Official Department of the Army Forms

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Department of Defense Forms Repository [DD Forms]

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DA5000_to_DA5299
Form Number Date Title Version XFDL PDF
DA 5000-R SEP 81 APPLICANT'S INTERVIEW REPORT-JUDGE ADVOCATE GENERAL'S CORPS V1.01 XFDL PDF-F
DA 5007A FEB 03 MEDICAL RECORD - ALLERGY IMMUNOTHERAPY RECORD V1.02ES XFDL PDF-F
DA 5007B FEB 03 MEDICAL RECORD - ALLERGY IMMUNOTHERAPY RECORD V1.02ES XFDL PDF-F
DA 5008 OCT 81 TELEPHONE MEDICAL ADVICE/CONSULTATION RECORD V1.02ES XFDL PDF-F
DA 5009 FEB 04 RELEASE AGAINST MEDICAL ADVICE V1.01ES XFDL PDF-F
DA 5011 AUG 05 TRAINING EVALUATION SUMMARY V1.01ES XFDL PDF-F
DA 5016-R APR 84 CHRONOLOGICAL RECORD OF MILITARY SERVICE V1.00 XFDL PDF-F
DA 5017 NOV 01 CIVILIAN EMPLOYEE CONSENT STATEMENT V2.01ES XFDL PDF-F
DA 5018-R NOV 81 ADAPCP CLIENT'S CONSENT STATEMENT FOR RELEASE OF TREATMENT INFORMATION V3.00ES XFDL PDF-F
DA 5019 NOV 01 CONDITION OF EMPLOYMENT FOR CERTAIN CIVILIAN POSITIONS IDENTIFIED CRITICAL UNDER THE DEPARTMENT OF THE ARMY DRUG-FREE FEDERAL WORKPLACE PROGRAM V3.01ES XFDL PDF-F
DA 5026-R MAR 82 RECORD OF CERTIFICATION SMALL ARMS SHIPMENT CONTROL V1.01ES XFDL PDF-F
DA 5027-R JUL 97 MEDCASE PROGRAM REQUIREMENT V1.03ES XFDL PDF-F
DA 5028-R JUL 97 MEDCASE SUPPORT AND TRANSMITTAL FORM V1.01ES XFDL PDF-F
DA 5030 AUG 10 ENGINEER DIVER TRAINING APPLICATION v1.00 XFDL PDF-F
DA 5032-R JAN 82 FIELD ARTILLERY DELIVERED MINEFIELD PLANNING SHEET V1.00 XFDL PDF-F
DA 5033-R PDF ONLY DEC 81 LIMITED SURFACE OBSERVATION

PDF
DA 5051-10-R JUL 90 MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OV/RV-1) V1.00 XFDL PDF-F
DA 5051-1-R APR 93 MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-58A/C) V1.00 XFDL PDF-F
DA 5051-2-R NOV 92 MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (UH-1) V1.00 XFDL PDF-F
DA 5051-4-R NOV 92 MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (AH-1) V1.01 XFDL PDF-F
DA 5051-5-R AUG 92 MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (CH-47) V1.00 XFDL PDF-F
DA 5051-7-R APR 93 MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-6) V1.00 XFDL PDF-F
DA 5051-9-R JUL 90 MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (CH-54) V1.00 XFDL PDF-F
DA 5056 FEB 02 ACTEDS INTERN WORK YEAR REQUIREMENTS V1.00 XFDL PDF-F
DA 5070 JAN 11 JUSTIFICATION STATEMENT FOR .0015 CONTINGENCY FUNDS V1.00ES XFDL PDF-F
DA 5071 JAN 11 PAYING AGENT RECEIPT CONTROL AND CASH ACCOUNTABILITY JOURNAL V1.00ES XFDL PDF-F
DA 5072 APR 82 EMERGENCY ACTION STATEMENT V1.00 XFDL PDF-F
DA 5073 MAY 01 MAGNETIC COMPASS DEVIATION TABLE V1.01ES XFDL PDF-F
DA 5074-1-R FEB 82 RECORD OF AWARD OF ENTRY GRADE CREDIT (HEALTH SERVICES OFFICERS) V1.01ES XFDL PDF-F
DA 5074-R FEB 82 RECORD OF AWARD OF ENTRY GRADE CREDIT (MEDICAL AND DENTAL OFFICERS) V1.01ES XFDL PDF-F
DA 5075-R MAR 82 ARTILLERY SURVEY CONTROL POINT V1.00 XFDL PDF-F
DA 5105 PDF ONLY MAY 82 JANITORIAL STANDARDS CHECKLIST

PDF
DA 5106 JAN 13 MISSION SUPPORT PLAN (MSP) V1.01 XFDL PDF-F
DA 5108-R MAY 82 DOCUMENTATION FOR PRODUCTIVITY CAPITAL INVESTMENT PROGRAMS V1.00 XFDL PDF-F
DA 5109 SEP 02 REQUEST TO SUPERIOR TO EXERCISE ARTICLE 15, UCMJ, JURISDICTION V2.01ES XFDL PDF-F
DA 5110 SEP 02 ARTICLE 15-RECONCILIATION LOG V1.00 XFDL PDF-F
DA 5111 NOV 09 SUMMARY COURT-MARTIAL RIGHTS NOTIFICATION/WAVER STATEMENT V1.00ES XFDL PDF-F
DA 5112 SEP 02 CHECKLIST FOR PRETRIAL CONFINEMENT V1.02ES XFDL PDF-F
DA 5117 MAR 07 REASSIGNMENT CONTROL SHEET V1.00 XFDL PDF-F
DA 5118 OCT 12 REASSIGNMENT STATUS AND ELECTION STATEMENT V1.00ES XFDL PDF-F
DA 5121 MAR 07 OVERSEAS TOUR ELECTION STATEMENT V1.01ES XFDL PDF-F
DA 5123 APR 10 IN- AND OUT-PROCESSING RECORDS CHECKLIST V1.00 XFDL PDF
DA 5123-1 APR 10 IN-PROCESSING PERSONNEL RECORD V1.00 XFDL PDF-F
DA 5137 MAR 09 APPLICATION FOR VOLUNTARY MOBILIZATION PREASSIGNMENT V1.00ES XFDL PDF-F
DA 5138 SEP 10 SEPARATION ACTION CONTROL SHEET V1.00 XFDL PDF-F
DA 5146-R NOV 82 ASPHALT PAVEMENT INSPECTION SHEET V1.00 XFDL PDF-F
DA 5147-R NOV 82 SECTION EVALUATION SUMMARY V1.00 XFDL PDF-F
DA 5148-R NOV 82 PRESENT WORTH COMPUTATION V1.00 XFDL PDF-F
DA 5149-1-R NOV 82 BRANCH IDENTIFICATION SUMMARY CONTINUATION SHEET V2.00 XFDL PDF-F
DA 5149-R NOV 82 BRANCH IDENTIFICATION SUMMARY V2.00 XFDL PDF-F
DA 5150-R NOV 82 SECTION IDENTIFICATION RECORD V1.00 XFDL PDF-F
DA 5151-R NOV 82 SECTION PAVEMENT STRUCTURE RECORD V1.00 XFDL PDF-F
DA 5152-R NOV 82 SECTION MATERIALS PROPERTIES RECORD V1.00 XFDL PDF-F
DA 5153-R NOV 82 SECTION TRAFFIC RECORD V1.00 XFDL PDF-F
DA 5155-R NOV 82 BRANCH MAINTENANCE & REPAIR REQUIREMENTS V1.00 XFDL PDF-F
DA 5156-R NOV 82 SECTION MAINTENANCE AND REPAIR RECORD V1.00 XFDL PDF-F
DA 5159 OCT 07 INVENTORY OF ARMY PERSONNEL TEST MATERIAL V1.01ES XFDL PDF-F
DA 5160 SEP 09 TEST ADMINISTRATION STATEMENT V1.00ES XFDL PDF-F
DA 5161-1-R OCT 01 FOOD ESTABLISHMENT SANITATION INSPECTION - REMARKS FORM V1.01ES XFDL PDF-F
DA 5161-R OCT 01 COMPREHENSIVE FOOD ESTABLISHMENT INSPECTION V1.01ES XFDL PDF-F
DA 5162-R OCT 01 ROUTINE FOOD ESTABLISHMENT INSPECTION REPORT V1.01ES XFDL PDF-F
DA 5163 SEP 10 NONAPPROPRIATED FUND CENTRAL PAYROLL SYSTEM TIPS, SERVICE CHARGES AND MEALS REPORT V1.00ES XFDL PDF-F
DA 5164-R SEP 85 HANDS-ON EVALUATION V2.01 XFDL PDF-F
DA 5165-R JUN 10 FIELD EXPEDIENT SQUAD BOOK V1.00 XFDL PDF-F
DA 5167 DEC 08 INCENTIVE AWARDS NOMINATION AND APPROVAL - NONAPPROPRIATED FUNDS V1.01ES XFDL PDF-F
DA 5168-R JUN 99 SAFETY CLEARANCE ORDER (ELECTRICAL FACILITIES) V1.00 XFDL PDF-F
DA 5170-R MAY 86 PROPONENT MANAGEMENT INFORMATION REQUIREMENT REVIEW V1.02 XFDL PDF-F
DA 5178 SEP 10 PROJECT DEVELOPMENT IDENTIFIER (PDI) AND PROJECT DEVELOPMENT SKILL IDENTIFIER (PDSI) V1.00 XFDL PDF-F
DA 5179 JUN 91 MEDICAL RECORD PREOPERATIVE/POSTOPERATIVE NURSING DOCUMENT V1.03ES XFDL PDF-F
DA 5179-1 OCT 87 MEDICAL RECORD INTRAOPERATIVE DOCUMENT V1.02ES XFDL PDF-F
DA 5181 FEB 03 SCREENING NOTE OF ACUTE MEDICAL CARE V1.01ES XFDL PDF-F
DA 5182-R MAR 83 SOIL SUCTION, WATER CONTENT, AND SPECIFIC VOLUME V1.00 XFDL PDF-F
DA 5184 MAY 99 CONSUMER COMPLAINT V1.00 XFDL PDF-F
DA 5187 JUN 09 APPLICATION FOR RESPITE CAREGIVERS V1.00ES XFDL PDF-F
DA 5188 SEP 02 MEDICAL REPORT ON APPLICANT FOR CERTIFICATION TO PROVIDE CARE FOR CHILDREN OR ADULTS WITH DISABILITIES V1.01ES XFDL PDF-F
DA 5189 SEP 02 APPLICATION FOR RESPITE CARE FOR CHILDREN AND ADULTS WITH DISABILITIES V1.00 XFDL PDF
DA 5190 SEP 02 CLINICIAN'S INFORMATION V1.01ES XFDL PDF-F
DA 5191 SEP 02 INFORMATION ON INDIVIDUAL WITH DISABILITY V1.00ES XFDL PDF-F
DA 5192 OCT 03 FAMILY IDENTIFICATION SHEET FOR A CHILD RECEIVING SERVICE V1.00 XFDL PDF-F
DA 5193 OCT 03 CHILD'S FACE AND WHEREABOUTS SHEET V1.00 XFDL PDF-F
DA 5195 OCT 03 HEALTH DATA V1.00 XFDL PDF-F
DA 5203 MAY 83 DODIC MASTER/LOT LOCATOR RECORD V1.00 XFDL PDF-F
DA 5212-R PDF ONLY MAY 83 GUNNER'S REFERENCE CARD (LRA)

PDF
DA 5219 JUN 09 CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) PROVIDER APPLICATION V1.00ES XFDL PDF-F
DA 5220-R JUL 89 CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) PROVIDER BACKGROUND CLEARANCE REQUEST V2.01 XFDL PDF-F
DA 5221-R JUL 89 CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) CERTIFICATION DENIAL/ REVOCATION V2.01ES XFDL PDF-F
DA 5222-R JUL 89 CHILD DEVELOPMENT SERVICES (CDS) SPONSOR CONSENT V3.00ES XFDL PDF-F
DA 5223-R JUL 89 CHILD DEVELOPMENT SERVICES (CDS) CHILD HEALTH ASSESSMENT V2.01ES XFDL PDF-F
DA 5224-R JUL 89 CHILD DEVELOPMENT SERVICES (CDS) CHILD AND FAMILY PROFILE V2.00 XFDL PDF-F
DA 5225-R JUL 89 CHILD DEVELOPMENT SERVICES (CDS) MEDICAL DISPENSATION RECORD V2.01ES XFDL PDF-F
DA 5226-R JUL 89 CHILD DEVELOPMENT SERVICE (CDS) SPONSOR/ PROGRAM AGREEMENT V3.01ES XFDL PDF-F
DA 5227 FEB 02 DA EMPLOYMENT AND MOBILITY AGREEMENT FOR DA ACTEDS INTERNS V1.01ES XFDL PDF-F
DA 5228 FEB 02 DEPARTMENT OF THE ARMY PRESIDENTIAL MANAGEMENT INTERN MOBILITY AGREEMENT V1.01ES XFDL PDF-F
DA 5239-R SEP 08 100-, 200-, AND 300-METER DOWNRANGE FEEDBACK SCORECARD V1.00 XFDL PDF-F
DA 5241-R SEP 08 SINGLE AND MULTIPLE TARGETS FIELD FIRE II SCORECARD V1.00 XFDL PDF-F
DA 5246-R JUL 89 ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT V1.01 XFDL PDF-F
DA 5248-R SEP 83 REPORT OF UNFAVORABLE INFORMATION FOR SECURITY DETERMINATION V1.21ES XFDL PDF-F
DA 5250 AUG 83 ROTC SCHOLARSHIP - RESERVE FORCES DUTY V1.01ES XFDL PDF-F
DA 5251-R PDF ONLY MAR 86 CONAUTH KEY MANAGEMENT WORKSHEET

PDF
DA 5252-R PDF ONLY NOV 83 STATEMENT - EVIDENCE OF CITIZENSHIP STATUS

PDF
DA 5261-1-R NOV 84 SELECTED RESERVE INCENTIVE PROGRAM - EDUCATIONAL ASSISTANCE ADDENDUM V2.00 XFDL PDF
DA 5261-2-R FEB 96 SELECTED RESERVE INCENTIVE PROGRAM - REENLISTMENT/EXTENSION BONUS ADDENDUM V2.00 XFDL PDF
DA 5261-3-R FEB 96 SELECTED RESERVE INCENTIVE PROGRAM - AFFILIATION BONUS ADDENDUM V3.01 XFDL PDF
DA 5261-4-R FEB 96 STUDENT LOAN REPAYMENT PROGRAM ADDENDUM V3.01ES XFDL PDF-F
DA 5261-5-R FEB 96 SELECTED RESERVE INCENTIVE PROGRAM - USAR PRIOR SERVICE ENLISTMENT BONUS ADDENDUM V1.00 XFDL PDF
DA 5261-R FEB 96 SELECTED RESERVE INCENTIVE PROGRAM - ENLISTMENT BONUS ADDENDUM V2.01 XFDL PDF
DA 5286 JAN 84 INDIVIDUAL BASIC TRAINING (BT), ADVANCED INDIVIDUAL TRAINING (AIT), ONE STATION UNIT TRAINING (OSUT) V1.02ES XFDL PDF-F
DA 5286-1 JAN 84 INDIVIDUAL TRAINING RECORD (CONTINUATION SHEET),BASIC TRAINING (BT), ADVANCED INDIVIDUAL TRAINING (AIT), ONE STATION UNIT TRAINING (OSUT) V1.01 XFDL PDF-F
DA 5289-R MAR 84 TRAVELING PURCHASE REQUEST V1.00 XFDL PDF-F
DA 5297 JUL 02 ABSTRACT OF VENDOR DELIVERIES V1.00 XFDL PDF-F
DA 5298 JUL 02 OPERTIONAL RATIONS ACCOUNTABILITY V1.00 XFDL PDF-F

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DA 0001 thru DA 1299 DA 3700 thru DA 4399 DA 5443 thru DA 5799
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DA 2200 thru DA 2999 DA 5000 thru DA 5299 DA 7360 thru DA 7499
DA 3000 thru DA 3699 DA 5300 thru DA 5442 DA 7500 thru DA 9999
LABELS, HQDA
 
 
     
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