DA Form 3964 Classified Document Accountability Record

What Is DA Form 3964?

DA Form 3964, Classified Document Accountability Record is an official form used by the Department of the Army Information Security Program and designed as a single-entry active or inactive document-control register. The form will commonly accompany a classified document and is used to bring a document "under control" according to local procedures. The DA 3964 is usually used either as a documented receipt, a certificate of destruction or a document-control copy.

The latest version of the document - sometimes incorrectly referred to as the DD Form 3964 - was released by the Department of the Army (DA) in July 1979 and replaces the November 1972 edition of the form. An up-to-date DA Form 3964 fillable version can be downloaded below or can be found on the APD Forms website.

Additionally, the DA Form 4011 (Telecommunications Center Delivery List) is used by message centers as a multiple-entry control register. The AE Form 380-5A (Multiple Classification Message Destruction Record) may be used as a multiple CD for messages.

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DATE
CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD
For use of this form, see AR 380-5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence.
SECTION A - GENERAL
TO:
FROM:
DATE RECEIVED
ACTION OFFICE(S)
SUSPENSE DATE(S)
REGISTER OR CONTROL NO.
CONTROL LOG
CLASSIFI-
NUMBER
DESCRIPTION (Type, File Ref., Unclassified Subject
DATE OF
ORIGINATOR
OR FILE NO.
CATION
OF COPIES
DOCUMENT
or Short Title and Number of Indorsements/Incls)
SECTION B - ROUTING
I ACKNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREON
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
1.
2.
3.
4.
5.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN:
PAGE OR COPY NO
TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5)
DESTROYED
OFFICE SYMBOL
DATE
PRINTED NAME OF CUSTODIAN OR REP
SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR. OFF.
SIGNATURE
PAGE OR COPY NUMBER
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
SECTION D - REPRODUCTION AUTHORITY
NUMBER OR COPIES TO BE REPRODUCED AUTHORIZED BY
DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
RECEIPT OF DOCUMENT(S) ACKNOWLEDGED
DOCUMENT(S) HAVE NOT BEEN RECEIVED
TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE
PRINTED NAME, GRADE OR TITLE
SIGNATURE
COMMENTS
DA FORM 3964, JUL 1979
EDITION OF 1 NOV 72 IS OBSOLETE.
APD LC V2.00
DATE
CLASSIFIED DOCUMENT ACCOUNTABILITY RECORD
For use of this form, see AR 380-5; the proponent agency is the Office, Assistant Chief of Staff for Intelligence.
SECTION A - GENERAL
TO:
FROM:
DATE RECEIVED
ACTION OFFICE(S)
SUSPENSE DATE(S)
REGISTER OR CONTROL NO.
CONTROL LOG
CLASSIFI-
NUMBER
DESCRIPTION (Type, File Ref., Unclassified Subject
DATE OF
ORIGINATOR
OR FILE NO.
CATION
OF COPIES
DOCUMENT
or Short Title and Number of Indorsements/Incls)
SECTION B - ROUTING
I ACKNOWLEDGE RECEIPT OF THE MATERIAL DESCRIBED HEREON
TO
COPY NO.
DATE
PRINTED NAME
SIGNATURE
1.
2.
3.
4.
5.
SECTION C - DESTRUCTION CERTIFICATE (Check appropriate block)
MATERIAL DESCRIBED HEREON HAS BEEN:
PAGE OR COPY NO
TORN IN HALF AND PLACED IN A CLASSIFIED WASTE CONTAINER (AR 380-5)
DESTROYED
OFFICE SYMBOL
DATE
PRINTED NAME OF CUSTODIAN OR REP
SIGNATURE
DESTRUCTION RECORD NO.
DATE
PRINTED NAME OF CERTIFYING/DESTR. OFF.
SIGNATURE
PAGE OR COPY NUMBER
DATE
PRINTED NAME OF WITNESSING OFFICIAL
SIGNATURE
SECTION D - REPRODUCTION AUTHORITY
NUMBER OR COPIES TO BE REPRODUCED AUTHORIZED BY
DATE
SECTION E - RECEIPT/TRACER ACTION (Check appropriate block)
RECEIPT OF DOCUMENT(S) ACKNOWLEDGED
DOCUMENT(S) HAVE NOT BEEN RECEIVED
TRACER ACTION: SIGNED RECEIPT FOR MATERIAL DESCRIBED ABOVE HAS NOT BEEN RECEIVED.
DATE
PRINTED NAME, GRADE OR TITLE
SIGNATURE
COMMENTS
DA FORM 3964, JUL 1979
EDITION OF 1 NOV 72 IS OBSOLETE.
APD LC V2.00

Download DA Form 3964 Classified Document Accountability Record

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How to Fill Out DA Form 3964?

Procedural information and additional tips can be found in the AR 380-5, Department of the Army Information Security Program, released in September 2000. DA Form 3964 instructions are as follows:

  1. Either a DA Form 3964 or a DA Form 455, Mail and Document Register may be used as active or inactive control registers. All registers will be maintained in serial control-number sequences by calendar year.
  2. Personnel filing the form must prepare enough copies. The current date is specified in the block labeled "Date" in the upper right corner of the page.
  3. The complete address of the agency where the classified document, will be sent is entered in the block labeled "To", and the address of the issuing organization is provided in the block labeled "From".
  4. The "Control, Log or File No." block requires a number specified on the classified document.
  5. The "Classification" block should be completed with a code to reflect the overall security rating of the of the document: TS - for Top Secret; S - for Secret; C - for Confidential.
  6. The exact number of copies of each document being transferred is listed in the "Number of Copies" block.
  7. The "Description" block requires the following information:
    • The type of classified document,
    • A file reference symbol,
    • The unclassified subject or a short title of the document,
    • The number of endorsements or enclosures.
  8. The date of origin and the name of the originator of the document is specified in the last two columns in the first part of the form. The other four sections of the form are mostly self-explanatory:
    • Section B - Routing - describes the transfer of the form and documents.
    • Section C - Destruction Certificate - is filed if the classified material is destructed or disposed of.
    • Section D - Reproduction Authority - is filed if the original document needs to be copied. Reproduction of classified material requires the approval of an originator or the higher DOD authority.
    • Section E - Receipt/Tracer Action - specifies whether or not the classified documents were delivered and received.