Download the form
DA Form 4916 handles one job: certificate of service/attempted service. The official title is CERTIFICATE OF SERVICE/ATTEMPTED SERVICE. Download it below, fill it in, sign it, send it where your directive says. The edition on this page is 06/01/2009, status ACTIVE, running 1 page(s) with about 195 fields to complete.
Two references decide everything about your use of it: TJAG maintains the content, AR 27-10 sets the trigger and the routing. Consult the directive when your case is not routine; otherwise the printed blocks tell you enough. The person named in the entries fills it, or the administrative office holding the file does it for them.
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.
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.
Free, unregistered, unmodified. What arrives is what the publisher released.
What the form asks for
- ACCA_B
- ACCA_C
- ACMR
- CONFINE_A
- CONFINE_B
- ContentArea1
- DATE
- DAYS_C
- DAY_A
- DAY_B
- DAY_BB
- DAY_D
- DAY_E
- DAY_F
- DAY_G
- HIM_HER
- LSTNAME_B
- MONTH_A
- MONTH_B
- MONTH_BB
- MONTH_C
- MONTH_D
- MONTH_E
- MONTH_F
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.
Move between fields with tab; the build-time order follows the page and misses nothing. Click check boxes and option buttons, and expect an exclusive group to release the old choice when you set a new one. The trap is field width. Single-line fields do not wrap, so an overlong entry displays complete on screen and prints cut at the margin — put it in remarks or on a continuation instead. Mark inapplicable fields rather than leaving them blank, since an empty box carries no information about whether the question was read.
Signature comes after every other entry — ink or an approved electronic means, and without it the document is a draft. Where reviewing, approving or witnessing signatures are called for, take them in printed block order, each dated on the day applied. Before release, one pass from the top. The defects worth hunting are always the same four: mandatory fields left empty, identification digits transposed, dates with day and month reversed, and stale data surviving in a copy reused in place of a blank form.
Read the Privacy Act statement at the point it appears. Authority, purpose, routine uses, mandatory or voluntary — four facts, and they govern what you are about to enter. A completed copy holds personal data and takes the handling rules that attach to it.
Send it where the directive says: the office it names, the unit administrative channel, or the individual's file. Take your copy before submission. How long the record is held comes from the schedule for the series, not from the office holding it.
Look for associated forms by series and number. In the DA series, documents sharing a proponent or a governing directive tend to travel together, and anything referenced on the page normally submits alongside. Collect continuations, covers and transmittals in advance of sending.
A stored file goes stale silently. The proponent revises, a new edition date is published, and your copy says nothing about it — so compare the printed date against the edition in force before typing into it again. Completed submissions on an earlier edition are not reopened.
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 TJAG or your servicing administrative office.
Questions and answers
- What is DA Form 4916?
- CERTIFICATE OF SERVICE/ATTEMPTED SERVICE
- Which edition is current?
- 06/01/2009
- Who is responsible for this form?
- TJAG
- In which formats can it be downloaded?
- PDF, PDF
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA,