Department of the Army (DA) Forms -- Complete Listing
Page 8 of 12: DA 5300
thru DA 5442
(1-2-3-4-5-6-7-9-10-11-12)
Also See our List of Commonly Used DA and DD Forms
| Form No. | Title | Version | XFDL | FF22 | FF99 | |
| DA 5303-R | VOLUNTEER AGREEMENT AFFIDAVIT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5304 | FAMILY CARE PLAN COUNSELING CHECKLIST | V1.00 | XFDL | FF22 | ||
| DA 5305 | FAMILY CARE PLAN | V1.00 | XFDL | FF22 | ||
| DA 5310-R PDF ONLY | FIREFINDER FRIENDLY FIRE | |||||
| DA 5313-1-R | NONAPPROPRIATED FUND PAYABLE/DISBURSEMENT VOUCHER CONTINUATION SHEET | V1.00 | XFDL | FF22 | FF99 | |
| DA 5313-R | NONAPPROPRIATED FUND PAYABLE/DISBURSEMENT VOUCHER | V1.00 | XFDL | FF22 | FF99 | |
| DA 5315-R | US ARMY ADVANCED EDUCATION FINANCIAL ASSISTANCE RECORD | V1.00 | XFDL | FF22 | FF99 | |
| DA 5327 | BONA FIDE DEPENDENT DECLARATION - MILITARY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5328 | BONA FIDE DEPENDENT DECLARATION (CIVILIAN) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5329 | ESCORT REPORT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5330 | RELEASE OF REMAINS FOR LOCAL DISPOSITION (OCONUS) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5339 | OCS APPLICANT'S COMMANDERS EVALUATION SHEET | V1.00 | XFDL | FF22 | FF99 | |
| DA 5353-R | BANK RECONCILIATION WORKSHEET | V1.00 | XFDL | FF22 | FF99 | |
| DA 5356-R | PROGRAM WORKSHEET (SB-3614A(V)/TT) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5359 | LONG-RANGE SPECIAL ASSIGNMENT AIRLIFT MISSION (SAAM) FLYING HOURS REQUIREMENTS | V1.00 | XFDL | |||
| DA 5367-R | PERSONNEL STATUS REPORT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5368 | QUICK FIRE PLAN | V1.00 | XFDL | FF22 | FF99 | |
| DA 5369-R | ROTATION AGREEMENT - EMPLOYEES RECRUITED FROM THE UNITED STATES | V2.00 | XFDL | FF22 | FF99 | |
| DA 5370-R | ROTATION AGREEMENT - EMPLOYEES RECRUITED LOCALLY IN FOREIGN AREA | V2.00 | XFDL | FF22 | FF99 | |
| DA 5371-R | ROTATION AGREEMENT - EMPLOYEES RECRUITED FROM THE US TERRITORIES AND POSSESSIONS | V2.00 | XFDL | FF22 | FF99 | |
| DA 5372-R | ORIENTATION STATEMENT | V2.00 | XFDL | FF22 | FF99 | |
| DA 5373-R PDF ONLY | REQUEST FOR PROCESSING OF OVERSEAS SELECTEE | |||||
| DA 5374 | PERFORMANCE ASSESSMENT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5376 | INDIVIDUAL TRAINING EVALUATION RECORD | V1.00 | XFDL | FF22 | ||
| DA 5376 | INDIVIDUAL TRAINING EVALUATION RECORD, PAGE 2 | V1.00 | FF22 | |||
| DA 5377 | FIRE AND EMERGENCY SERVICES TRAINING RECORD | V1.00 | XFDL | FF22 | ||
| DA 5379 | APPARATUS MAINTENANCE CHECKLIST | V1.00 | XFDL | FF22 | ||
| DA 5380 | FIRE APPARATUS TEST RECORD | V1.00 | XFDL | FF22 | ||
| DA 5381 | BUILDING - FIRE RISK MANAGEMENT SURVEY | V1.00 | XFDL | FF22 | ||
| DA 5382 | HAZARD/DEFICIENCY INSPECTION RECORD | V1.00 | XFDL | FF22 | ||
| DA 5383 | HOT-WORK PERMIT | V1.00 | XFDL | FF22 | ||
| DA 5384 | WATER FLOW TEST | V1.00 | XFDL | FF22 | ||
| DA 5391-R | WORKLOAD MANAGEMENT SYSTEM FOR NURSING | V1.00 | XFDL | FF22 | FF99 | |
| DA 5394-1 | PRINTING FACILITY PRODUCTIVITY REPORT | V1.01 | XFDL | FF22 | FF99 | |
| DA 5396 | OVERSEAS TOUR EXTENSION INCENTIVE PROGRAM MONTHLY REPORT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5402 | BARBER/BEAUTY SHOP INSPECTION | V1.00 | XFDL | FF22 | FF99 | |
| DA 5409 | INOPERATIVE EQUIPMENT REPORT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5410 | UNIT LEVEL DEADLINING PARTS REPORT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5412-R | WAIVER OF COMPENSATION STATEMENT | V2.00 | XFDL | FF22 | FF99 | |
| DA 5413-R | CONSULTANT/EXPERT CERTIFICATE | V2.00 | XFDL | FF22 | FF99 | |
| DA 5414-R | ADMINISTRATIVE REEMPLOYMENT RIGHTS AGREEMENT | V2.00 | XFDL | FF22 | FF99 | |
| DA 5415 | GARRISON CATEGORY COMPETITION CHECKLIST | V1.00 | ||||
| DA 5416 | FIELD CATEGORY COMPETITION CHECKLIST | V1.00 | XFDL | |||
| DA 5422-R | REQUEST FOR BULK FUND ORDER | V2.00 | XFDL | FF22 | FF99 | |
| DA 5425 | APPLICANT/NOMINEE PERSONAL FINANCIAL STATEMENT | V1.00 | XFDL | FF22 | ||
| DA 5426 | BATTALION COMMAND TEAM RECRUITER CANDIDATE INTERVIEW AND EVALUATION | V1.00ES | XFDL | FF22 | ||
| DA 5427 | COMPANY COMMANDER RECRUITER CANDIDATE INTERVIEW AND ASSESSMENT | V1.00 | XFDL | FF22 | ||
| DA 5429-R PDF ONLY | CONDUCT OF FIRE | |||||
| DA 5433-R | VERIFICATION OF OVERSEAS EMPLOYMENT FOR NONCOMPETITIVE APPOINTMENT UNDER EO 12362 | V3.00 | XFDL | FF22 | FF99 | |
| DA 5434 | SPONSORSHIP PROGRAM COUNSELING AND INFORMATION SHEET | V2.00 | XFDL | FF22 | FF99 | |
| DA 5435-R | STATEMENT OF UNDERSTANDING - THE SELECTED RESERVE MONTGOMERY GI BILL(10 USC CHAPTER 1606) | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440 | DELINEATION OF CLINICAL PRIVILEGES - ANESTHESIA | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-1 | DELINEATION OF CLINICAL PRIVILEGES - DENTISTRY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-10 | DELINEATION OF CLINICAL PRIVILEGES - PSYCHIATRY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-11 | DELINEATION OF CLINICAL PRIVILEGES - CLINICAL PSYCHOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-12 | DELINEATION OF CLINICAL PRIVILEGES - DIAGNOSTIC RADIOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-13 | DELINEATION OF CLINICAL PRIVILEGES - GENERAL SURGERY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-14 | DELINEATION OF CLINICAL PRIVILEGES - NURSE ANESTHETIST | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-15 | DELINEATION OF CLINICAL PRIVILEGES - CERTIFIED NURSE MIDWIFE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-16 | DELINEATION OF CLINICAL PRIVILEGES - NURSE PRACTITIONER | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-18 | DELINEATION OF CLINICAL PRIVILEGES - PHYSICIAN ASSISTANT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-19 | DELINEATION OF CLINICAL PRIVILEGES - DIETETICS | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-2 | DELINEATION OF CLINICAL PRIVILEGES - FAMILY PRACTICE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-20 | DELINEATION OF CLINICAL PRIVILEGES - OCCUPATIONAL THERAPY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-21 | DELINEATION OF CLINICAL PRIVILEGES - PHYSICAL THERAPY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-22 | DELINEATION OF CLINICAL PRIVILEGES | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-23 | DELINEATION OF CLINICAL PRIVILEGES - EMERGENCY MEDICINE | V2.00 | XFDL | FF22 | FF99 | |
| DA 5440-24 | DELINEATION OF CLINICAL PRIVILEGES - AEROSPACE MEDICINE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-25 | DELINEATION OF CLINICAL PRIVILEGES - GENERAL MEDICAL OFFICER | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-28 | DELINEATION OF CLINICAL PRIVILEGES | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-29 | DELINEATION OF CLINICAL PRIVILEGES - ALLERGY/IMMUNOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-3 | DELINEATION OF CLINICAL PRIVILEGES - INTERNAL MEDICINE | V1.01 | XFDL | FF22 | FF99 | |
| DA 5440-30 | DELINEATION OF CLINICAL PRIVILEGES - NEPHROLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-31 | DELINEATION OF CLINICAL PRIVILEGES - CHIROPRACTIC | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-32 | DELINEATION OF CLINICAL PRIVILEGES - DERMATOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-33 | DELINEATION OF CLINICAL PRIVILEGES - UROLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-34 | DELINEATION OF CLINICAL PRIVILEGES - BEHAVIORAL HEALTH PRACTIONER | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-35 | DELINEATION OF CLINICAL PRIVILEGES - PSYCHOLOGICAL ASSOCIATE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-36 | DELINEATION OF CLINICAL PRIVILEGES - AUDIOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-37 | DELINEATION OF CLINICAL PRIVILEGES - SPEECH PATHOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-38 | DELINEATION OF CLINICAL PRIVILEGES - CLINICAL PHARMACY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-39 | DELINEATION OF CLINICAL PRIVILEGES - NUCLEAR MEDICINE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-4 | DELINEATION OF CLINICAL PRIVILEGES - NEUROLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-40 | DELINEATION OF CLINICAL PRIVILEGES - THERAPEUTIC RADIOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-41 | DELINEATION OF CLINICAL PRIVILEGES - PHYSICAL MEDICINE AND REHABILITATION | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-42 | DELINEATION OF CLINICAL PRIVILEGES - CARDIOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-43 | DELINEATION OF CLINICAL PRIVILEGES - OPHTHAMOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-44 | DELINEATION OF CLINICAL PRIVILEGES - OTOLARYNGOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-45 | DELINEATION OF CLINICAL PRIVILEGES - CARDIOVASCULAR SURGERY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-46 | DELINEATION OF CLINICAL PRIVILEGES - PULMONARY DISEASE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-47 | DELINEATION OF CLINICAL PRIVILEGES - PREVENTIVE MEDICINE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-48 | DELINEATION OF CLINICAL PRIVILEGES - ORAL & MAXILLOFACIAL SURGERY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-49 | DELINEATION OF CLINICAL PRIVILEGES - PLASTIC SURGERY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-5 | DELINEATION OF CLINICAL PRIVILEGES - OBSTETRICS AND GYNECOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-50 | DELINEATION OF CLINICAL PRIVILEGES - VASCULAR SURGERY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-51 | DELINEATION OF CLINICAL PRIVILEGES - NEUROSURGERY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-52 | DELINEATION OF CLINICAL PRIVILEGES - CRITICAL CARE MEDICINE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-53 | DELINEATION OF CLINICAL PRIVILEGES - OCCUPATIONAL MEDICINE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-54 | DELINEATION OF CLINICAL PRIVILEGES - THORACIC SURGERY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-55 | DELINEATION OF CLINICAL PRIVILEGES - ORTHOPAEDICS | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-56 | DELINEATION OF CLINICAL PRIVILEGES - BLOOD SERVICES | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-57 | DELINEATION OF CLINICAL PRIVILEGES - PSYCHIATRIC ADVANCED PRACTICE NURSE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-58 | DELINEATION OF CLINICAL PRIVILEGES - SUBSTANCE ABUSE REHABILITATION | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-6 | DELINEATION OF CLINICAL PRIVILEGES - OPTOMETRY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-7 | DELINEATION OF CLINICAL PRIVILEGES - PATHOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-8 | DELINEATION OF CLINICAL PRIVILEGES - PEDIATRICS | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440-9 | DELINEATION OF CLINICAL PRIVILEGES - PODIATRY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5440A | APPROVAL OF CLINICAL PRIVILEGES/STAFF APPOINTMENT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441 | EVALUATION OF CLINICAL PRIVILEGES - ANESTHESIA | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-1 | EVALUATION OF CLINICAL PRIVILEGES - DENTISTRY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-10 | EVALUATION OF CLINICAL PRIVILEGES - PSYCHIATRY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-11 | EVALUATION OF CLINICAL PRIVILEGES - CLINICAL PSYCHOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-12 | EVALUATION OF CLINICAL PRIVILEGES - DIAGNOSTIC RADIOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-13 | EVALUATION OF CLINICAL PRIVILEGES - GENERAL SURGERY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-14 | EVALUATION OF CLINICAL PRIVILEGES - NURSE ANESTHETIST | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-15 | EVALUATION OF CLINICAL PRIVILEGES - CERTIFIED NURSE MIDWIFE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-16 | EVALUATION OF CLINICAL PRIVILEGES - NURSE PRACTITIONER | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-18 | EVALUATION OF CLINICAL PRIVILEGES - PHYSICIAN ASSISTANT | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-19 | EVALUATION OF CLINICAL PRIVILEGES - DIETETICS | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-2 | EVALUATION OF CLINICAL PRIVILEGES - FAMILY PRACTICE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-20 | EVALUATION OF CLINICAL PRIVILEGES - OCCUPATIONAL THERAPY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-21 | EVALUATION OF CLINICAL PRIVILEGES - PHYSICAL THERAPY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-22 | EVALUATION OF CLINICAL PRIVILEGES | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-23 | EVALUATION OF CLINICAL PRIVILEGES - EMERGENCY MEDICINE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-24 | EVALUATION OF CLINICAL PRIVILEGES - AEROSPACE MEDICINE | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-25 | EVALUATION OF CLINICAL PRIVILEGES - GENERAL MEDICAL OFFICER | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-28 | EVALUATION OF CLINICAL PRIVILEGES - SOCIAL WORK | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-29 | EVALUATION OF CLINICAL PRIVILEGES - ALLERGY/IMMUNOLOGY | V1.00 | XFDL | FF22 | FF99 | |
| DA 5441-3 | EVALUATION OF CLINICAL PRIVILEGES - INTERNAL MEDICINE | V1.00 | XFDL |