA 4909 SEP 06 ARMY FLYING ACTIVITY ANNUAL STATUS REPORT V1.01 XFDL PDF
DA 4916 JUN 09 CERTIFICATE OF SERVICE/ATTEMPTED SERVICE V1.00ES XFDL PDF
DA 4917 JUN 09 ADVICE AS TO APPELLATE RIGHTS V1.00ES XFDL PDF
DA 4918 JUN 09 PETITION FOR GRANT OF REVIEW IN THE UNITED STATES COURT OF APPEALS FOR THE ARMED FORCES V1.00 XFDL PDF-F
DA 4919 JUN 09 REQUEST FOR FINAL ACTION V1.00ES XFDL PDF
DA 4922 SEP 99 CHAPLAINS' FUND GENERAL LEDGER V1.00 XFDL PDF
DA 4922-1 SEP 99 CHAPLAINS' FUND GENERAL LEDGER (CONTINUATION) V1.00 XFDL PDF-F
DA 4923 SEP 99 CHAPLAINS' FUND CHARGE PURCHASE REQUEST MEMORANDUM RECORD V1.00 XFDL PDF-F
DA 4924 SEP 99 CHAPLAINS' FUND PROPERTY RECORD V1.00 XFDL PDF-F
DA 4925 SEP 99 CHAPLAINS' FUND STATEMENT OF ASSETS V1.01ES XFDL PDF
DA 4926 SEP 99 CHAPLAINS' FUND ANNUAL SUMMARY FINANCIAL DATA REPORT V1.00 XFDL PDF
DA 4927-R NOV 09 PHYSICIANS COMPARABILITY ALLOWANCE SERVICE AGREEMENT V1.00 ES XFDL PDF
DA 4930 SEP 06 ALARM/INTRUSION DETECTION RECORD V1.00 XFDL PDF
DA 4935 AUG 10 REQUEST FOR UNIT VACANCY FILL v1.00ES XFDL PDF
DA 4939 MAR 09 GENERAL/FLAG OFFICER'S QUARTERS QUARTERLY OBLIGATIONS REPORT V1.00ES XFDL PDF
DA 4941 MAY 05 STATEMENT OF OPTIONS, QUALITATIVE MANAGEMENT PROGRAM (QMP) V1.00 XFDL PDF
DA 4944-R JUL 92 REPORT ON LEGAL ASSISTANCE SERVICES V1.00 XFDL PDF
DA 4945 JUL 02 DINING FACILITY MODERNIZATION PLAN DEVELOPMENT V1.00 XFDL PDF
DA 4948-R NOV 89 FREEDOM OF INFORMATION ACT (FOIA)/OPERATIONS SECURITY (OPSEC) DESK TOP GUIDE V1.01 XFDL PDF-F
DA 4949 JAN 82 ADMINISTRATIVE ADJUSTMENT REPORT (AAR) V1.21ES XFDL PDF-F
DA 4951 APR 99 LEASE/PURCHASE ANALYSIS FOR COPYING/DUPLICATING MACHINES V1.01 XFDL PDF
DA 4965 OCT 09 COMMAND LOGISTICS REVIEW PROGRAM OBSERVATION WORKSHEET V1.00 XFDL PDF
DA 4977-R JAN 87 INDIVIDUAL READY RESERVE BONUS PROGRAM - AGREEMENT V1.00 XFDL PDF
DA 4982-1-R NOV 88 M90 VELOCIMETER WORK SHEET V1.00 XFDL PDF-F
DA 4982-R NOV 88 MUZZLE VELOCITY RECORD V1.00 XFDL PDF
DA 4985 JAN 02 NAF REFERRAL AND SELECTION LIST (Nonappropriated Fund Employment) V2.00ES XFDL PDF
DA 4989-R MAR 86 WARRANT OFFICER FLIGHT TRAINING APPLICATION V1.00 XFDL PDF
DA 4991-R MAY 98 DECLINATION OF CONTINUED SERVICE STATEMENT V1.00 XFDL PDF
DA 4995-1-R OCT 81 ANNUAL STATUS REPORT OF EXEMPTED LASERS V1.01 XFDL PDF
DA 4995-R OCT 81 LASER EXEMPTION FROM FEDERAL STANDARDS V1.00 XFDL PDF
DA 4996-R APR 94 QUALITY CONTROL CARD V1.00 XFDL PDF
DA 4997-R AUG 81 LOCATOR CARD V1.00 XFDL PDF
DA 4998-R APR 94 QUALITY CONTROL AND SURVEILLANCE RECORD FOR TOE MEDICAL ASSEMBLAGES V1.00 XFDL PDF
DA 4999 JAN 82 DUE IN RECORD V1.00 XFDL PDF

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