Administrative documents are written for readers who were not present, and DA Form 3904 is no exception. Titled PUBLIC VOUCHER FOR MEDICAL EXAMINATION, it is used to public voucher for medical examination — a transaction that means little in conversation and a great deal in a file. The published edition here carries the date 08/01/1972 and the status ACTIVE. Its 1 page(s) and roughly 200 fields are sized to what the record must prove years later, which is always more than the moment appears to need.
The form has an author and an occasion, held by different authorities. TSG owns the content and reshapes it when what is being recorded changes. AR 40-400 governs the event that calls for the form and the route the finished document takes afterwards. Keeping those two apart is what allows a procedure to be amended without the page being rebuilt each time.
The heading blocks come first because the record is retrieved by them, not read into. Name as official records spell it, identification number, unit, date of preparation — those four are the index, and everything below them is content that only surfaces once the index has done its work. A form filed under a name written casually is not lost in principle, only in practice, which amounts to the same thing.
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
The published formats — PDF — reflect the range of places a form gets filled in. Where there is a computer, the fillable pdf supplies live fields that keep entries positioned and readable. Where there is not, the printable pdf gives the identical page as flat artwork for pen entry. The distinction is one of setting rather than of authority; the page is the same document in both.
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.
There is no charge and no sign-up. Published documents are distributed as published, without modification.
What the form asks for
- Address
- Amount
- AmountA
- AppTitle
- AppTitle_1
- ApprAmt
- ApprAmt_1
- Apprvd
- Because
- BureauNum
- Category
- ChargeA
- ChargeA_1
- ChargeA_2
- ChargeA_3
- ChargeA_4
- ChargeA_5
- ChargeA_6
- ChargeA_7
- ChargeA_8
- ChargeA_9
- ChargeB
- ChargeB_1
- ChargeB_2
The routing in AR 40-400 decides where the document goes — a named office, the administrative channel, or the individual's file — and the records schedule for the series decides how long it stays. Neither is a local judgement, because a record system loses its meaning if each office keeps things for its own preferred interval. Copy the form before submitting it.
Forms cluster by series and number for the same reason files do: shared proponency and a shared prescribing directive usually mean a shared process. So a document in the DA series referenced on the face of another is generally part of the same transaction, and continuation sheets, cover sheets and transmittals belong to the package from the outset rather than arriving after a query.
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 TSG or to the administrative office servicing your unit.
Questions and answers
- What is DA Form 3904?
- PUBLIC VOUCHER FOR MEDICAL EXAMINATION
- Which edition is current?
- 08/01/1972
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, PDF
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA,