Department of the Army (DA) Forms -- Complete Listing
Page 7 of 12: DA 5000
thru DA 5299
(1-2-3-4-5-6-8-9-10-11-12)
Also See our List of Commonly Used DA and DD Forms
| Form No. | Title | Version | XFDL | FF22 | FF99 | |
| DA 5000-R | APPLICANT'S INTERVIEW REPORT-JUDGE ADVOCATE GENERAL'S CORPS | V1.00 | XFDL | FF22 | FF99 | |
| DA 5006 | AUTHORIZATION FOR DISCLOSURE OF INFORMATION | 1 | XFDL | FF22 | FF99 | |
| DA 5007A | MEDICAL RECORD - ALLERGY IMMUNOTHERAPY RECORD | V1.01 | XFDL | FF22 | FF99 | |
| DA 5007B | MEDICAL RECORD - ALLERGY IMMUNOTHERAPY RECORD | V1.01 | XFDL | FF22 | FF99 | |
| DA 5008 | TELEPHONE MEDICAL ADVICE/CONSULTATION RECORD | V1.01 | XFDL | FF22 | FF99 | |
| DA 5009 | RELEASE AGAINST MEDICAL ADVICE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5011 | TRAINING EVALUATION SUMMARY | V1.01ES | XFDL | FF22 | ||
| DA 5016-R | CHRONOLOGICAL RECORD OF MILITARY SERVICE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5017 | CIVILIAN EMPLOYEE CONSENT STATEMENT | V2.00ES | XFDL | FF22 | FF99 | |
| DA 5018-R | ADAPCP CLIENT'S CONSENT STATEMENT FOR RELEASE OF TREATMENT INFORMA- TION | V1.00 | XFDL | FF22 | FF99 | |
| DA 5019 | CONDITION OF EMPLOYMENT FOR CERTAIN CIVILIAN POSITIONS IDENTIFIED CRITICAL UNDER THE DEPARTMENT OF THE ARMY DRUG-FREE FEDERAL WORKPLACE PROGRAM | V3.00ES | XFDL | FF22 | FF99 | |
| DA 5026-R | RECORD OF CERTIFICATION SMALL ARMS SHIPMENT CONTROL | V1.00 | XFDL | FF22 | FF99 | |
| DA 5027-R | MEDCASE PROGRAM REQUIREMENT | V1.02 | XFDL | FF22 | FF99 | |
| DA 5028-R | MEDCASE SUPPORT AND TRANSMITTAL FORM | V1.00 | XFDL | FF22 | FF99 | |
| DA 5030 | ENGINEER DIVER TRAINING APPLICATION | V1.00 | XFDL | FF22 | FF99 | |
| DA 5032-R | FIELD ARTILLERY DELIVERED MINEFIELD PLANNING SHEET | V1.00 | XFDL | FF22 | FF99 | |
| DA 5033-R PDF ONLY | LIMITED SURFACE OBSERVATION | |||||
| DA 5051-10-R | MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OV/RV-1) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5051-12-R | MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-58D) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5051-1-R | MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-58A/C) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5051-2-R | MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (UH-1) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5051-4-R | MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (AH-1) | V1.01 | XFDL | FF22 | FF99 | |
| DA 5051-5-R | MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (CH-47) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5051-7-R | MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-6) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5051-9-R | MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (CH-54) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5056 | ACTEDS INTERN WORK YEAR REQUIREMENTS | V1.00 | XFDL | FF22 | FF99 | |
| DA 5070-R | JUSTIFICATION STATEMENT FOR .0015 CONTINGENCY FUNDS | V1.00 | XFDL | FF22 | FF99 | |
| DA 5071-R | FUND CUSTODIAN RECEIPT CONTROL AND CASH ACCOUNTABILITY JOURNAL | V1.00 | XFDL | FF22 | FF99 | |
| DA 5072 | EMERGENCY ACTION STATEMENT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5073 | MAGNETIC COMPASS DEVIATION TABLE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5074-1-R | RECORD OF AWARD OF ENTRY GRADE CREDIT (HEALTH SERVICES OFFICERS) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5074-R | RECORD OF AWARD OF ENTRY GRADE CREDIT (MEDICAL AND DENTAL OFFICERS) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5075-R | ARTILLERY SURVEY CONTROL POINT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5095-A-R | FIRE MISSION SUMMARY (CLASSIFIED WHEN FILLED IN) | V1.00 | FF22 | FF99 | ||
| DA 5095-B-R | FIRE PLAN SUMMARY | V1.00 | FF22 | |||
| DA 5100-R | REQUEST FOR SUBSISTENCE PAYROLL DEDUCTION | V1.00 | XFDL | FF22 | FF99 | |
| DA 5105 PDF ONLY | JANITORIAL STANDARDS CHECKLIST | |||||
| DA 5106 | MISSION SUPPORT PLAN (MSP) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5108-R | DOCUMENTATION FOR PRODUCTIVITY CAPITAL INVESTMENT PROGRAMS | V1.00 | XFDL | FF22 | FF99 | |
| DA 5109 | REQUEST TO SUPERIOR TO EXERCISE ARTICLE 15, UCMJ, JURISDICTION | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5110 | ARTICLE 15-RECONCILIATION LOG | V1.00 | XFDL | FF22 | FF99 | |
| DA 5111 | SUMMARY COURT-MARTIAL RIGHTS NOTIFICATION/WAIVER STATEMENT | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5112 | CHECKLIST FOR PRETRIAL CONFINEMENT | V1.01ES | XFDL | FF22 | FF99 | |
| DA 5117 | REASSIGNMENT CONTROL SHEET | V1.00 | XFDL | FF22 | ||
| DA 5118 | REASSIGNMENT STATUS AND ELECTION STATEMENT | V1.00 | XFDL | FF22 | ||
| DA 5121 | OVERSEAS TOUR ELECTION STATEMENT | V1.00 | XFDL | FF22 | ||
| DA 5123 | IN- AND OUT-PROCESSING RECORDS CHECKLIST | V1.00 | XFDL | FF22 | FF99 | |
| DA 5123-1 | IN-PROCESSING PERSONNEL RECORD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5137-R | APPLICATION FOR VOLUNTARY MOBILIZATION PREASSIGNMENT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5138 | SEPARATION ACTION CONTROL SHEET | V1.00 | XFDL | FF22 | ||
| DA 5142-R | THE INSPECTOR GENERAL ACTION REQUEST SYSTEM (IGARS)DATA | V1.00 | XFDL | FF22 | FF99 | |
| DA 5146-R | ASPHALT PAVEMENT INSPECTION SHEET | V1.00 | XFDL | FF22 | FF99 | |
| DA 5147-R | SECTION EVALUATION SUMMARY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5148-R | PRESENT WORTH COMPUTATION | V1.00 | XFDL | FF22 | FF99 | |
| DA 5149-1-R | BRANCH IDENTIFICATION SUMMARY CONTINUATION SHEET | V1.00 | XFDL | FF22 | FF99 | |
| DA 5149-R | BRANCH IDENTIFICATION SUMMARY | V2.00 | XFDL | FF22 | FF99 | |
| DA 5150-R | SECTION IDENTIFICATION RECORD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5151-R | SECTION PAVEMENT STRUCTURE RECORD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5152-R | SECTION MATERIALS PROPERTIES RECORD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5153-R | SECTION TRAFFIC RECORD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5155-R | BRANCH MAINTENANCE & REPAIR REQUIREMENTS | V1.00 | XFDL | FF22 | FF99 | |
| DA 5156-R | SECTION MAINTENANCE AND REPAIR RECORD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5159 | INVENTORY OF ARMY PERSONNEL TEST MATERIAL | V1.00 | FF22 | |||
| DA 5160 | TEST ADMINISTRATION STATEMENT | V2.00 | XFDL | FF22 | FF99 | |
| DA 5161-1-R | FOOD ESTABLISHMENT SANITATION INSPECTION - REMARKS FORM | V1.00 | XFDL | FF22 | FF99 | |
| DA 5161-R | COMPREHENSIVE FOOD ESTABLISHMENT INSPECTION | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5162-R | ROUTINE FOOD ESTABLISHMENT INSPECTION REPORT | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5163-R | NONAPPROPRIATED FUND CENTRAL PAYROLL SYSTEM TIPS, SERVICE CHARGES AND MEALS REPORT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5164-R | HANDS-ON EVALUATION | V2.01 | XFDL | FF22 | ||
| DA 5165-R | FIELD EXPEDIENT SQUAD BOOK | V1.00 | XFDL | FF22 | ||
| DA 5167 | INCENTIVE AWARDS NOMINATION AND APPROVAL - NONAPPROPRIATED FUNDS | V1.000 | XFDL | FF22 | FF99 | |
| DA 5168-R | SAFETY CLEARANCE ORDER (ELECTRICAL FACILITIES) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5170-R | PROPONENT MANAGEMENT INFORMATION REQUIREMENT REVIEW | V1.01 | XFDL | FF22 | FF99 | |
| DA 5178-R | PROJECT DEVELOPMENT IDENTIFIER (PDI) AND PROJECT DEVELOPMENT SKILL IDENTIFIER (PDSI) | V2.00 | XFDL | FF22 | FF99 | |
| DA 5179 | MEDICAL RECORD PREOPERATIVE/POSTOPERATIVE NURSING DOCUMENT | V1.02 | XFDL | FF22 | FF99 | |
| DA 5179-1 | MEDICAL RECORD INTRAOPERATIVE DOCUMENT | V1.01 | XFDL | FF22 | FF99 | |
| DA 5179-1 IMAGE 1/2 | MEDICAL RECORD INTRAOPERATIVE DOCUMENT | V1.00 | IMG | |||
| DA 5179-1 IMAGE 2/2 | MEDICAL RECORD INTRAOPERATIVE DOCUMENT | V1.00 | IMG | |||
| DA 5181 | SCREENING NOTE OF ACUTE MEDICAL CARE | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5182-R | SOIL SUCTION, WATER CONTENT, AND SPECIFIC VOLUME | V1.00 | XFDL | FF22 | FF99 | |
| DA 5184 | CONSUMER COMPLAINT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5187 | APPLICATION FOR RESPITE CAREGIVERS | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5188 | MEDICAL REPORT ON APPLICANT FOR CERTIFICATION TO PROVIDE CARE FOR CHILDREN OR ADULTS WITH DISABILITIES | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5189 | APPLICATION FOR RESPITE CARE FOR CHILDREN AND ADULTS WITH DISABILITIES | V1.00 | XFDL | FF22 | FF99 | |
| DA 5190 | CLINICIAN'S INFORMATION | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5191 | INFORMATION ON INDIVIDUAL WITH DISABILITY | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5192 | FAMILY IDENTIFICATION SHEET FOR A CHILD RECEIVING SERVICE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5193 | CHILD'S FACE AND WHEREABOUTS SHEET | V1.00 | XFDL | FF22 | FF99 | |
| DA 5195 | HEALTH DATA | V1.00 | XFDL | FF22 | FF99 | |
| DA 5202-R | INTERNATIONL CONTROL IMPROVEMENT ACTIVITIES REPORT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5203 | DODIC MASTER/LOT LOCATOR RECORD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5212-R PDF ONLY | PDF SCAN PROJECT | |||||
| DA 5219-R | CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) PROVIDER APPLICATION | V2.00 | XFDL | FF22 | FF99 | |
| DA 5220-R | CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) PROVIDER BACKGROUND CLEARANCE REQUEST | V2.00 | XFDL | FF22 | FF99 | |
| DA 5221-R | CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) CERTIFICATION DENIAL/ REVOCATION | V2.00 | XFDL | FF22 | FF99 | |
| DA 5222-R | CHILD DEVELOPMENT SERVICES (CDS) SPONSOR CONSENT | V2.00 | XFDL | FF22 | FF99 | |
| DA 5223-R | CHILD DEVELOPMENT SERVICES (CDS) CHILD HEALTH ASSESSMENT | V2.00 | XFDL | FF22 | FF99 | |
| DA 5224-R | CHILD DEVELOPMENT SERVICES (CDS) CHILD AND FAMILY PROFILE | V2.00 | XFDL | FF22 | FF99 | |
| DA 5225-R | CHILD DEVELOPMENT SERVICES (CDS) MEDICAL DISPENSATION RECORD | V2.00 | XFDL | FF22 | FF99 | |
| DA 5226-R | CHILD DEVELOPMENT SERVICE (CDS) SPONSOR/ PROGRAM AGREEMENT | V3.00 | XFDL | FF22 | FF99 | |
| DA 5227 | DA EMPLOYMENT AND MOBILITY AGREEMENT FOR DA ACTEDS INTERNS | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5228 | DEPARTMENT OF THE ARMY PRESIDENTIAL MANAGEMENT INTERN MOBILITY AGREEMENT | V1.00ES | XFDL | FF22 | FF99 | |
| DA 5234-R | OER CONTROL LOG | V1.00 | XFDL | FF22 | FF99 | |
| DA 5235-R | VOLUNTER STATEMENT FOR THE ENLISTED CLUB MANAGEMENT CAREER PROGRAM (MOS OOJ) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5237-R | PSNCO EER SUSPENSE ROSTER | V1.00 | XFDL | FF22 | FF99 | |
| DA 5239-R | 75-, 175- AND 300-METER DOWN RANGE FEEDBACK SCORECARD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5239-R IMAGE 1/2 | 75-, 175- AND 300-METER DOWN RANGE FEEDBACK SCORECARD | IMG | ||||
| DA 5239-R IMAGE 2/2 | 75-, 175- AND 300-METER DOWN RANGE FEEDBACK SCORECARD | IMG | ||||
| DA 5241-R | SINGLE AND MULTIPLE TARGETS FIELD FIRING SCORECARD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5246-R FILE 1/3 | ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5246-R FILE 2/3 | ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT | V1.00 | FF22 | FF99 | ||
| DA 5246-R FILE 3/3 | ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT | V1.00 | FF22 | FF99 | ||
| DA 5247-R | REQUEST FOR SECURITY DETERMINATION | V2.00 | XFDL | FF22 | FF99 | |
| DA 5248-R | REPORT OF UNFAVORABLE INFORMATION FOR SECURITY DETERMINATION | V1.20 | XFDL | FF22 | FF99 | |
| DA 5250 | ROTC SCHOLARSHIP - RESERVE FORCES DUTY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5251-R PDF ONLY | CONAUTH KEY MANAGEMENT WORKSHEET | |||||
| DA 5252-R PDF ONLY | STATEMENT - EVIDENCE OF CITIZENSHIP STATUS | |||||
| DA 5257-R | STINGER GUNNER PERFORMANCE EVALUATION SHEET | V1.00 | FF22 | FF99 | ||
| DA 5258-R | REDEYE GUNNER PERFORMANCE EVALUATION SHEET | V1.00 | FF22 | FF99 | ||
| DA 5261-1-R | SELECTED RESERVE INCENTIVE PROGRAM - EDUCATIONAL ASSISTANCE ADDENDUM | V2.00 | XFDL | FF22 | FF99 | |
| DA 5261-2-R | SELECTED RESERVE INCENTIVE PROGRAM - REENLISTMENT/EXTENSION BONUS ADDENDUM | V2.00 | XFDL | FF22 | FF99 | |
| DA 5261-3-R | SELECTED RESERVE INCENTIVE PROGRAM - AFFILIATION BONUS ADDENDUM | V3.01 | XFDL | FF22 | FF99 | |
| DA 5261-4-R | STUDENT LOAN REPAYMENT PROGRAM ADDENDUM | V3.00 | XFDL | FF22 | FF99 | |
| DA 5261-5-R | SELECTED RESERVE INCENTIVE PROGRAM - USAR PRIOR SERVICE ENLISTMENT BONUS ADDENDUM | V1.00 | XFDL | FF22 | FF99 | |
| DA 5261-R | SELECTED RESERVE INCENTIVE PROGRAM - ENLISTMENT BONUS ADDENDUM | V2.00 | XFDL | FF22 | FF99 | |
| DA 5274-R | STANDARD INPUT DATA COMPUTATIONS | V1.10 | XFDL | FF22 | FF99 | |
| DA 5275-R | TIME STUDY RECORD | V1.10 | XFDL | FF22 | FF99 | |
| DA 5276-R | PROGRAM MANAGEMENT DATA | V2.00 | FF22 | FF99 | ||
| DA 5277-R | OPERATIONAL AUDIT DATA |