DA Form 4571-R: AMEDD Officer Procurement Guide & PDF – DA Form 4571-R, titled Data Required by the Privacy Act of 1974 (Eligibility for AMEDD Officer Procurement Programs – Miscellaneous Documentation) (LRA), is a U.S. Army form used in the application process for commissioning as an officer in the Army Medical Department (AMEDD).
The form serves as a Privacy Act statement and acknowledgment. It covers the collection and use of personal information and miscellaneous supporting documents for AMEDD officer procurement programs, including direct appointments, scholarships, and related pathways in branches like the Medical Corps, Dental Corps, Nurse Corps, and others.
Prescribed by AR 135-101, the proponent agency is the Office of The Surgeon General. The current edition is from November 1983 (edition of 1 July 79 is obsolete).
Download the Official DA Form 4571-R PDF here: https://armypubs.army.mil/pub/eforms/DR_a/pdf/A4571_R.pdf
Purpose of DA Form 4571-R
The principal purpose is to determine your qualifications for appointment as a commissioned officer in the U.S. Army Medical Department or for selection into an AMEDD officer procurement program.
It ensures compliance with the Privacy Act of 1974 by informing applicants about:
- Authority (10 USC 3012, 10 USC 4301)
- How their data (including SSN) will be used
- Routine uses for evaluation, security determinations, service agreements, and personnel management
- Voluntary nature of disclosure (failure to provide information may result in denial of appointment or consideration)
Your signature acknowledges that you have been advised of this Privacy Act information. It does not collect new data but references and accompanies miscellaneous documentation.
Key Authority and Legal Basis
The form operates under:
- 10 U.S.C. 3012 and 10 U.S.C. 4301
- AR 135-101 (Appointment of Reserve Commissioned Officers for Assignment to Army Medical Department Branches)
- Related regulations such as AR 601-100, DA Pam 600-4, and USAREC policies for health professions recruiting.
It supports eligibility determinations for Regular Army (RA) and Army Reserve (AR) appointments, including programs like the Health Professions Scholarship Program (HPSP).
Miscellaneous Documentation Covered by DA Form 4571-R
The form lists common supporting documents that applicants may need to submit alongside it, including:
- Curriculum vitae (including professional organization memberships)
- Resume or autobiography
- Official transcripts
- Letters of Recommendation
- Interview evaluations
- Proof of professional qualifications or licensure
- Courses in progress or statements of school acceptance/enrollment
- Special test results (e.g., MCAT, DAT)
- Motivation statements
- Citizenship statements
- Statements regarding malpractice claims, professional privileges, or conscientious objector status
- Requests for waivers of eligibility requirements
- Various service agreements and conditional releases
These documents help evaluate educational background, experience, constructive service credit, and overall suitability.
Who Needs to Complete DA Form 4571-R?
This form is required for individuals applying to:
- AMEDD direct commission programs
- Health Professions Scholarship Program (HPSP) and similar student programs
- Graduate medical education or internship pathways
- Army Nurse Corps and other AMEDD branches (physicians, dentists, veterinarians, allied health professionals, etc.)
It applies to both new applicants and those with prior service seeking appointment in the RA or USAR.
Applicants must generally meet U.S. citizenship, medical fitness (AR 40-501), security clearance, moral character, and age/service obligation requirements.
How to Fill Out and Use DA Form 4571-R?
- Review the Privacy Act statement on the form carefully.
- Type or print your full name.
- Sign and date the form to acknowledge the information.
- Attach it to your application packet with the listed miscellaneous documents.
- Submit through your USAREC Health Care Recruiter or appropriate channel (packets are often uploaded digitally).
The form is reproducible locally on 8.5 x 11-inch paper. Always use the official PDF from Army Publishing Directorate for accuracy.
Tip: Work with an AMEDD recruiter early. Requirements vary by specific program (e.g., HPSP needs proof of acceptance to an accredited school).
Importance in the AMEDD Application Process
DA Form 4571-R ensures transparency and legal compliance in handling sensitive personal data. It protects applicants’ privacy rights while allowing the Army to evaluate qualifications, award constructive credit, process security clearances, and manage accessions effectively.
Incomplete documentation or failure to provide required information can delay or disqualify your application. This form is a standard part of board packets reviewed for selection.
Related AMEDD Resources and Forms
- AR 135-101 and AR 601-100 (core appointment regulations)
- USAREC UR 601-37 (AMEDD recruiting guidance)
- Other common forms: DA Form 4628 (HPSP Application), transcripts, LORs, etc.
- Official source: Army Publishing Directorate
For the most current eligibility criteria, contact a U.S. Army Health Care Recruiter or visit the official Army Medical recruiting website.
This guide is for informational purposes based on official U.S. Army publications. Always verify the latest requirements with an official recruiter or through Army channels, as policies can be updated.