DD Form 365-4 Weight and Balance Clearance Form F - Transport

DD Form 365-4 or the "Weight And Balance Clearance Form F - Transport" is a Department of Defense-issued form used by and within the United States Army.

The form - often mistakenly referred to as the DA form 365-4 - was last revised on August 1, 1996. Download an up-to-date fillable PDF version of the DD 365-4 down below or find it on the Department of Defense documentation website.

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WEIGHT AND BALANCE CLEARANCE FORM F - TRANSPORT
FOR USE WITH T.O. 1-1B-40, NAVAIR
Form Approved
(Use reverse for tactical missions)
01-1B-40, AND TM-55-1500-342-23
OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should
be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a
currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION.
DATE (YYYYMMDD)
AIRCRAFT TYPE
FROM
HOME STATION
MISSION
SERIAL NO.
TO
PILOT
INDEX OR
REMARKS
REF
ITEM
WEIGHT
MOM/
1
BASIC AIRCRAFT (From Chart C)
2
3
CREW (No.)
4
CREW'S BAGGAGE
5
STEWARD'S EQUIPMENT
6
EMERGENCY EQUIPMENT
7
EXTRA EQUIPMENT
8
9
OPERATING WEIGHT
10
TAKEOFF FUEL (
Gal.)
11
WATER INJ.
LOAD ADJUSTER NUMBER
12
TOTAL AIRCRAFT WEIGHT
CORRECTION/MOST FWD/MOST AFT
13 DISTRIBUTION OF ALLOWABLE LOAD (PAYLOAD)
14 ZERO FUEL WT
ZERO FUEL WT
COMPT
COMPT
COMPT
CHANGES (+ or -)
PASSENGERS
INDEX OR MOM
OR
ITEM
OR
CARGO
CARGO
OR
INDEX OR
WEIGHT
NO.
WEIGHT
ZERO FUEL % M.A.C.
ARM
ARM
ARM
MOM/
TOTAL WEIGHT
REMOVED
TOTAL WEIGHT
ADDED
NET DIFFERENCE
LIMITATIONS
15
CONDITION
TAKEOFF
LANDING
1 FUEL
ALLOWABLE GROSS WEIGHT
16
TAKEOFF CONDITION (Uncorrected)
TOTAL AIRCRAFT WT. (Ref. 12)
17
TAKEOFF C.G. IN % M.A.C. OR IN
(Ref. 9) + (Ref. 23)
18
CORRECTIONS (If required)
OPERATING WT. (Ref. 9)
19
TAKEOFF CONDITION (Corrected)
ALLOWABLE LOAD (Ref. 13)
20
TAKEOFF C.G. IN % M.A.C. OR IN
(use smallest figure)
1 Zero Fuel or Limiting Wing Fuel
21
ZERO FUEL WT (Ref. 14)
PERMISSIBLE C.G.
FORWARD
AFT
22
LESS AIR DROP LOAD
TAKEOFF
PERMISSIBLE C.G.
FORWARD
AFT
LANDING
PERMISSIBLE C.G.
FORWARD
AFT
ZERO FUEL WT.
COMPUTED BY
SIGNATURE
23
ESTIMATED LANDING FUEL
WEIGHT AND BALANCE
AUTHORITY SIGNATURE
24
ESTIMATED LANDING CONDITION
PILOT SIGNATURE
25
ESTIMATED LANDING C.G. IN % M.A.C. OR IN
DD FORM 365-4, AUG 96
PREVIOUS EDITION MAY BE USED.
Adobe Professional 8.0
WEIGHT AND BALANCE CLEARANCE FORM F - TRANSPORT
FOR USE WITH T.O. 1-1B-40, NAVAIR
Form Approved
(Use reverse for tactical missions)
01-1B-40, AND TM-55-1500-342-23
OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect
of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should
be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a
currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION.
DATE (YYYYMMDD)
AIRCRAFT TYPE
FROM
HOME STATION
MISSION
SERIAL NO.
TO
PILOT
INDEX OR
REMARKS
REF
ITEM
WEIGHT
MOM/
1
BASIC AIRCRAFT (From Chart C)
2
3
CREW (No.)
4
CREW'S BAGGAGE
5
STEWARD'S EQUIPMENT
6
EMERGENCY EQUIPMENT
7
EXTRA EQUIPMENT
8
9
OPERATING WEIGHT
10
TAKEOFF FUEL (
Gal.)
11
WATER INJ.
LOAD ADJUSTER NUMBER
12
TOTAL AIRCRAFT WEIGHT
CORRECTION/MOST FWD/MOST AFT
13 DISTRIBUTION OF ALLOWABLE LOAD (PAYLOAD)
14 ZERO FUEL WT
ZERO FUEL WT
COMPT
COMPT
COMPT
CHANGES (+ or -)
PASSENGERS
INDEX OR MOM
OR
ITEM
OR
CARGO
CARGO
OR
INDEX OR
WEIGHT
NO.
WEIGHT
ZERO FUEL % M.A.C.
ARM
ARM
ARM
MOM/
TOTAL WEIGHT
REMOVED
TOTAL WEIGHT
ADDED
NET DIFFERENCE
LIMITATIONS
15
CONDITION
TAKEOFF
LANDING
1 FUEL
ALLOWABLE GROSS WEIGHT
16
TAKEOFF CONDITION (Uncorrected)
TOTAL AIRCRAFT WT. (Ref. 12)
17
TAKEOFF C.G. IN % M.A.C. OR IN
(Ref. 9) + (Ref. 23)
18
CORRECTIONS (If required)
OPERATING WT. (Ref. 9)
19
TAKEOFF CONDITION (Corrected)
ALLOWABLE LOAD (Ref. 13)
20
TAKEOFF C.G. IN % M.A.C. OR IN
(use smallest figure)
1 Zero Fuel or Limiting Wing Fuel
21
ZERO FUEL WT (Ref. 14)
PERMISSIBLE C.G.
FORWARD
AFT
22
LESS AIR DROP LOAD
TAKEOFF
PERMISSIBLE C.G.
FORWARD
AFT
LANDING
PERMISSIBLE C.G.
FORWARD
AFT
ZERO FUEL WT.
COMPUTED BY
SIGNATURE
23
ESTIMATED LANDING FUEL
WEIGHT AND BALANCE
AUTHORITY SIGNATURE
24
ESTIMATED LANDING CONDITION
PILOT SIGNATURE
25
ESTIMATED LANDING C.G. IN % M.A.C. OR IN
DD FORM 365-4, AUG 96
PREVIOUS EDITION MAY BE USED.
Adobe Professional 8.0
WEIGHT AND BALANCE CLEARANCE FORM F - TACTICAL
FOR USE WITH T.O. 1-1B-40, NAVAIR
(Use reverse for transport missions)
01-1B-40, AND TM-55-1500-342-23
DATE (YYYYMMDD)
AIRCRAFT TYPE
FROM
HOME STATION
MISSION
SERIAL NO.
TO
PILOT
CORRECTION/MOST FWD/MOST AFT (Ref. 11)
INDEX OR MOM/
REF
ITEM
WEIGHT
1
CHANGES (+ or -)
BASIC AIRCRAFT (From Chart C)
2
COMPT
ITEM
INDEX OR
WEIGHT
MOM/
CREW
3
COMPT
CARGO/MISC
NO.
WEIGHT
D
I
S
T
R
I
B
U
T
I
O
N
O
F
L
O
A
D
4
OPERATING WEIGHT
5
A
M
M
O
6
B
O
M
TOTAL WEIGHT ADDED
+
+
B
TOTAL WEIGHT REMOVED
_
_
S,
NET DIFFERENCE (Ref. 11)
M
REMARKS
I
S
S
I
L
E
S,
E
T
C.
7
F
U
E
L
8
MISC. VARIABLES
9
TAKEOFF CONDITION (Uncorrected)
10
TAKEOFF C.G. IN % M.A.C. OR IN
LIMITATIONS
11
CORRECTIONS (If required)
GROSS WEIGHT TAKEOFF (lb.)
GROSS WEIGHT LANDING (lb.)
12
TAKEOFF CONDITION (Corrected)
13
TAKEOFF C.G. IN % M.A.C. OR IN
PERMISSIBLE C.G.
FORWARD
AFT
14
TAKEOFF FUEL
TAKEOFF (%
E
M.A.C. or in.)
L
X
E
P
PERMISSIBLE C.G.
FORWARD
AFT
S
E
LANDING (%
N
S
M.A.C. or in.)
D
A
COMPUTED BY SIGNATURE
B
L
E
S
WEIGHT AND BALANCE AUTHORITY SIGNATURE
15
ESTIMATED LANDING FUEL
PILOT SIGNATURE
16
ESTIMATED LANDING CONDITION
17
ESTIMATED LANDING C.G. IN % M.A.C. OR IN
DD FORM 365-4 (BACK), AUG 96
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