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DA Form 3611-R is a Department of the Army form in the DA series. Title of record: FOOD SERVICE DIVISION-PATIENT SATISFACTION SURVEY (LRA). Function: food service division-patient satisfaction survey (lra). The edition presently published bears the date 06/01/1970, with a status of ACTIVE. Physical extent is 1 page(s) and about 57 fillable fields.
The office of primary responsibility is TSG. Use is prescribed by TM 8-504, which defines when the form is raised and where it goes afterward. The form is normally completed by the subject of the entries or by administrative personnel maintaining the record, then reviewed and signed as the governing authority directs.
Available formats: PDF, XFDL. Each is a rendering of the same official layout; the content is identical across them and only the means of completion differs. The pdf is the reference copy. Fillable pdf carries interactive form fields; a printable pdf is the same page image without them, intended for pen entry after printing.
The pdf displays in current browsers and in any reader application. For fillable use a full reader is preferable to a browser viewer, since viewers vary in whether entered data is retained. An xfdl file is available too. The format is IBM Lotus Forms, in use across Army form systems, and it opens only in the Lotus Forms Viewer.
Every format is available at no charge and without sign-up. Files are distributed exactly as published, with no changes to the page.
What the form asks for
- COMMENTS
- ContentArea1
- FOOD_ITEMS
- NO_A
- NO_B
- NO_C
- NO_D
- NO_E
- Page1
- R54
- R55
- R56
- R57
- R58
- R59
- R60
- R61
- R62
- R63
- Rectangle1
- SUGGESTION
- T24
- T25
- T26
Completion follows the printed sequence of blocks from the top of the page downward. The heading area takes the identifying particulars — name, identification number, organisation, date of preparation. Retrieval of the record from a file depends on these entries, and they are therefore filled first.
Interactive fields are filled by typing into them. Movement between fields is by tab, following the order established when the form was constructed, which usually tracks the page layout. Check boxes and radio groups are set by clicking, and exclusive groups permit one selection at a time. A one-line field has no wrap: text beyond its width prints truncated even when the screen shows it. Overlong content is placed in remarks or on a continuation, not forced into the field.
The signature block is the final entry, made by hand or by an authorised electronic method, and without it the document remains a draft. Countersignatures — review, approval, witness — are added in the sequence printed, dated at the moment of signing and not at preparation. Empty mandatory fields lead the list of defects; an inapplicable field is annotated as such, not passed over. Behind it come digit transposition in identification numbers, day-month inversion in dates, and residual entries surviving from a reused copy in place of a blank form.
A Privacy Act statement appears on the form where personal information is collected. It sets out the authority for collection, the purpose, the routine uses, and whether disclosure is mandatory or voluntary. The statement is read before entry, not after. Completed copies carry personal data and are handled and stored under the safeguards applicable to that data.
Disposition of the completed document follows the prescribing authority — delivery to the office it names, transmission through the unit administrative channel, or placement in the individual's record, according to circumstance. The preparer keeps a copy. Retention is governed by the applicable records schedule, not by office custom.
Related forms are found by series and number. Documents in the DA series sharing a proponent or a prescribing directive commonly travel together, and a form referenced within the body of another is usually filed with it. Continuation sheets, cover sheets, and transmittal documents belong to this group and are collected before submission rather than after.
Editions are replaced when the proponent revises the content. The edition date printed on the form is the means of telling one version from another, and the date on a downloaded copy is checked against the edition in force before use. Records already executed on a prior edition are not reworked on that account.
The documents on this page are reproductions of published Department of the Army forms, offered for download. This is an independent site with no connection to the Department of the Army and no authority to issue forms. Nothing stated is legal advice, and no assurance is given regarding acceptance by any office. Doubts about a specific entry, requirement, or eligibility are resolved by the proponent or by the servicing administrative office.
Questions and answers
- What is DA Form 3611-R?
- FOOD SERVICE DIVISION-PATIENT SATISFACTION SURVEY (LRA)
- Which edition is current?
- 06/01/1970
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, XFDL, PDF
Publisher notes
- 41-ITEM ALSO PRODUCED IN ELECTRONIC MEDIA