The DA 4991 R form, pivotal in the administrative landscape of the United States Army, encapsulates the structured process through which soldiers can formally decline continued service. Essential under the guidelines of AR 601-280, and stewarded by the DCS, G-1 as the proponent agency, this form takes a central role in managing the personal decisions of army personnel with respect to their service commitments. It's designed not only to document a soldier's election against extending their enlistment but also to outline the ensuing implications of such a decision on their military career and future prospects. The form serves multiple purposes: facilitating a formal acknowledgment from the soldier about understanding the career effects of not fulfilling service remaining requirements (SRR), ensuring that the soldier's decision is well-informed and recorded in their Official Military Personnel File (OMPF), and interacting with various governmental bodies for statistical and management reasons. The DA 4991 R meticulously balances the autonomy of the individual soldier with the operational and personnel management needs of the Army, making it a critical document for both the individuals involved and the broader military administration.
| Question | Answer |
|---|---|
| Form Name | Da Form 4991 R |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | da 4991 fillable, da form 4991 fillable, da 4991 r fillable, da from 4991 |
DECLINATION OF CONTINUED SERVICE STATEMENT
For use of this form, see AR
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE
USES:
10 USC 509, Voluntary extension of enlistments: periods and benefits, Army Regulation
Soldier's election to decline additional service to satisfy Service Remaining Requirements (SRR). This information becomes part of the subject's military personnel records which are used to document personnel management actions.
For additional information see the System of Records Notice
To the Army Human Resources Command, for appropriate personnel action processing and filing in the Soldiers Official Military Personnel File (OMPF). To the Department of Veterans Affairs to verify eligibility of benefits. To the U.S Government Accountability Office for statistical management. To the members of Congress for inquiries.
DISCLOSURE: Voluntary; however, failure to furnish information requested may delay processing the action.
1. |
Name (Last, First, Middle) |
2. |
Rank |
3. |
DODI |
|
|
|
|
|
|
4. |
Unit/Organization |
5. |
ETS |
6. |
SRR Date |
7.You have incurred a service remaining requirement under the provisions of Chapter 4, AR
8.In order to comply with the service remaining requirement, your ETS must be equal to, or later than the date noted in block 6.
SECTION A - COUNSELING BY THE CAREER COUNSELOR (PMOS 79S)
9.The Soldier has been advised as to the options available to acquire sufficient remaining service to satisfy the commitment, but has declined to take necessary action to meet the length of service. Soldier has been advised that declination to take action to comply with the operational commitment will have the following effects:
Initials |
The Soldier will initial in the first, last name sequence in the space provided next to all career effects |
||
signifying understanding of that statement. |
|
|
|
|
|
|
|
|
|
||
|
a. I understand that I have no later than 45 days from the EDAS transmittal date to extend, reenlist or execute this statement. |
||
|
|
|
|
|
b. I understand that I will be prohibited from reenlistment or extension of enlistment at a later date. |
||
|
|
|
|
|
c. I understand that I will be removed from the promotion standing list by HQDA. |
||
|
|
|
|
|
d. I understand that I may be prohibited from applying for |
||
|
separated at current ETS, and at least 2 years if voluntarily separated before current ETS. |
||
|
|
|
|
|
e. I understand that I am prohibited from application, election, or attendance for commissioning or warrant officer programs while |
||
|
on the current period of active duty. |
|
|
|
|
|
|
|
f. I understand that I may be eligible to request voluntary separation under the provisions of AR |
||
|
|
|
|
|
g. I understand that I may be eligible to join the Reserve Component. |
||
|
|
|
|
|
h. I understand that I may be considered eligible for other assignments (CONUS and OCONUS) provided I have sufficient |
||
|
service remaining to meet the requirements of the new assignment. |
||
|
i. I understand that I am not eligible for separation pay. |
|
|
|
|
|
|
10a. Name, Rank and Unit of Career Counselor (PMOS 79S) |
b. Place where the Soldier was advised |
||
|
|
|
|
c. Signature |
|
|
d. Date |
|
|
|
|
|
|
|
|
SECTION B - SOLDIER'S ACKNOWLEDGEMENT OF COUNSELING
11.I hereby acknowledge that I have been counseled by the above career counselor concerning action required by me to satisfy a
a. Soldier's Signature
b. Date
12. If Soldier refuses to sign acknowledgment of counseling received, complete 12a, 12b and 12c below.
a. Name, Rank of Witness
b. Signature
c. Date
SECTION C - IMMEDIATE COMMANDER'S/FIRST SERGEANT'S REVIEW
13.I have reviewed and discussed the above statement with the Soldier and have determined that the Soldier has been properly counseled. The Soldier refused to take action to acquire sufficient service to comply with the operational commitment.
a. Name, Rank, and Branch of Commander/First Sergeant |
b. Signature |
c. Date |
|
|
|
|
|
DA FORM 4991, OCT 2019 |
PREVIOUS EDITIONS ARE OBSOLETE |
APD AEM v1.01ES |
|
|
|
|
|