What is DA Form 5440-34? It is the Department of the Army form titled DELINEATION OF CLINICAL PRIVILEGES - BEHAVIORAL HEALTH PRACTITIONER, and it exists so that you can delineation of clinical privileges - behavioral health practitioner. That single line covers most of what people arrive looking for. The rest of this page fills in the details.
Is this the current version? The edition offered here is dated 02/01/2004, published with the status ACTIVE. That date is the version number of a military form; there is no other. And no, this is not the newest one. A later edition has been published, and this copy is kept only for reference and for records already completed on it.
Who is responsible for this document? TSG maintains it, and AR 40-68 prescribes when it is used and where it goes. Completion falls to the person the entries describe or to the administrative staff holding the file. As for effort: 2 page(s), roughly unknown fields.
Download the form
What file types are offered? PDF, XFDL. The page image is the same in every one of them; only the way you complete it changes from format to format.
Should I take the fillable pdf or the printable one? Take the fillable version if you will type, since its entry areas respond to the keyboard and hold what you enter. Take the printable version if you will write by hand — it is the same blank form as a flat page image. The finished result looks the same either way.
What do I open a pdf with? Any current browser will display one, and any dedicated reader will do better. For fillable use the reader is the safer choice, because some browser viewers accept typing and then discard it when the tab closes. Test one field and one save before committing. What opens an xfdl file? Only the IBM Lotus Forms Viewer. The format is IBM Lotus Forms, carried by several Army systems, and no pdf reader or word processor will touch it.
Is it free? Yes, entirely. No registration stands between you and the file, and what arrives is exactly what the publisher released.
What goes in first? The heading block — your name exactly as official records show it, then identification number, then organisation, then the date you prepared the form. Is the order important? It is, because those four entries become the index for the finished record, and an error there is the one mistake that hides the document from everyone looking for it.
How should you work through the entry fields? With the tab key. It follows the order the form was constructed in, which is usually the order the page reads, so nothing gets passed over. Do check boxes work the same way? They are clicked rather than tabbed into. In an exclusive group, a second click elsewhere clears your first choice, as intended.
Why does my text vanish when I print? Because one-line fields have no wrap, and anything past the field width is truncated on paper even though the screen shows all of it. Where should the overflow go? Into remarks, or onto a continuation. What about entries that do not apply? Enter the mark meaning "none". Blank space is ambiguous; a reviewer cannot tell an omission from a considered nil.
Is a signature really the last step? Yes, and without it you have a draft, not a form. Who else signs? Whoever the form calls for — reviewer, approver, witness — in printed block order, each dated as of the day they sign. Which errors cause the most returns? Blank mandatory fields lead, followed by identification numbers with two digits swapped, dates written day-for-month, and leftover data in a reused file that goes forward as though it were meant.
What is the Privacy Act statement on the page? A notice appearing wherever personal information is collected, setting out the authority for the collection, the purpose, the routine uses, and whether your disclosure is mandatory or voluntary. When should you read it? At the point you reach it, before entering the details it covers. And afterwards? Your completed copy holds personal data and is stored and transmitted under the rules that apply to such records.
Where does the finished form go? Wherever AR 40-68 says — to the office it names, along your unit administrative channel, or into the individual's own record, depending on why it was raised. Should you keep a copy? Yes, before it leaves your hands. How long is it held? The records schedule for the series decides that, and local practice does not override it.
Which other forms travel with this one? Those found by series and number: DA series documents sharing a proponent or a governing directive are frequently needed in combination, and a form referenced on the face of another generally accompanies it. Do you assemble them before or after sending? Before. Continuation sheets, cover sheets and transmittals are part of the same package.
What causes a form to be superseded? A revision issued by the proponent, after which the previous edition date no longer matches the one in force. How do you check a copy you saved? Read the edition date on the page and hold it against the current edition. Must earlier submissions be redone? They must not — a completed record executed on a prior edition is unaffected.
Is this an official Department of the Army site? No. It is an independent site distributing reproductions of published Department of the Army documents for download, with no authority to issue forms. Does it guarantee acceptance of anything you submit? It does not, and nothing on the page is legal advice. Who should you ask instead? TSG or your servicing administrative office, whenever an entry, a requirement or your eligibility is in doubt.
Questions and answers
- What is DA Form 5440-34?
- DELINEATION OF CLINICAL PRIVILEGES - BEHAVIORAL HEALTH PRACTITIONER
- Which edition is current?
- 02/01/2004
- Who is responsible for this form?
- TSG
- In which formats can it be downloaded?
- PDF, XFDL, PDF
Publisher notes
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA,