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DA Form 4475 — DATA REQUIRED BY THE PRIVACY ACT OF 1974 PERSONAL INFORMATION FROM THE NOK OF A DECEASED SERVICE MEMBER

data required by the privacy act of 1974 personal information from the nok of a deceased service member

A newer edition of this form has been issued (04/30/2026). Download the current edition.

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DA Form 4475 handles one job: data required by the privacy act of 1974 personal information from the nok of a deceased service member. The official title is DATA REQUIRED BY THE PRIVACY ACT OF 1974 PERSONAL INFORMATION FROM THE NOK OF A DECEASED SERVICE MEMBER. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is 04/30/2026, status ACTIVE, running 1 page(s) with about 33 fields to complete. This edition is superseded — pull the newer one unless your record was already executed on this version.

Authority sits in two places. G-1 owns the form, AR 638-8 says when it is raised and where it goes. Routine cases need neither read in full — the page itself carries the sequence. The entries are completed by their subject or by unit administrative staff working from what that person supplies.

Pick by how you will enter data: PDF, XFDL on offer. Typing means fillable pdf, where the boxes accept keystrokes and hold them on save. Handwriting means printable pdf, a flat page image sent straight to a printer. Neither version changes what appears on the page.

A standalone reader is the safe choice for fillable work. Browser viewers vary in whether entered data survives the session, and there is no warning when it does not; a one-field save test settles it in seconds. Xfdl means IBM Lotus Forms. The Lotus Forms Viewer opens it; pdf readers and word processors do not.

No charge, no account, no email address. The file is the published document, distributed unaltered.

What the form asks for

  • ContentArea1
  • Line1
  • Line2
  • Line3
  • Page1
  • R40
  • R41
  • R42
  • R43
  • R44
  • R45
  • T11
  • T16
  • T23
  • T26
  • T27
  • T28
  • T29
  • T30
  • T31
  • T32
  • T34
  • T35
  • T37

The heading entries carry more weight than the body. Name spelled as in official records, identification number, organisation, date prepared. Retrieval runs on those values, so a transposed digit or a casual spelling costs someone a file search. Fill them before anything else.

Tab through the fields rather than clicking. The tab order was fixed when the form was built and generally follows the page, which catches boxes a mouse skips past. Check boxes and option buttons take a click, and an exclusive group clears the previous selection when you make a new one. Single-line fields do not wrap — text past the field width prints truncated while still showing in full on screen, which is why the loss is discovered after printing. Overflow goes to remarks or a continuation sheet. A field that does not apply gets the mark meaning none; blank space reads as an omission.

The signature closes the form and nothing precedes it. Draft status holds until it is applied, by hand or by an accepted electronic method. Countersignatures go in printed order, each dated at signing. Then one final read from the top, looking for the four recurring defects: empty mandatory fields, swapped digits in identification numbers, day-month inversion in dates, and residue from a reused file that goes forward as though intended.

The Privacy Act statement is read before the personal entries, not after. It gives the collection authority, the purpose, the routine uses and whether disclosure is mandatory or voluntary. Once filled, your copy is a personal record and gets stored and transmitted accordingly.

Routing follows AR 638-8 and nothing else — a named office, the unit administrative channel, or the individual's file, according to why the form was raised. Copy it before it leaves. Retention is fixed by the records schedule for the series, which local practice does not shorten or extend.

Related forms are found by series and number. DA series documents under the same proponent or the same prescribing directive are commonly required as a set, and any form named on the face of this one goes forward with it. Assemble continuations, covers and transmittals before submitting, not after the query comes back.

Edition date is the version number, printed on the page. Hold a locally saved copy against the current edition before reuse, since nothing on your machine signals a revision. Work already executed under a superseded edition remains as filed.

These are reproductions of published Department of the Army documents, offered for download. The site is independent, connected to nothing official, and issues no forms of its own. Nothing here is legal advice and no statement is made about acceptance by any office. Questions about an entry, a requirement or eligibility go to G-1 or your servicing administrative office.

Questions and answers

What is DA Form 4475?
DATA REQUIRED BY THE PRIVACY ACT OF 1974 PERSONAL INFORMATION FROM THE NOK OF A DECEASED SERVICE MEMBER
Which edition is current?
04/30/2026
Who is responsible for this form?
G-1
In which formats can it be downloaded?
PDF, XFDL, PDF

Publisher notes

  1. 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
  2. 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA

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