Download the form
DA Form 4569-1 handles one job: security assistance da publication requisition code sheet. The official title is SECURITY ASSISTANCE PUBLICATION REQUISITION CODE SHEET. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is 06/01/2021, status ACTIVE, running 1 page(s) with about 200 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 This edition is superseded — pull the newer one unless your record was already executed on this version.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. CIO owns the form, PAM 25-38 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.
The formats are PDF, and the choice comes down to keyboard or pen. Fillable pdf for typing — live fields, tab order, saved entries. Printable pdf for handwriting — same page, no interactive objects, print it blank. Content is identical; only entry method differs.
Use a full pdf reader, not the browser viewer. Browser viewers display fields they cannot always save, and the loss shows up only when you reopen the file — type one entry, save, reopen, verify, then fill the rest.
No charge, no account, no email address. The file is the published document, distributed unaltered.
What the form asks for
- CaseDesigna
- Chg_Reqa1
- Chg_Reqa10
- Chg_Reqa11
- Chg_Reqa12
- Chg_Reqa13
- Chg_Reqa14
- Chg_Reqa15
- Chg_Reqa16
- Chg_Reqa17
- Chg_Reqa18
- Chg_Reqa19
- Chg_Reqa2
- Chg_Reqa20
- Chg_Reqa3
- Chg_Reqa4
- Chg_Reqa5
- Chg_Reqa6
- Chg_Reqa7
- Chg_Reqa8
- Chg_Reqa9
- Chg_Reqb1
- Chg_Reqb10
- Chg_Reqb11
Start at the top and get the header exactly right. Official spelling of the name, identification number, unit, date. Everything downstream finds the record through those entries; nothing else on the page has that consequence.
Tabbing beats clicking for coverage. The order was set at build time and tracks the page layout, so following it leaves no gaps. Boxes and buttons are clicked; where options are exclusive, one selection cancels another by design. Watch field width on long entries: one-line fields have no wrap, and what runs past the edge disappears in print though the screen still shows it. Move that text to remarks or a continuation. Never leave an inapplicable field empty — enter the nil mark, because a reviewer cannot distinguish a skipped question from a considered answer.
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 PAM 25-38 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.
Companion documents come from the same series and number scheme. Within the DA series, a shared proponent or a shared directive usually means shared use, and a form cited on the face of another accompanies it. Gather the whole package first — continuation sheets, cover sheets, transmittals.
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.
The files are copies of published Department of the Army forms. This site has no official connection, no authority to issue anything, and no basis for saying whether an office will accept a given submission. None of the text is legal advice. Real questions — entry, requirement, eligibility — belong with CIO or the administrative office servicing your unit.
Questions and answers
- What is DA Form 4569-1?
- SECURITY ASSISTANCE PUBLICATION REQUISITION CODE SHEET
- Which edition is current?
- 06/01/2021
- Who is responsible for this form?
- CIO
- In which formats can it be downloaded?
- PDF, PDF