The reason DA Form 1622-1-R looks the way it does is that a file has to speak for itself. Officially AFFIDAVITS OF INDIVIDUAL SURETIES (LRA), it serves to affidavits of individual sureties (lra), and the record it produces outlasts the people and the circumstances behind it. Edition 07/01/1989, status ACTIVE, is the version published here: 2 page(s), close to 149 fields, each one present because some later reader will need that fact without being able to ask for it.
Two offices stand behind the form, and the distinction between them explains most of what follows. G-4 is the proponent: it decides what the form asks and revises it when the underlying process changes. AR 735-5 is the prescribing authority: it decides when the form is raised at all and where the completed document travels. Content and occasion are separated deliberately, so that a change in procedure does not require redesigning the page.
Retrieval governs the order of entry. The head of the form takes name, identification number, unit and date, and those values become the handles by which the record is found later — the substantive blocks are never searched on. This is why the spelling must match official records exactly rather than approximately.
Much of the form's behaviour follows from its being a fixed page. Tab order was set at build time along the reading sequence, which is why tabbing catches boxes a pointer passes over. Exclusive groups release one choice when another is made because a record cannot carry two answers to a single question. Single-line fields refuse to wrap because every entry must print where the layout expects it — text beyond the width is lost at the margin, visible on screen to the end. That is what remarks areas and continuation sheets are for. Marking a field that does not apply matters for a related reason: emptiness is ambiguous, and a reviewer reading the file later cannot distinguish an omission from a decision.
A signature is what converts entries into a record, which is why it comes last and why an unsigned form remains a draft however complete it looks. Where a reviewing official, an approving authority or a witness also signs, each adds a distinct attestation, and each dates the day of signing rather than the day of preparation — the dates trace the sequence of responsibility. The recurring defects are worth knowing precisely because they defeat that purpose: an empty mandatory field leaves an obligation unmet, transposed identification digits attach the record to nobody, a date with day and month reversed puts events in the wrong order, and entries left in a reused working copy assert facts nobody intended.
Personal information may not be gathered silently, and the Privacy Act statement is how that obligation is met on paper: it names the collection authority, the purpose, the routine uses and whether disclosure is mandatory. Because it exists to inform a decision, it belongs before the fields it covers rather than after them. A filled copy then holds personal data and is stored and transmitted under the corresponding safeguards.
Download the form
Why several files for one page? Because the form has to be completed in a headquarters and in places without a workstation, and PDF, XFDL covers both. The fillable pdf holds interactive fields that fix each entry in place and remove handwriting from the equation. The printable pdf is the same layout without those fields, meant for a printer and a pen. Neither is a lesser copy of the other; each answers a condition the other cannot.
Software determines whether an entry lasts. A browser viewer is designed for reading, and several will take typed input into fields without any means of writing it back — the text is simply absent when you reopen. A standalone reader handles the form structure properly. The xfdl file is IBM Lotus Forms, carried in Army systems for the routing and signature support it provides, which is why the Lotus Forms Viewer is its only reader.
There is no charge and no sign-up. Published documents are distributed as published, without modification.
What the form asks for
- COUN_A
- COUN_B
- COUN_C
- ContentArea1
- DAY_A
- DAY_B
- DAY_C
- L118
- L119
- LOC_1A
- LOC_1B
- LOC_1C
- LOC_2A
- LOC_2B
- LOC_2C
- MONTH_A
- MONTH_B
- MONTH_C
- NAME_A
- NAME_B
- NAME_C
- NAME_D
- NAME_E
- NOT_A
Disposition is prescribed, not chosen. AR 735-5 names the destination, whether that is a specific office, the unit administrative channel or the personal record, and the applicable records schedule governs how long it survives there. Both rules exist to keep the file consistent across offices with different habits. Take your copy before the document leaves, since it will not come back.
Related documents are located by series and number, and the relation is rarely accidental — forms under one proponent or one directive tend to serve steps of a single procedure. Anything the DA series form names on its face normally travels with it, as do the continuations, covers and transmittals the process generates. Assembling them together is what makes the submission a complete account.
Revision follows the process, which is why editions appear without a fixed interval, and the printed date rather than any version number identifies them. Nothing on a stored copy signals that it has aged; the check is manual. Work already completed under a superseded edition stands as filed, because the record was made under those terms and is properly interpreted under them.
A word on where this page sits. These are reproductions of published Department of the Army documents, made available by an independent site with no official role and no authority to issue forms. The structure described above — proponent, prescribing directive, records schedule — exists apart from this site entirely, which is why nothing written here is legal advice and why acceptance by any office is not something that can be promised. Put questions of entry, requirement or eligibility to G-4 or to the administrative office servicing your unit.
Questions and answers
- What is DA Form 1622-1-R?
- AFFIDAVITS OF INDIVIDUAL SURETIES (LRA)
- Which edition is current?
- 07/01/1989
- Who is responsible for this form?
- G-4
- In which formats can it be downloaded?
- PDF, XFDL, PDF
Publisher notes
- 41-ITEM ALSO PRODUCED IN ELECTRONIC MEDIA,