Hqda Form 5 – Fill Out and Use This PDF

( UNCLASSIFIED )

8.What is in this packet? TAB A:

TAB B: TAB C:

9. Action seeks senior leader	Signature	Approval	Guidance	Information Only	Other

Recommendation to senior leader:

11. Key point(s) the senior leaders should get from this action:

12. Additional information:

13. Senior Leader/Decision/Comments:
APPROVED		DISAPPROVED		NOTED			SEE ME		COMMENT
HQDA FORM 5, NOV 2012			( UNCLASSIFIED			)	PREVIOUS EDITIONS ARE OBSOLETE. Page 1 of 3
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(UNCLASSIFIED )

	14. LEAD AGENCY STAFF COORDINATION LEAD STAFF AGENCY:			TRACKING NO.:
	TITLE	INITIAL	TYPE OR PRINT NAME		DATE
					(YYYYMMDD)

PRINCIPAL ONLY

ACTION OFFICER (Signature)

(Name/Title/Phone No./Email/Office Symbol)

SACO (Signature)

(Name/Title/Phone No./Email)

RECOMMENDATION FOR STAFF PRINCIPAL:

15. STAFF COORDINATION

CONCUR	NON-	AGENCY	NAME (TITLE, LAST NAME)	PHONE	DATE	REMARKS
	CONCUR			(XXX) XXX-XXXX	(YYYYMMDD)

OGC

OTJAG

16. REMARKS BY ECC:

PRIVACY ACT STATEMENT

DATA REQUIRED BY THE PRIVACY ACT STATEMENT OF 1974.

INSTRUCTIONS

PARENTHESES AT TOP AND BOTTOM OF FORM: Select a classification (UNCLASSIFIED or FOUO) from the drop down menu. If for the Army’s senior

leadership (SA, CSA, USA and VCSA), use a minimum classification of FOUO (default). If using a classified SIPRnet system, select a classification (FOUO, CONFIDENTIAL or SECRET).

Block 1. TRACKING NUMBER:

a. If the action has been assigned a tracking number by ECC/OJDA, enter that number.

b. If the action has been assigned a tracking number by the activity Staff Action Control Office (SACO), enter that number along with the ECC/OJDA tracking number (if applicable).

c. When this form is being used as a read ahead coversheet, select from the drop down list "READ AHEAD COVERSHEET" in lieu of a tracking number.

Block 2. TODAY'S DATE: Enter today's date. The Army standard date format is YYYYMMDD (for example, 20120426). This allows for HQDA Tracking System

searches by a calendar date.

Block 3. SUSPENSE DATE: The format is YYYYMMDD.

a. If the action is responding to an external suspense, enter the date of the assigned suspense.

b. If the suspense date is established internally, enter that date.

Block 4. LEAD STAFF AGENCY:Select from the drop down menu the office responsible for generating the response to the requested action.

Block 5. SUBJECT: Enter the primary subject line of the action. The subject on the HQDA Form 5 should match the subject used in the HQDA Tracking System

(use upper and lower case).

Block 6. ROUTING: (ECC USE ONLY) or (OJDA USE ONLY): The ECC POC or OJDA POC will complete the routing block. Select whether this action is to be routed

through the ECC or OJDA from the drop down menu. This selection will also affect: ECC/OJDA POC and DIR, ECC as well as block 16.

Block 7. Origin: Requirement from: Select only one block indicating the individual or organization prompting the submission of this HQDA Form 5.

Meeting/Forum/Other: Examples: Directed by the CSA at the 26 Apr XX Morning Update; the SA asked for this information at the 26 Apr XX GA update.

Block 8. What is in the packet? List all enclosures/TABs. Explain what is included within the packet. If none, state N/A (for example, TAB A: Memorandum for SA

signature. TAB B: DOD tasking and ECC tasking).

Block 9. Action seeks senior leader: Select the most appropriate box defining the desired action by the final approval authority. Two lines are provided to clearly state/indicate the recommendation to the final approval authority and indicate where the senior leader should sign or initial (for example, to obtain the SA’s signature on the memorandum at TAB A; approve this action by initialing in block 13 at the bottom of this page).

Block 10. Key areas impacted: Check all boxes that apply. If “other” is checked, specify accordingly.

Block 11. Key point(s) the senior leaders should get from this action: The key points are the salient information that the SA, CSA, USA and VCSA need to take

away from the action and are written at the Army senior leaders' level. These are the key points your Principal Official or Deputy wants to convey to the Army’s senior leaders. Each key point area allows essentially two lines to express your key point with a maximum of two key points.

Block 12. Additional information: Summarize the information and provide a current status, if applicable. Why are you telling this to the senior leader?

What should the senior leader know and discuss? Describe the task, origin of the action, issue and the requirement. Provide fact-filled background and comment. This discussion should tell the "story" on an action without "begging questions." The final approval authority should fully understand why this action is necessary.

Block 13. Senior Leader/Decision/Comments: This space allows the SA, CSA, USA and VCSA to approve, disapprove or comment on the action.

Block 14. LEAD AGENCY STAFF COORDINATION (Lead Staff Agency Use Only): These blocks are designated for the internal approval chain within a Staff.

Possible entries could include Branch, Division, Director and Deputy. The appropriate releasing authority should electronically sign and date the action once they have released/approved for forwarding to the next appropriate office for disposition.

The Staff Principal will electronically sign and date. His or her electronic signature represents concurrence with the contents of the HQDA Form 5 and the

final product to be submitted to ECC/OJDA for the Army’s senior leaders to review. Note: ONLY THE PRINCIPAL will sign in this space. If the Principal Official

is not available, the next most senior individual will initial in the space immediately above the ”Principal Only” space and indicate “FOR” and clearly enter his or her name and title.

ACTION OFFICER (Name/Title/Phone No./Email/Office Symbol): Enter the responsible action officer's name, rank and/or position title, office phone number

and email address. This information is especially important to ensure any questions related to the action can be quickly directed to the appropriate point of contact avoiding delay in processing the action. Action Officer will electronically sign.

SACO (Name/Title/Phone No./Email): Enter the responsible SACO's name, rank and/or position title, office phone number and email address. This information is especially important to ensure any questions related to the action can be quickly directed to the appropriate POC avoiding delay in processing the action. SACO will electronically sign.

RECOMMENDATION FOR STAFF PRINCIPAL:This block allows for recommendations to the Staff Principal (for example, G-3/5/7 approves the memorandum

at TAB A by electronically signing block 14).

Block 15. STAFF COORDINATION: When staffing an action for review and comment, include each office and POC information that the action is being staffed

with and include instructions for the addressees to indicate their concurrence by checking the appropriate block and returning to the originator. If concurrence indicates "concur with comments," then include comments at appropriate tab. Note that space is allocated for OGC and OTJAG who can make their recommendation (No Legal Objection (NLO) or Legal Objection (LO) w/comment) in the REMARKS section.

Block 16. REMARKS BY ECC (ECC use only): or SERVICES COORDINATION (OJDA selection): The ECC POC will complete the REMARKS BY ECC block.

Lead Agency Action Officers will complete the	SERVICES COORDINATION block.
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