What does this form do? DA Form 5441-30 is titled EVALUATION OF CLINICAL PRIVILEGES - NEPHROLOGY, and its job is to evaluation of clinical privileges - nephrology. Anyone sent to find "the 5441-30" is being sent here. Everything below expands on that one function.
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.
Do I fill this in myself? Usually yes, unless an administrative office keeps the record for you, in which case they enter what you supply. The form itself belongs to TSG and is prescribed by AR 40-68. It runs to 2 page(s) and about unknown fields.
Download the form
Which formats can I download? These: PDF, XFDL. All of them carry the same published page — the difference is not what the form says but how you get words onto it.
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.
Does the download cost anything? No. There is no charge, no account and no email address to surrender, and the file you receive is the published document with nothing added to it.
Where do you start? At the top of the page, with the identifying entries: name as your official records spell it, identification number, unit or organisation, date of preparation. Why first? Because those entries are what the form is filed and searched under later, and a record indexed on a misspelled name is a record nobody retrieves.
How do you move through the fields? By tab, not by mouse. The tab order was fixed when the form was built and generally follows the reading order of the page, so following it is the simplest way to avoid skipping a box. What about check boxes? Click them. If a group is exclusive, your new selection clears the old one — that is the design, not a malfunction.
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 does the Privacy Act notice tell you? The legal authority behind the collection, what the information is for, the routine uses it may be put to, and whether disclosure is compulsory. When is the right moment to read it? Before completing the personal entries, at the point the statement appears. What follows from it? Your finished copy contains personal data, so store and send it the way your office handles that category.
Where do you send it? To the destination the prescribing directive names, which may be a specific office, the unit administrative channel, or the individual's file. Is a copy worth keeping? Always, and taken before submission. How long does the receiving office keep it? For the period the records schedule for the series prescribes, regardless of local custom.
How do you find related forms? By series and number. Documents in the DA series sharing a proponent or a prescribing directive are commonly used together, and a form cited on the face of another usually goes forward with it. When should you gather them? Before submission — continuation sheets, cover sheets and transmittal documents belong in the package from the start.
When is an edition replaced? When the proponent revises the form and publishes a new edition date. What should you do with a copy kept on your own machine? Check its date against the edition in force before reusing it. Does the change reach backwards? It does not; work already completed on an earlier edition remains valid as filed.
Who publishes these files? This site does, as copies of published Department of the Army forms offered for download. Is there any official connection? None — the site is independent of the Department of the Army and issues nothing itself. Will a given office accept your document? That is not something anyone here can state, and none of this page is legal advice. Where do you take a specific question? To TSG, or to the administrative office that services your unit.
Questions and answers
- What is DA Form 5441-30?
- EVALUATION OF CLINICAL PRIVILEGES - NEPHROLOGY
- 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
- 42-ITEM ONLY PRODUCED IN ELECTRONIC MEDIA
- 14-REQUIRES PRIVACY ACT STATEMENT (AR 340-21)