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DA Form 5440-20 is a DA series document issued for use across the Department of the Army. Official title: DELINEATION OF CLINICAL PRIVILEGES-OCCUPATIONAL THERAPY. Purpose: delineation of clinical privileges-occupational therapy. The current edition carries the date 02/01/2004 and is listed with a publication status of ACTIVE. The form runs to 3 page(s) and contains approximately unknown entry fields.
Responsibility for content and revision lies with TSG. The prescribing directive is AR 40-68, 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. This edition has been superseded by a newer one. It is kept accessible for reference and for records already completed under it.
Formats offered: PDF, XFDL. All are the same published layout in different containers, and the choice between them is a matter of how the entries will be made rather than what appears on the page. The pdf serves as the authoritative rendering. A fillable pdf exposes editable fields on screen; a printable pdf is the blank form as a flat page for handwriting.
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.
Entry proceeds block by block in the order printed on the page. Identifying particulars occupy the head of the form: name, identification number, unit or organisation, and date of preparation. These fields govern how the record is later retrieved from the file, so they are completed before any substantive block.
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 completed last and by hand or by an accepted electronic means. An unsigned form is a draft. Where a second signature is called for — reviewing official, approving authority, witness — each is applied in the order the blocks appear and dated as of application, not as of preparation. Blank mandatory fields are the most frequent defect; a nil entry is marked as such rather than left empty. Other recurring faults: transposed digits in identification numbers, dates in the wrong order of day and month, and stale copies retaining prior data because a working file was reused instead of a fresh 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.
Once completed, the form goes where the governing authority directs: to the designated office, along the unit administrative channel, or into the personal file. The preparer retains a copy. The length of retention and the manner of filing are set by the records schedule for the series, not by local arrangement.
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.
The files here are reproductions of published Department of the Army documents, provided for download. This site is not part of the Department of the Army and issues no forms of its own. Nothing on this page is legal advice, and no representation is made as to acceptance of a document by any office. Where an entry, a requirement, or a question of eligibility is in doubt, the proponent or the servicing administrative office answers it.
Questions and answers
- What is DA Form 5440-20?
- DELINEATION OF CLINICAL PRIVILEGES-OCCUPATIONAL THERAPY
- Which edition is current?
- 02/01/2004
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, XFDL, PDF
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21),