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DA Form 4213 is a DA series document issued for use across the Department of the Army. Official title: SUPPLEMENTAL DATA FOR ARMY MEDICAL SERVICE RESERVE OFFICERS. Purpose: supplemental data for army medical service reserve officers. The current edition carries the date 04/01/1976 and is listed with a publication status of ACTIVE. The form runs to 2 page(s) and contains approximately 200 entry fields.
The office of primary responsibility is TSG. Use is prescribed by AR 135-133, 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. 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.
All formats are free to download and no registration is involved. The files are the published documents, distributed unmodified.
What the form asks for
- Address
- AppDate
- AppFrom
- AppFrom_1
- AppFrom_2
- AppThru
- AppThru_1
- AppThru_2
- AssnType
- AssnType_1
- AssnType_2
- Branch
- CertBy
- CertDate
- CertN
- CertY
- CertifiedN
- CertifiedY
- Commision
- ContentArea1
- CurrLice
- DOB
- DateA
- DateB
The blocks are worked through in the order they appear on the sheet. At the head sit the identifying entries: name, identification number, unit, date. Because the filed record is indexed on these, they precede everything substantive.
Fillable fields accept typing directly. Tab advances from one field to the next in the order the form was built, which is normally the reading order of the page. Check boxes and option buttons are clicked; where a set of options is exclusive, selecting one clears the rest. Fields sized for a single line will not wrap, and text exceeding the width is truncated in print even where it remains visible on screen. Long entries belong in the remarks area or on a continuation, not compressed into a narrow field.
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.
Where personal information is gathered, the form carries a Privacy Act statement giving the collection authority, the purpose, the routine uses, and the mandatory or voluntary character of the disclosure. It is read before entries are made rather than afterwards. A completed copy holds personal data and is stored and transmitted under the corresponding safeguards.
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.
An edition stands until the proponent issues a revision. The printed edition date identifies the version, and a copy held locally is checked against the edition now in force before reuse. Prior executions under a superseded edition are not reopened for that reason.
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 4213?
- SUPPLEMENTAL DATA FOR ARMY MEDICAL SERVICE RESERVE OFFICERS
- Which edition is current?
- 04/01/1976
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, PDF