Da Form 461 5 is a form used by the United States military to document property that has been lost or damaged. The form must be completed and submitted as soon as possible after the loss or damage occurs. Submission of the form is required in order to receive reimbursement for the loss or damage. Failure to submit the form may result in denial of reimbursement. The specific information required on the form varies depending on whether the property was lost or damaged, and whether it is Government or non-Government property. However, some general information that is always required includes name and contact information for the person submitting the form, description of the property, estimated value of the property, and reason for loss or damage. Detailed instructions on how to complete Da
| Question | Answer |
|---|---|
| Form Name | Da Form 461 5 |
| Form Length | 3 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 45 sec |
| Other names | SUBTOTALS, 461 5 army form, 2000, DA |
VEHICLE CLASSIFICATION INSPECTION
For use of this form, see AR
NOMENCLATURE |
REGISTRATION NUMBER |
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CLASSIFICATION CODE
DATE OF DELIVERY (YYYYMMDD)
MANUFACTURER
REASON
ITEM |
DIAGNOSIS |
FRAME AND
BRACKETS
BUMPERS
TOWING
CONNECTIONS
FIFTH WHEEL
BRUSH GUARD
AND GRILLE
HOOD AND
FENDERS
BODY
CANVAS
PAINT
CAB AND
DOORS
WINDSHIELD
AND WINDOWS
WIPER MOTOR
AND BLADES
HORN AND
MIRROR
HEATER
SPEEDOMETER & TACHOMETER
AMMETER OR
VOLTMETER
GAGES AND
SENDING UNIT
SEATS AND
UPHOLSTERY
FLOOR
INTERIOR TRIM
ENGINE
CYL HEAD AND
BLOCK
SUBTOTALS
DA FORM
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MODEL |
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SERIAL NUMBER |
AGE |
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ECHELON OF REP |
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INSPECTION STANDARDS |
CONDITION |
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REPAIR |
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REPLACE |
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SATISFACTORY |
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MAN |
COST |
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HOURS |
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DIAGNOSIS |
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LABOR |
PARTS |
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VALVES AND |
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PISTON RINGS |
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INT AND EXH |
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MANIFOLDS |
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OIL PAN |
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OIL PUMP AND |
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LINES |
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OIL FILTER AND |
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ELEMENTS |
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TRANSMISSION |
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RADIATOR |
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THERMOSTAT |
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AND HOSES |
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WATER PUMP |
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AND FAN |
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DRIVE BELTS |
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AIR |
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COMPRESSOR |
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AIR GOVERNOR |
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AIR TANKS |
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AND LINES |
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GENERATOR OR |
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ALTERNATOR |
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REGULATOR |
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RECTIFIER |
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BATTERY |
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STARTER AND |
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SOLENOID |
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DISTRIBUTOR |
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AND POINTS |
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IGNITION COIL |
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SPARK PLUGS |
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AND CABLES |
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SVC & |
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BLACKOUT |
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HEADLIGHTS |
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SUBTOTALS
DA FORM
MILEAGE
DATE OF UNECON REP (YYYYMMDD)
SATISFACTORY |
REPAIR |
REPLACE |
MAN |
COST |
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HOURS |
OF |
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LABOR |
PARTS |
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PAGE 1 OF 3 |
USAPA V1.00ES |
ITEM |
DIAGNOSIS |
SVC & BLACK-
OUT TAILLIGHTS
CLEARANCE AND
MARKER LIGHTS
SWITCHES
WIRING AND
CONNECTORS
CARBURETOR
AND GOVERNOR
AIR CLEANER
FUEL PUMP
AND FILTER
FUEL TANK
AND LINES
MUFFLER
EXHAUST AND
TAILPIPES
CLUTCH
TRANSFER
POWER
TAKEOFF
DRIVE SHAFTS
AND
DIFFERENTIAL
FRONT AXLE
INTERMEDIATE
AXLE
REAR AXLE
WINCH AND
CABLE
HOIST OR
CRANE
SVC BRAKE
SYSTEM
MASTER
CYLINDER
SUBTOTALS
REMARKS
SATISFACTORY
REPAIR
REPLACE
MAN |
COST |
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HOURS |
OF |
ITEM |
DIAGNOSIS |
LABOR |
PARTS |
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AIR HYDRAULIC |
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CYLINDER |
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WHEEL |
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CYLINDERS |
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HAND BRAKE |
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SYSTEM |
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STEERING GEAR |
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AND CONTROLS |
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SPRINGS AND |
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SHACKLES |
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SHOCK |
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ABSORBERS |
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WHEELS |
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TIRES AND TUBES |
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SUBTOTALS
SATISFACTORY
REPAIR
REPLACE
MAN
HOURS
LABOR
COST
OF
PARTS
DA FORM |
PAGE 2 OF 3 |
USAPA V1.00ES |
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MODIFICATIONS |
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$ |
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OTHER SHORTAGES |
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$ |
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TOTAL REPAIR COSTS |
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COSTS DUE TO DAMAGE |
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TOTAL |
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TOTAL |
$ |
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LABOR & OVERHEAD RATE PER |
$ |
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COST OF PARTS |
$ |
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TOTAL COST OF LABOR & OVERHEAD |
$ |
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TOTAL COST |
$ |
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TOTAL COST OF PARTS |
$ |
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OTHER COSTS (LIST) |
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TOTAL COST OF REPAIRS |
$ |
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$ |
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INDIVIDUAL REPAIR EXPENDITURE LIMIT |
$ |
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TOTAL COST OF PREVIOUS REPAIRS |
$ |
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ACCUMULATED REPAIR EXPENDITURE LIMIT |
$ |
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INSTALLATION |
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DATE OF INSPECTION (YYYYMMDD) |
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NAME OF INSPECTOR |
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TELEPHONE NUMBER (COMMERCIAL & DSN) |
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SIGNATURE OF INSPECTOR |
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FAX NUMBER |
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DA FORM |
PAGE 3 OF 3 |
USAPA V1.00ES |