DA Form 4817-R Consent / Nonconsent to Disclose Personal Information

What Is DA Form 4817-R?

This is a military form that was released by the U.S. Department of the Army (DA) on December 1, 1985. The form, often mistakenly referred to as the DD Form 4817-R, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

FAQ

Q: What is DA Form 4817-R?A: DA Form 4817-R is a form used to indicate consent or nonconsent to disclose personal information.

Q: Why would I need to fill out DA Form 4817-R?A: You would need to fill out DA Form 4817-R to give or withhold consent for the disclosure of your personal information.

Q: What kind of personal information can be disclosed with this form?A: This form can be used to disclose various types of personal information, such as your name, contact information, medical data, or financial details.

Q: Who may require me to fill out this form?A: Government agencies, healthcare providers, or any entity that needs to disclose your personal information may require you to fill out this form.

Q: What are the options for consent and nonconsent on the form?A: The form allows you to indicate consent, nonconsent, or conditional consent, depending on your preferences for the disclosure of your personal information.

Q: Is DA Form 4817-R legally binding?A: DA Form 4817-R is a legal document, and the decision you make regarding consent or nonconsent can have legal implications.

Q: Can I change my consent or nonconsent decision after filling out the form?A: You may be able to change your consent or nonconsent decision by contacting the entity that received the form and following their procedures for modification or revocation.

Q: What should I do if I have concerns or questions about the form?A: If you have concerns or questions about DA Form 4817-R, it is recommended to seek legal advice or consult with the entity requiring the form for clarification.