Da Form 4283 PDF Details

The Department of Defense has created a form to document acquisitions of property, known as the Da Form 4283. This form is used to track and report the acquisition of any type of tangible personal property by DoD personnel or organizations. The use of this form is required by law for all federal agencies. The purpose of this form is to ensure that accurate information is collected about each acquisition, including the value of the property and the parties involved in the transaction. The use of this form helps to prevent fraud and misuse of government funds.~Breaking News! New Federal Form Released Today! Da Form 4283~The Department was created a brand new Federal Acquisition Regulation (FAR) today, which happens to beForm number 4283; described as "Document

QuestionAnswer
Form NameDa Form 4283
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesda 4283 fillable, form 4283, da4283, blank da 4283

Form Preview Example

FACILITIES ENGINEERING WORK REQUEST

PART A

 

CUSTOMER

DOCUMENT

(See requestor

 

ID

SERIAL

 

NUMBER

instructions)

 

 

 

 

 

 

 

 

 

INSTALLATION

 

 

ABBREVIATION

 

 

OF FACILITIES

 

1

1

2

3

REMARKS

INSTALLATION NAME

For use of this form, see DA Pam 420-6; the proponent agency is OACSIM.

FY

TYPE

 

 

 

 

SHORT JOB DESCRIPTION

 

 

 

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DA

 

MON

 

YR

 

 

 

 

 

 

BUILDING/FACILITY NUMBERS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

3

 

4

 

6

 

7

 

8

 

9

 

 

10

 

 

 

5

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CUSTOMER NAME

POC NAME

POC PHONE NUMBER

 

 

 

WORK DESCRIPTION (Description and justification of work request)

AUTHORIZED REQUESTOR (Type or print)

 

 

 

 

 

 

 

 

 

 

 

AUTHORIZED REQUESTOR SIGNATURE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPROVAL ACTION CODE:

 

 

 

 

 

 

 

 

 

 

SPECIAL INTEREST CODE:

 

 

 

 

 

 

DATE

 

 

 

 

 

PART B

 

WORK REQUEST PRIORITY:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ESTIMATED WORK START DATE:

 

 

 

 

 

DA

MON

 

YR

 

(Approving Official Only)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PROGRAM INDICATOR CODE:

 

 

 

 

 

 

 

 

 

ESTIMATED WORK COMPLETION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DATE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ENVIRONMENTAL IMPACT

 

WORK TO BE PERFORMED

WORKCLASS

 

APPROVAL AMOUNTS

 

 

 

 

SOURCE OF FUNDS

 

 

YES

 

NO

 

 

 

 

 

 

 

IN-HOUSE

 

 

 

 

 

 

FUNDED

 

 

UNFUNDED

 

 

DIRECT

 

 

 

 

 

 

 

 

 

 

ENVIRONMENTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

AUTOMATIC REIMBURSEMENT

 

 

 

 

 

 

 

CONSIDERATION

 

 

 

 

 

SELF-HELP

 

 

 

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EIS / EIA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FUNDED REIMBURSEMENT

 

 

 

 

 

 

 

 

 

 

 

 

 

CONTRACT

 

 

 

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

INITIATED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

$

 

 

 

 

ACCOUNT PROCESSING CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EIS / EIA

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TROOP

 

 

TOTAL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

COMPLETED

 

 

 

 

 

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESIGN APPROVAL (Please type or print name)

 

 

 

 

DATE

 

APPROVAL AUTHORITY (Please type or print name)

 

 

 

APPROVAL ACTION

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DA

 

MON

 

YR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DA

MON

 

YR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DESIGN APPROVAL SIGNATURE

 

 

APPROVAL AUTHORITY SIGNATURE

 

 

 

 

 

APPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DISAPPROVED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DA FORM 4283, SEP 2003

DA FORM 4283, AUG 1978, IS OBSOLETE.

APD LC v1.03ES

 

Page 1 of 2

COMPLETION INSTRUCTION FOR DA Form 4283 - FACILITIES ENGINEERING WORK REQUEST

(Part "A" completed by requestor per instructions below)

(Part "B" completed by the DPW in accordance with local procedures)

PART "A"

CUSTOMER ID: One to three alpha numeric characters per local DPW policy.

A code used to identify the user, occupant, owner of a facility, or the organizational activity submitting a work request.

DOCUMENT SERIAL NO: Must be five alpha numeric characters. Based on local procedures, this number may be generated and entered by the requestor or computer generated and assigned by DPW. It is a number which indicates a place in a series and when used in conjunction with installation number, customer identification, document type, and fiscal year, it uniquely identifies one document of a particular type.

FISCAL YEAR: The last digit of the fiscal year; i.e., '3' for Fiscal Year 2003.

TYPE: Leave blank; DPW Work Reception will complete

SHORT JOB DESCRIPTION: Up to 30 alpha numeric characters that provide a description with a concise summary statement of the work to be performed.

DATE: The date Work Request was completed (Format - 15 JUL 03).

INSTALLATION ABBREVIATION: Up to eight alpha numeric characters for the locally assigned abbreviation of the installation's officially designated name; e.g., Fort Benjamin Harrison abbreviated as Fort Ben.

FACILITY NUMBER: A code of five alpha numeric characters which represent the unique serial number assigned to a real property facility within an installation for identification through its life cycle, e.g. P0001.

REMARKS: At a minimum, include email address of the Primary POC and an Alternate POC for requested work.

INSTALLATION NAME: The official name of an Army real estate holding and the principal function as defined in the real property inventory, e.g., Fort Lee.

CUSTOMER NAME: The name or description of the user, occupant, owner of a facility, or the organizational activity authorized to submit a request for work consisting of up to 15 alpha numeric characters.

POC NAME: Name of the person responsible for specific work information about requested work consisting of up to 15 alpha numeric characters (Format - Last Name, First Name)

POC PHONE NUMBER: Phone number for POC of this particular work request consisting of up to 12 alpha numeric characters.

WORK DESCRIPTION: Description of work to include impact and justification.

AUTHORIZED REQUESTOR: The name of the individual who is authorized to request work.

SIGNATURE: Signature of Authorized Requestor.

DA FORM 4283, SEP 2003

APD LC v1.03ES

 

Page 2 of 2

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