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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 PDF FF22 FF99
DA 5000-R APPLICANT'S INTERVIEW REPORT-JUDGE ADVOCATE GENERAL'S CORPS V1.00 XFDL PDF FF22 FF99
DA 5006 AUTHORIZATION FOR DISCLOSURE OF INFORMATION 1 XFDL PDF FF22 FF99
DA 5007A MEDICAL RECORD - ALLERGY IMMUNOTHERAPY RECORD V1.01 XFDL PDF FF22 FF99
DA 5007B MEDICAL RECORD - ALLERGY IMMUNOTHERAPY RECORD V1.01 XFDL PDF FF22 FF99
DA 5008 TELEPHONE MEDICAL ADVICE/CONSULTATION RECORD V1.01 XFDL PDF FF22 FF99
DA 5009 RELEASE AGAINST MEDICAL ADVICE V1.00 XFDL PDF FF22 FF99
DA 5011 TRAINING EVALUATION SUMMARY V1.01ES XFDL PDF FF22  
DA 5016-R CHRONOLOGICAL RECORD OF MILITARY SERVICE V1.00 XFDL PDF FF22 FF99
DA 5017 CIVILIAN EMPLOYEE CONSENT STATEMENT V2.00ES XFDL PDF FF22 FF99
DA 5018-R ADAPCP CLIENT'S CONSENT STATEMENT FOR RELEASE OF TREATMENT INFORMA- TION V1.00 XFDL PDF 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 PDF FF22 FF99
DA 5026-R RECORD OF CERTIFICATION SMALL ARMS SHIPMENT CONTROL V1.00 XFDL PDF FF22 FF99
DA 5027-R MEDCASE PROGRAM REQUIREMENT V1.02 XFDL PDF FF22 FF99
DA 5028-R MEDCASE SUPPORT AND TRANSMITTAL FORM V1.00 XFDL PDF FF22 FF99
DA 5030 ENGINEER DIVER TRAINING APPLICATION V1.00 XFDL PDF FF22 FF99
DA 5032-R FIELD ARTILLERY DELIVERED MINEFIELD PLANNING SHEET V1.00 XFDL PDF FF22 FF99
DA 5033-R PDF ONLY LIMITED SURFACE OBSERVATION     PDF    
DA 5051-10-R MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OV/RV-1) V1.00 XFDL PDF FF22 FF99
DA 5051-12-R MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-58D) V1.00 XFDL PDF FF22 FF99
DA 5051-1-R MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-58A/C) V1.00 XFDL PDF FF22 FF99
DA 5051-2-R MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (UH-1) V1.00 XFDL PDF FF22 FF99
DA 5051-4-R MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (AH-1) V1.01 XFDL PDF FF22 FF99
DA 5051-5-R MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (CH-47) V1.00 XFDL PDF FF22 FF99
DA 5051-7-R MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (OH-6) V1.00 XFDL PDF FF22 FF99
DA 5051-9-R MAINTENANCE TEST FLIGHT MANEUVERS GRADE SLIP (CH-54) V1.00 XFDL PDF FF22 FF99
DA 5056 ACTEDS INTERN WORK YEAR REQUIREMENTS V1.00 XFDL PDF FF22 FF99
DA 5070-R JUSTIFICATION STATEMENT FOR .0015 CONTINGENCY FUNDS V1.00 XFDL PDF FF22 FF99
DA 5071-R FUND CUSTODIAN RECEIPT CONTROL AND CASH ACCOUNTABILITY JOURNAL V1.00 XFDL PDF FF22 FF99
DA 5072 EMERGENCY ACTION STATEMENT V1.00 XFDL PDF FF22 FF99
DA 5073 MAGNETIC COMPASS DEVIATION TABLE V1.00 XFDL PDF FF22 FF99
DA 5074-1-R RECORD OF AWARD OF ENTRY GRADE CREDIT (HEALTH SERVICES OFFICERS) V1.00 XFDL PDF FF22 FF99
DA 5074-R RECORD OF AWARD OF ENTRY GRADE CREDIT (MEDICAL AND DENTAL OFFICERS) V1.00 XFDL PDF FF22 FF99
DA 5075-R ARTILLERY SURVEY CONTROL POINT V1.00 XFDL PDF FF22 FF99
DA 5095-A-R FIRE MISSION SUMMARY (CLASSIFIED WHEN FILLED IN) V1.00   PDF FF22 FF99
DA 5095-B-R FIRE PLAN SUMMARY V1.00   PDF FF22  
DA 5100-R REQUEST FOR SUBSISTENCE PAYROLL DEDUCTION V1.00 XFDL PDF FF22 FF99
DA 5105 PDF ONLY JANITORIAL STANDARDS CHECKLIST     PDF    
DA 5106 MISSION SUPPORT PLAN (MSP) V1.00 XFDL PDF FF22 FF99
DA 5108-R DOCUMENTATION FOR PRODUCTIVITY CAPITAL INVESTMENT PROGRAMS V1.00 XFDL PDF FF22 FF99
DA 5109 REQUEST TO SUPERIOR TO EXERCISE ARTICLE 15, UCMJ, JURISDICTION V1.00ES XFDL PDF FF22 FF99
DA 5110 ARTICLE 15-RECONCILIATION LOG V1.00 XFDL PDF FF22 FF99
DA 5111 SUMMARY COURT-MARTIAL RIGHTS NOTIFICATION/WAIVER STATEMENT V1.00ES XFDL PDF FF22 FF99
DA 5112 CHECKLIST FOR PRETRIAL CONFINEMENT V1.01ES XFDL PDF FF22 FF99
DA 5117 REASSIGNMENT CONTROL SHEET V1.00 XFDL PDF FF22  
DA 5118 REASSIGNMENT STATUS AND ELECTION STATEMENT V1.00 XFDL PDF FF22  
DA 5121 OVERSEAS TOUR ELECTION STATEMENT V1.00 XFDL PDF FF22  
DA 5123 IN- AND OUT-PROCESSING RECORDS CHECKLIST V1.00 XFDL PDF FF22 FF99
DA 5123-1 IN-PROCESSING PERSONNEL RECORD V1.00 XFDL PDF FF22 FF99
DA 5137-R APPLICATION FOR VOLUNTARY MOBILIZATION PREASSIGNMENT V1.00 XFDL PDF FF22 FF99
DA 5138 SEPARATION ACTION CONTROL SHEET V1.00 XFDL PDF FF22  
DA 5142-R THE INSPECTOR GENERAL ACTION REQUEST SYSTEM (IGARS)DATA V1.00 XFDL PDF FF22 FF99
DA 5146-R ASPHALT PAVEMENT INSPECTION SHEET V1.00 XFDL PDF FF22 FF99
DA 5147-R SECTION EVALUATION SUMMARY V1.00 XFDL PDF FF22 FF99
DA 5148-R PRESENT WORTH COMPUTATION V1.00 XFDL PDF FF22 FF99
DA 5149-1-R BRANCH IDENTIFICATION SUMMARY CONTINUATION SHEET V1.00 XFDL PDF FF22 FF99
DA 5149-R BRANCH IDENTIFICATION SUMMARY V2.00 XFDL PDF FF22 FF99
DA 5150-R SECTION IDENTIFICATION RECORD V1.00 XFDL PDF FF22 FF99
DA 5151-R SECTION PAVEMENT STRUCTURE RECORD V1.00 XFDL PDF FF22 FF99
DA 5152-R SECTION MATERIALS PROPERTIES RECORD V1.00 XFDL PDF FF22 FF99
DA 5153-R SECTION TRAFFIC RECORD V1.00 XFDL PDF FF22 FF99
DA 5155-R BRANCH MAINTENANCE & REPAIR REQUIREMENTS V1.00 XFDL PDF FF22 FF99
DA 5156-R SECTION MAINTENANCE AND REPAIR RECORD V1.00 XFDL PDF FF22 FF99
DA 5159 INVENTORY OF ARMY PERSONNEL TEST MATERIAL V1.00   PDF FF22  
DA 5160 TEST ADMINISTRATION STATEMENT V2.00 XFDL PDF FF22 FF99
DA 5161-1-R FOOD ESTABLISHMENT SANITATION INSPECTION - REMARKS FORM V1.00 XFDL PDF FF22 FF99
DA 5161-R COMPREHENSIVE FOOD ESTABLISHMENT INSPECTION V1.00ES XFDL PDF FF22 FF99
DA 5162-R ROUTINE FOOD ESTABLISHMENT INSPECTION REPORT V1.00ES XFDL PDF FF22 FF99
DA 5163-R NONAPPROPRIATED FUND CENTRAL PAYROLL SYSTEM TIPS, SERVICE CHARGES AND MEALS REPORT V1.00 XFDL PDF FF22 FF99
DA 5164-R HANDS-ON EVALUATION V2.01 XFDL PDF FF22  
DA 5165-R FIELD EXPEDIENT SQUAD BOOK V1.00 XFDL PDF FF22  
DA 5167 INCENTIVE AWARDS NOMINATION AND APPROVAL - NONAPPROPRIATED FUNDS V1.000 XFDL PDF FF22 FF99
DA 5168-R SAFETY CLEARANCE ORDER (ELECTRICAL FACILITIES) V1.00 XFDL PDF FF22 FF99
DA 5170-R PROPONENT MANAGEMENT INFORMATION REQUIREMENT REVIEW V1.01 XFDL PDF FF22 FF99
DA 5178-R PROJECT DEVELOPMENT IDENTIFIER (PDI) AND PROJECT DEVELOPMENT SKILL IDENTIFIER (PDSI) V2.00 XFDL PDF FF22 FF99
DA 5179 MEDICAL RECORD PREOPERATIVE/POSTOPERATIVE NURSING DOCUMENT V1.02 XFDL PDF FF22 FF99
DA 5179-1 MEDICAL RECORD INTRAOPERATIVE DOCUMENT V1.01 XFDL PDF 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 PDF FF22 FF99
DA 5182-R SOIL SUCTION, WATER CONTENT, AND SPECIFIC VOLUME V1.00 XFDL PDF FF22 FF99
DA 5184 CONSUMER COMPLAINT V1.00 XFDL PDF FF22 FF99
DA 5187 APPLICATION FOR RESPITE CAREGIVERS V1.00ES XFDL PDF FF22 FF99
DA 5188 MEDICAL REPORT ON APPLICANT FOR CERTIFICATION TO PROVIDE CARE FOR CHILDREN OR ADULTS WITH DISABILITIES V1.00ES XFDL PDF FF22 FF99
DA 5189 APPLICATION FOR RESPITE CARE FOR CHILDREN AND ADULTS WITH DISABILITIES V1.00 XFDL PDF FF22 FF99
DA 5190 CLINICIAN'S INFORMATION V1.00ES XFDL PDF FF22 FF99
DA 5191 INFORMATION ON INDIVIDUAL WITH DISABILITY V1.00ES XFDL PDF FF22 FF99
DA 5192 FAMILY IDENTIFICATION SHEET FOR A CHILD RECEIVING SERVICE V1.00 XFDL PDF FF22 FF99
DA 5193 CHILD'S FACE AND WHEREABOUTS SHEET V1.00 XFDL PDF FF22 FF99
DA 5195 HEALTH DATA V1.00 XFDL PDF FF22 FF99
DA 5202-R INTERNATIONL CONTROL IMPROVEMENT ACTIVITIES REPORT V1.00 XFDL PDF FF22 FF99
DA 5203 DODIC MASTER/LOT LOCATOR RECORD V1.00 XFDL PDF FF22 FF99
DA 5212-R PDF ONLY PDF SCAN PROJECT     PDF    
DA 5219-R CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) PROVIDER APPLICATION V2.00 XFDL PDF FF22 FF99
DA 5220-R CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) PROVIDER BACKGROUND CLEARANCE REQUEST V2.00 XFDL PDF FF22 FF99
DA 5221-R CHILD DEVELOPMENT SERVICES (CDS) FAMILY CHILD CARE (FCC) CERTIFICATION DENIAL/ REVOCATION V2.00 XFDL PDF FF22 FF99
DA 5222-R CHILD DEVELOPMENT SERVICES (CDS) SPONSOR CONSENT V2.00 XFDL PDF FF22 FF99
DA 5223-R CHILD DEVELOPMENT SERVICES (CDS) CHILD HEALTH ASSESSMENT V2.00 XFDL PDF FF22 FF99
DA 5224-R CHILD DEVELOPMENT SERVICES (CDS) CHILD AND FAMILY PROFILE V2.00 XFDL PDF FF22 FF99
DA 5225-R CHILD DEVELOPMENT SERVICES (CDS) MEDICAL DISPENSATION RECORD V2.00 XFDL PDF FF22 FF99
DA 5226-R CHILD DEVELOPMENT SERVICE (CDS) SPONSOR/ PROGRAM AGREEMENT V3.00 XFDL PDF FF22 FF99
DA 5227 DA EMPLOYMENT AND MOBILITY AGREEMENT FOR DA ACTEDS INTERNS V1.00ES XFDL PDF FF22 FF99
DA 5228 DEPARTMENT OF THE ARMY PRESIDENTIAL MANAGEMENT INTERN MOBILITY AGREEMENT V1.00ES XFDL PDF FF22 FF99
DA 5234-R OER CONTROL LOG V1.00 XFDL PDF FF22 FF99
DA 5235-R VOLUNTER STATEMENT FOR THE ENLISTED CLUB MANAGEMENT CAREER PROGRAM (MOS OOJ) V1.00 XFDL PDF FF22 FF99
DA 5237-R PSNCO EER SUSPENSE ROSTER V1.00 XFDL PDF FF22 FF99
DA 5239-R 75-, 175- AND 300-METER DOWN RANGE FEEDBACK SCORECARD V1.00 XFDL PDF 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 PDF FF22 FF99
DA 5246-R FILE 1/3 ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT V1.00 XFDL PDF FF22 FF99
DA 5246-R FILE 2/3 ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT V1.00   PDF FF22 FF99
DA 5246-R FILE 3/3 ARMY CHILD DEVELOPMENT SERVICES (CDS) REPORT V1.00   PDF FF22 FF99
DA 5247-R REQUEST FOR SECURITY DETERMINATION V2.00 XFDL PDF FF22 FF99
DA 5248-R REPORT OF UNFAVORABLE INFORMATION FOR SECURITY DETERMINATION V1.20 XFDL PDF FF22 FF99
DA 5250 ROTC SCHOLARSHIP - RESERVE FORCES DUTY V1.00 XFDL PDF FF22 FF99
DA 5251-R PDF ONLY CONAUTH KEY MANAGEMENT WORKSHEET     PDF    
DA 5252-R PDF ONLY STATEMENT - EVIDENCE OF CITIZENSHIP STATUS     PDF    
DA 5257-R STINGER GUNNER PERFORMANCE EVALUATION SHEET V1.00   PDF FF22 FF99
DA 5258-R REDEYE GUNNER PERFORMANCE EVALUATION SHEET V1.00   PDF FF22 FF99
DA 5261-1-R SELECTED RESERVE INCENTIVE PROGRAM - EDUCATIONAL ASSISTANCE ADDENDUM V2.00 XFDL PDF FF22 FF99
DA 5261-2-R SELECTED RESERVE INCENTIVE PROGRAM - REENLISTMENT/EXTENSION BONUS ADDENDUM V2.00 XFDL PDF FF22 FF99
DA 5261-3-R SELECTED RESERVE INCENTIVE PROGRAM - AFFILIATION BONUS ADDENDUM V3.01 XFDL PDF FF22 FF99
DA 5261-4-R STUDENT LOAN REPAYMENT PROGRAM ADDENDUM V3.00 XFDL PDF FF22 FF99
DA 5261-5-R SELECTED RESERVE INCENTIVE PROGRAM - USAR PRIOR SERVICE ENLISTMENT BONUS ADDENDUM V1.00 XFDL PDF FF22 FF99
DA 5261-R SELECTED RESERVE INCENTIVE PROGRAM - ENLISTMENT BONUS ADDENDUM V2.00 XFDL PDF FF22 FF99
DA 5274-R STANDARD INPUT DATA COMPUTATIONS V1.10 XFDL PDF FF22 FF99
DA 5275-R TIME STUDY RECORD V1.10 XFDL PDF FF22 FF99
DA 5276-R PROGRAM MANAGEMENT DATA V2.00   PDF FF22 FF99
DA 5277-R OPERATIONAL AUDIT DATA V1.10 XFDL PDF FF22 FF99
DA 5278-R FILE 1/2 WORK SAMPLING RECORD V1.00 XFDL PDF FF22 FF99
DA 5278-R FILE 2/2 WORK SAMPLING RECORD V1.10   PDF FF22 FF99
DA 5279-R MANPOWER STANDARD AND TABLE V2.00 XFDL PDF FF22 FF99
DA 5286 INDIVIDUAL BASIC TRAINING (BT), ADVANCED INDIVIDUAL TRAINING (AIT), ONE STATION UNIT TRAINING (OSUT) V1.01 XFDL PDF FF22 FF99
DA 5286-1 INDIVIDUAL TRAINING RECORD (CONTINUATION SHEET),BASIC TRAINING (BT), ADVANCED INDIVIDUAL TRAINING (AIT), ONE STATION UNIT TRAINING (OSUT) V1.01 XFDL PDF FF22 FF99
DA 5289-R TRAVELING PURCHASE REQUEST V1.00 XFDL PDF FF22 FF99
DA 5297 ABSTRACT OF VENDOR DELIVERIES V1.00 XFDL PDF FF22 FF99
DA 5298 OPERTIONAL RATIONS ACCOUNTABILITY V1.00 XFDL PDF FF22 FF99

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

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