DA Forms 4980 - 5203

The United States Army places great importance on recognizing the achievements and service of its members. One way to acknowledge outstanding performance is through the presentation of medals or awards, which are often accompanied by certificates. The Army uses various forms to document these certifications, including DA Form 4980-1 for the Medal of Honor Certificate and DA Form 4980-10 for the Purple Heart Medal Certificate. In this list, we will highlight some of the most essential certificate forms used by the Army.

• DA Form 4980-1 - Medal of Honor Certificate (S&I, PERSCOM): A certificate used to recognize the awarding of the Medal of Honor.
• DA Form 4980-2 - Distinguished Service Cross Medal Certificate: A certificate used to recognize the awarding of the Distinguished Service Cross medal.
• DA Form 4980-3 - Distinguished Service Medal Certificate: A certificate used to recognize the awarding of the Distinguished Service Medal.
• DA Form 4980-4 - Silver Star Medal Certificate: A certificate used to recognize the awarding of the Silver Star Medal.
• DA Form 4980-5 - Bronze Star Medal Certificate: A certificate used to recognize the awarding of the Bronze Star Medal.
• DA Form 4980-6 - Soldier's Medal Certificate: A certificate used to recognize the awarding of the Soldier's Medal.
• DA Form 4980-7 - Distinguished Flying Cross Certificate (Heroism): A certificate used to recognize the awarding of the Distinguished Flying Cross for heroism.
• DA Form 4980-8 - Distinguished Flying Cross Certificate (Achievement): A certificate used to recognize the awarding of the Distinguished Flying Cross for achievement.
• DA Form 4980-9 - Air Medal Certificate: A certificate used to recognize the awarding of the Air Medal.
• DA Form 4980-10 - Purple Heart Medal Certificate: A certificate used to recognize the awarding of the Purple Heart Medal.
• DA Form 4980-11 - Legion of Merit Certificate: A certificate used to recognize the awarding of the Legion of Merit.
• DA Form 4980-12 UNSIGNED - Meritorious Service Medal: A certificate used to recognize the awarding of the Meritorious Service Medal.
• DA Form 4980-13 - Presidential Unit Citation Certificate: A certificate used to recognize the awarding of the Presidential Unit Citation.
• DA Form 4980-14 - Army Commendation Medal: A certificate used to recognize the awarding of the Army Commendation Medal.
• DA Form 4980-16 - Valorous Unit Award Certificate: A certificate used to recognize the awarding of the Valorous Unit Award.
• DA Form 4980-17 - Meritorious Unit Commendation Certificate: A certificate used to recognize the awarding of the Meritorious Unit Commendation.
• DA Form 4980-18 UNSIGNED - The Army Achievement Medal Certificate: A certificate used to recognize the awarding of the Army Achievement Medal.
• DA Form 4980-19 - Army Superior Unit Award Certificate: A certificate used to recognize the awarding of the Army Superior Unit Award.
• DA Form 4982 - Muzzle Velocity Record: A record used to document muzzle velocity for Army weapons.
• DA Form 4982-1 - M90 Velocimeter Work Sheet: A worksheet used to calculate muzzle velocity using the M90 Velocimeter.
• DA Form 4985 - NAF Referral and Selection List (Nonappropriated Fund Employment): A list used to manage nonappropriated fund employment referrals and selections.
• DA Form 4991 - Declination of Continued Service Statement: A form used to document an individual's declination of continued military service.
• DA Form 4993 - Harbor Boat Engine Department Log for Class A and C-1 Vessels: A log used to document engine department activity on Class A and C-1 vessels.
• DA Form 4996-R - Quality Control Card (LRA): A card used to track quality control for Army operations.
• DA Form 4997-R - Locator Card (LRA): A card used to track the location of Army personnel.
• DA Form 4998-R - Quality Control and Surveillance Record for TOE Medical Assemblage (LRA): A record used to track quality control and surveillance for TOE Medical Assemblages.
• DA Form 4999 - Due In Record: A record used to track equipment due for maintenance or repair.
• DA Form 5000-R - Applicant Interview Report - Judge Advocate General's Corps (LRA): A report used to document an applicant's interview for the Judge Advocate General's Corps.
• DA Form 5007A - Medical Record - Allergy Immunotherapy Record (Single Extract): A record used to document allergy immunotherapy treatments for Army personnel.
• DA Form 5007B - Medical Record - Allergy Immunotherapy Record (Double Extract): A record used to document allergy immunotherapy treatments for Army personnel, with additional copies for transfer to other medical facilities.
• DA Form 5008 - Telephone Medical Advice/Consultation Record: A record used to document telephone consultations between medical personnel and Army personnel.
• DA Form 5009 - Medical Record - Release Against Medical Advice: A form used to document an individual's release against medical advice.
• DA Form 5016 - Chronological Statement of Retirement Points (Copy Availability at https://www.hrcapps.army.mil): A statement used to track retirement points for Army personnel.
• DA Form 5017 - Civilian Employee Consent Statement: A statement used to document a civilian employee's consent for certain actions or procedures.
• DA Form 5018-R - ADAPCP Client's Consent Statement for Release of Treatment Information (LRA): A statement used to obtain a client's consent for the release of treatment information in the Army Substance Abuse Program.
• DA Form 5019 - Condition of Employment for Certain Civilian Positions Identified Critical Under the Department of the Army Drug-Free Federal Workplace Program: A form used to document the condition of employment for civilian positions deemed critical under the Army's drug-free workplace program.
• DA Form 5025-GI-R - G. Design Data Checklist Physical Security Enhancement Against Terrorist Threat (LRA): A checklist used to evaluate physical security measures against terrorist threats.
• DA Form 5025-G-R - G. Design Data Checklist Physical Security Enhancement Against Terrorist Threat (Cont'd) (LRA): A continuation of the G. Design Data Checklist Physical Security Enhancement Against Terrorist Threat.
• DA Form 5026-R - Record of Certification - Small Arms Shipment Control (LRA): A record used to certify small arms shipment control.
• DA Form 5027-R - MEDCASE Program Requirement (LRA): A form used to document the requirements for the Army MEDCASE program.
• DA Form 5028-R - MEDCASE Support and Transmittal Form (LRA): A form used to request MEDCASE support and transmit information related to the MEDCASE program.
• DA Form 5030 - Engineer Diver Training Application: An application used to request engineer diver training.
• DA Form 5032 - Field Artillery Delivered Minefield Planning Sheet: A planning sheet used to coordinate the delivery of minefields by field artillery units.
• DA Form 5070 - Justification Statement for .0015 Contingency Funds: A statement used to justify the use of contingency funds for Army operations.
• DA Form 5071 - Paying Agent Receipt Control and Cash Accountability Journal: A journal used to track paying agent receipts and cash accountability.
• DA Form 5072 - Emergency Action Statement: A statement used to document emergency actions taken during Army operations.
• DA Form 5073 - Magnetic Compass Deviation Table Installations: A table used to document magnetic compass deviations at Army installations.
• DA Form 5074-1-R - Record of Award of Entry Grade Credit (Health Services Officer) (LRA): A record used to document the awarding of entry grade credit for Health Services Officers.
• DA Form 5074-R - Record of Award of Entry Grade Credit (Medical and Dental Officers) (LRA): A record used to document the awarding of entry grade credit for Medical and Dental Officers.
• DA Form 5075 - Artillery Survey Control Point: A point used to establish survey control for artillery operations.
• DA Form 5097 - The Inspector General Oath: An oath taken by Inspector General personnel in the Army.
• DA Form 5097-1 - Inspector General Oath (Non-IG): An oath taken by non-Inspector General personnel in the Army.
• DA Form 5097-2 - Inspector General Oath (Acting-IG): An oath taken by Acting Inspector General personnel in the Army.
• DA Form 5097-A - Assigned IG Cert: A certificate used to document an individual's assignment as an Inspector General.
• DA Form 5104 - Analysis of Custodial Personnel Requirements: A form used to analyze custodial personnel requirements for Army facilities.
• DA Form 5105 - Janitorial Standards Checklist: A checklist used to ensure compliance with janitorial standards for Army facilities.
• DA Form 5106 - Mission Support Plan (MSP): A plan used to document mission support requirements for Army operations.
• DA Form 5108-1-R - Post Investment Analysis (LRA): An analysis used to evaluate the post-investment performance of Army programs.
• DA Form 5108-2-R - Feeder Report to Annual Productivity Report - PECI (LRA): A report used to feed data into the Army's annual productivity report.
• DA Form 5108-R - Documentation for Productivity Capital Investments Program (LRA): Documentation used to support the Army's productivity capital investments program.
• DA Form 5109 - Request to Superior to Exercise Article 15, UCMJ, Jurisdiction: A form used to request that a superior officer exercise jurisdiction under Article 15 of the Uniform Code of Military Justice.
• DA Form 5110 - Article 15-Reconciliation Log: A log used to document actions taken during reconciliation of Article 15 proceedings.
• DA Form 5111 - Summary Court-Martial Rights Notification/Waiver Statement: A statement used to notify Army personnel of their rights and obtain waivers related to summary court-martial proceedings.
• DA Form 5112 - Checklist for Pretrial Confinement: A checklist used to ensure compliance with procedures related to pretrial confinement of Army personnel.
• DA Form 5117 - Reassignment Control Sheet: A sheet used to control the reassignment of Army personnel.
• DA Form 5118 - Reassignment Status and Election Statement: A statement used to document an individual's status and election related to reassignment in the Army.
• DA Form 5121 - Oversea Tour Election Statement: A statement used to document an individual's election for an overseas tour in the Army.
• DA Form 5123 - In- and Out- Processing Records Checklist: A checklist used to ensure compliance with procedures related to in- and out-processing of Army personnel.
• DA Form 5123-1 - In-Processing Personnel Record: A record used to document the in-processing of Army personnel.
• DA Form 5137 - Application for Voluntary Mobilization Preassignment: An application used to request voluntary mobilization preassignment in the Army.
• DA Form 5138 - Separation Action Control Sheet: A sheet used to control separation actions for Army personnel.
• DA Form 5140 - Caution Tag: A tag used to indicate caution for Army equipment or facilities.
• DA Form 5146-R - Asphalt Pavement Inspection Sheet (LRA): A sheet used to inspect asphalt pavement for Army facilities.
• DA Form 5147-R - Section Evaluation Summary (LRA): A summary used to evaluate sections of Army programs.
• DA Form 5148-R - Present Worth Computation (LRA): A computation used to determine present worth in Army programs.
• DA Form 5149-1-R - Branch Identification Summary - Continuation Sheet (LRA): A continuation sheet used to identify branches in Army programs.
• DA Form 5149-R - Branch Identification Summary (LRA): A summary used to identify branches in Army programs.
• DA Form 5150-R - Section Identification Record (LRA): A record used to identify sections in Army programs.
• DA Form 5151-R - Section Pavement Structure Record (LRA): A record used to document the pavement structure of Army program sections.
• DA Form 5152-R - Section Materials Property Record (LRA): A record used to document the materials properties of Army program sections.
• DA Form 5153-R - Section Traffic Record (LRA): A record used to document the traffic flow of Army program sections.
• DA Form 5154-R - Section Condition Record (LRA): A record used to document the condition of Army program sections.
• DA Form 5155-R - Branch Maintenance and Repair Requirements (LRA): A form used to document maintenance and repair requirements for branches in Army programs.
• DA Form 5156-R - Section Maintenance and Repair Record (LRA): A record used to document the maintenance and repair history of Army program sections.
• DA Form 5160 - Test Administration Statement: A statement used to document the administration of tests in the Army.
• DA Form 5163 - Nonappropriated Fund Central Payroll System - Tips, Service Charges and Meals Report: A report used to document tips, service charges, and meals in the Army's nonappropriated fund central payroll system.
• DA Form 5164-R - Hands-On Evaluation (LRA): An evaluation used to assess hands-on skills in Army programs.
• DA Form 5167 - Incentive Awards Nomination and Approval - Nonappropriated Funds: A form used to nominate and approve incentive awards in the Army's nonappropriated funds program.
• DA Form 5168-R - Safety Clearance Order (Electrical Facilities) (LRA): An order used to clear electrical facilities for safe operation in Army programs.
• DA Form 5179 - Medical Record - Preoperative/Postoperative Nursing Document: A record used to document preoperative and postoperative nursing care for Army personnel.
• DA Form 5179-1 - Intraoperative Document: A record used to document intraoperative medical procedures for Army personnel.
• DA Form 5181 - Screening Note of Acute Medical Care: A note used to screen and document acute medical care for Army personnel.
• DA Form 5182-R - Soil Suction, Water Content and Specific Volume (LRA): A record used to document soil properties in Army programs.
• DA Form 5184 - Consumer Complaint: A form used to document consumer complaints related to Army programs.
• DA Form 5187 - Application for Respite Caregivers: An application used to request respite caregivers for Army personnel.
• DA Form 5189 - Application for Respite Care for Children and Adults with Disabilities: An application used to request respite care for children and adults with disabilities in Army programs.
• DA Form 5190 - Clinician's Information: Information provided by a clinician related to the medical history and treatment of Army personnel.
• DA Form 5191 - Information on Individual with Disability: Information related to an individual with a disability in Army programs.
• DA Form 5192 - Family Identification Sheet for a Child Receiving Service: A sheet used to identify the family of a child receiving services in Army programs.
• DA Form 5193 - Child's Face and Whereabouts Sheet: A sheet used to document the face and whereabouts of a child in Army programs.
• DA Form 5195 - Health Data: Data related to the health of Army personnel.
• DA Form 5203 - DODIC Master/Lot Locator Record: A record used to locate master or lot information for Department of Defense Identification Codes (DODICs) in Army programs.

Certificates serve as a tangible reminder of an individual's service and sacrifice, and they play an important role in recognizing exceptional achievements. The forms listed above represent just a few examples of the many ways that the Army acknowledges the dedication and commitment of its members. Whether it is for acts of heroism, meritorious service, or exceptional leadership, these certificates help ensure that the contributions of our soldiers are never forgotten.