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DA Form 4170 is a Department of the Army form in the DA series. Title of record: STATEMENT OF GAINS AND LOSSES. Function: statement of gains and losses. The edition presently published bears the date 07/01/2002, with a status of ACTIVE. Physical extent is 1 page(s) and about 133 fillable fields.
Responsibility for content and revision lies with G-4. The prescribing directive is PAM 30-22, which sets both the trigger for use and the disposition of the completed document. Entry is made by the named party or by the records clerk holding the file, with review and signature applied in the prescribed order.
Distributed formats: PDF. The layout is common to all of them; what varies is the method of entry. The pdf is the reference version. In the fillable pdf the entry areas are live objects that accept typing; in the printable version the same areas are inert and are filled by hand 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.
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
- ACCOUNT
- ACCOUNT_1
- ACCOUNT_2
- ACCOUNT_3
- ACCOUNT_4
- ACCOUNT_5
- ACCOUNT_6
- ACCOUNT_7
- ACCOUNT_8
- ACCOUNT_9
- ALLOWANC
- ALLOWANC_1
- ALLOWANC_2
- ALLOWANC_3
- ALLOWANC_4
- ALLOWANC_5
- ALLOWANC_6
- ALLOWANC_7
- ALLOWANC_8
- ALLOWANC_9
- AUTHORIZ
- AUTHORIZ_1
- AUTHORIZ_2
- AUTHORIZ_3
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.
Typed entry is made straight into the interactive fields. The tab key moves through them in the order set at build time, generally matching the reading order of the page. Boxes and buttons respond to a click; in an exclusive group, one selection cancels the others. Single-line fields do not wrap, and anything longer than the field width prints cut off although it may still display in full on screen. Extended text goes to remarks or a continuation sheet rather than into a narrow box.
Signature comes at the end, applied in ink or by an accepted electronic method. Until it is applied the document is a draft. Additional signatures — reviewer, approver, witness — are taken in printed block order, each dated when signed rather than when the form was drafted. The commonest error is a mandatory field left blank; where nothing applies, the entry is marked accordingly instead of being skipped. Transposed identification digits, day and month reversed in dates, and carried-over data from a reused working copy account for most of the remainder.
Forms that collect personal information bear a Privacy Act statement covering authority, purpose, routine uses, and whether the disclosure is required or optional. Reading it precedes completion. Once filled, the document contains personal data and is subject to the handling and storage rules that attach to such records.
The completed form is routed as the governing authority prescribes: to the office named in the directive, through the unit administrative channel, or into the individual's file, depending on the case. A copy is retained by the preparer. Filing and retention follow the records schedule applicable to the series rather than local practice.
Companion forms are traced by series and number. Within the DA series, documents sharing a proponent or a governing directive are frequently required together, and a form cited on the face of another is generally submitted alongside it. Continuation sheets, covers, and transmittal forms are part of that set and are assembled in advance of submission.
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.
What is offered here are copies of published Department of the Army documents, made available for download. The site is independent of the Department of the Army and publishes no forms of its own. The material is informational and not legal advice, and no statement is made about whether any office will accept a given document. Questions of entry, requirement, or eligibility go to the proponent or the servicing administrative office.
Questions and answers
- What is DA Form 4170?
- STATEMENT OF GAINS AND LOSSES
- Which edition is current?
- 07/01/2002
- Who is responsible for this form?
- G-4
- In which formats can it be downloaded?
- PDF, PDF
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA,