Every entry on DA Form 4170 exists because a record system needs it in writing. The form's official title is STATEMENT OF GAINS AND LOSSES, and it is raised whenever an office must statement of gains and losses in a way that survives the departure of everyone involved. Memory does not transfer between assignments; a filed document does. The edition dated 07/01/2002, status ACTIVE, is what stands here, spread across 1 page(s) and about 133 fields — a count that reflects how much detail the receiving system requires, not how much the drafter wishes to give.
Behind any Army form sit two separate decisions. What the document asks is settled by G-4, which maintains and revises it. Whether you raise it, and where it goes once signed, is settled by PAM 30-22. That division is the reason a form can outlive several changes in the process it serves.
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.
Tab order is not a convenience feature; it was fixed when the form was built and generally traces the page, so following it produces the sequence the designer intended and leaves fewer gaps than a mouse. Exclusive option groups clear the previous selection because the record is not permitted to hold two contradictory answers. Single-line fields do not wrap for the same reason the layout is fixed: the printed page has to fall in known positions, so text past the field width is cut at the margin even though the screen still shows it whole. Overflow belongs in remarks or on a continuation, where there is room designed for it. And an inapplicable field is marked rather than skipped, since a blank tells a later reader nothing about whether the question was considered.
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.
The choice of application decides whether your work survives. Browsers render pdfs as documents to be read; where a viewer shows fields without a mechanism to store them, typed text disappears when the tab closes, and nothing announces the loss. A full reader treats the file as a form and preserves entries on save.
There is no charge and no sign-up. Published documents are distributed as published, without modification.
What the form asks for
- ACCOUNT
- ACCOUNT_1
- ACCOUNT_2
- ACCOUNT_3
- ACCOUNT_4
- ACCOUNT_5
- ACCOUNT_6
- ACCOUNT_7
- ACCOUNT_8
- ACCOUNT_9
- ALLOWANC
- ALLOWANC_1
- ALLOWANC_2
- ALLOWANC_3
- ALLOWANC_4
- ALLOWANC_5
- ALLOWANC_6
- ALLOWANC_7
- ALLOWANC_8
- ALLOWANC_9
- AUTHORIZ
- AUTHORIZ_1
- AUTHORIZ_2
- AUTHORIZ_3
Where the signed form goes is settled by PAM 30-22 rather than by the office holding it — a named recipient, the unit administrative channel, or the individual's own file, depending on why it was raised. Retention likewise belongs to the records schedule for the series, which exists so documents are kept for as long as anyone might need them and no longer. Keep a copy before release; the original serves the file from then on, not you.
Series and number are how the DA series signals which documents belong together, and the grouping follows real process boundaries: a shared proponent or directive usually means a shared purpose. A form cited on the face of another is part of that same transaction, and continuation sheets, covers and transmittals complete it.
An edition marks the form at a point in a process that keeps moving, and the date printed on the page is what distinguishes one from another. Since a saved file never announces its own obsolescence, compare its date against the current edition before using it again. Prior executions remain valid: the change applies forward, and a record is read against the edition it was written under.
One boundary should be stated clearly. What is distributed here are copies of published Department of the Army forms; the site is independent, issues nothing of its own, and holds no position in the system it describes. Proponency, prescribing directives and retention schedules operate without reference to it. Consequently nothing here is legal advice and no assurance about acceptance is possible. Questions about a particular entry, a requirement or eligibility belong with G-4 or your servicing administrative office.
Questions and answers
- What is DA Form 4170?
- STATEMENT OF GAINS AND LOSSES
- Which edition is current?
- 07/01/2002
- Who is responsible for this form?
- G-4
- In which formats can it be downloaded?
- PDF, PDF
Publisher notes
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA,