DA Form 969 Top Secret Document Record

DA Form 969 - also known as the "Top Secret Document Record" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 969 - was last revised on October 1, 1978. Download an up-to-date fillable PDF version of the DA 969 below or request a copy through the chain of command.

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DATE
TOP SECRET DOCUMENT RECORD
For use of this form, see AR 380-5; the proponent agency is Office, Assistant Chief of Staff for Intelligence.
FROM:
TO:
DATE RECEIVED
SUSPENSE DATE(S)
REGISTER OR CONTROL NO.
ACTION OFFICE(S)
NUMBER
DESCRIPTION (Type, File, Ref., Unclassified Subject
DATE OF
CONTROL, LOG
CLASSIFI-
OF
ORIGINATOR
OR FILE NO.
CATION
or Short Title and Number of Indorsements/Incls)
DOCUMENT
COPIES
DATE OF DISTRIBUTION
DISTRIBUTION DATA
COPY NO.
ADDRESSEE (Print or type)
COPY NO.
ADDRESSEE (Print or type)
INTRA-OFFICE ROUTING DATA
FOR:
ACTION
INFORMATION
SUSPENSE DATE
CHECK
TO
CHECK
TO
NAMES OF ALL PERSONS HANDLING ATTACHED DOCUMENT OR WHO HAVE BEEN INFORMED OF ITS CONTENT WILL BE LISTED
NAME (Print or type)
DATE
NAME (Print or type)
DATE
EDITION OF 1 MAY 60 MAY BE USED
DA FORM 969, OCT 1978
APD LC v2.00
DATE
TOP SECRET DOCUMENT RECORD
For use of this form, see AR 380-5; the proponent agency is Office, Assistant Chief of Staff for Intelligence.
FROM:
TO:
DATE RECEIVED
SUSPENSE DATE(S)
REGISTER OR CONTROL NO.
ACTION OFFICE(S)
NUMBER
DESCRIPTION (Type, File, Ref., Unclassified Subject
DATE OF
CONTROL, LOG
CLASSIFI-
OF
ORIGINATOR
OR FILE NO.
CATION
or Short Title and Number of Indorsements/Incls)
DOCUMENT
COPIES
DATE OF DISTRIBUTION
DISTRIBUTION DATA
COPY NO.
ADDRESSEE (Print or type)
COPY NO.
ADDRESSEE (Print or type)
INTRA-OFFICE ROUTING DATA
FOR:
ACTION
INFORMATION
SUSPENSE DATE
CHECK
TO
CHECK
TO
NAMES OF ALL PERSONS HANDLING ATTACHED DOCUMENT OR WHO HAVE BEEN INFORMED OF ITS CONTENT WILL BE LISTED
NAME (Print or type)
DATE
NAME (Print or type)
DATE
EDITION OF 1 MAY 60 MAY BE USED
DA FORM 969, OCT 1978
APD LC v2.00
NAMES OF ALL PERSONS HANDLING ATTACHED DOCUMENT OR WHO HAVE BEEN INFORMED OF ITS CONTENTS WILL BE LISTED
NAME (Print or type)
DATE
NAME (Print or type)
DATE
REGRADING INFORMATION
BASIC DOCUMENT TO BE REVIEWED FOR POSSIBLE DOWNGRADING AS INDICATED
DATE FOR REVIEW
CLASSIFICATION
DATE OF CLASS.
DATE FOR REVIEW
CLASSIFICATION
DATE OF CLASS.
RESERVED FOR USE BY TOP SECRET CONTROL OFFICER
APD LC v2.00

Download DA Form 969 Top Secret Document Record

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