You need DD Form 441-1, and this page gives you the blank plus the steps for handling it. Start with what the form does: Appendage to Department of Defense Security Agreement. Its official title is DD form 441-1, Appendage to DoD Security Agreement, 20120501 draft.
Next, check the edition. You want not stated, currently carried as not stated by the publisher. Then confirm the form applies to you — this is a Department of Defense form, so you use it whether you serve in the Army, Navy, Air Force, Marine Corps, Space Force or Coast Guard under Defense jurisdiction.
After that, turn to timing. The requirement comes from not stated; the form is maintained by not stated. Local implementing instructions fill in the dates, so check with the office that will receive your copy.
Finally, decide how you will complete it. You can type into a fillable file or print a blank and write by hand, and the rest of this page walks you through both paths in order.
Now fill it in. Work from the top of the page downward, and do not jump ahead — the identifying block comes first, the substance of your entry second, the certification last. Later boxes often depend on what you put at the top.
Before your first entry, look at the corner of the page and compare the printed date with not stated. If they do not match, stop and download again. Old copies circulate in shared drives for years, and a DD form is revised centrally for every service at once, so a superseded blank may not carry the fields your reviewer expects.
Work through the fields one at a time and leave nothing blank. When a box does not apply to you, write N/A rather than skipping it, so the reviewer can see you read the question. Follow the date format printed beside each date field instead of the one you normally use.
Do not skip past the Privacy Act Statement. It is placed ahead of the personal data fields on purpose: it explains under what authority you are being asked, what happens to the information, and what follows if you decline. Take the minute it costs.
Sign last, and sign properly. On paper that means ink in the signature block. Electronically it means a digital signature, usually applied with your Common Access Card in a reader that supports it. Typing your name into the field does not sign anything. Then add the date beside your signature — an unsigned or undated form is the most common reason one comes back.
Run a final pass over the form. The errors that send it back are the same ones every time: old edition, gaps in required fields, unreadable handwriting on a scan, non-conforming dates, no signature or no date.
If a particular field puzzles you, read the instructions printed on the form first, then go to not stated. When the two disagree, follow the directive.
Download the form
Step one is picking the format. You have PDF to choose from, across 1 pages, with approximately 50 fields to complete.
Download the pdf first. After it opens, test a field with your cursor. Fillable means you type, tab to the next box, and save your work inside the file. Printable means the page is a flat blank, so print it and write your answers in ink.
Prefer typing over writing. Your form will likely be scanned and emailed onward, and typed text reproduces at every stage while pen strokes fade or blur. When you do write, print in capitals so the receiving clerk can read it.
Whichever you pick, you pay nothing — every format here is a free download. One last tip: open your pdf in a desktop reader rather than in a browser tab, because browser viewers sometimes drop the interactive fields you need.
What the form asks for
- It is further agreed, on this (enter day).
- Day of (enter month).
- (Enter year).
- by and between the U.S. through the Defense Security Service, acting for the Department of Defense, hereinafter called the Government, and (enter name of contractor).
- Name of plant or facility, line 1.
- Number and street address.
- City and state.
- Name of plant or facility, line 2.
- Number and street address.
- City and state.
- Name of plant or facility, line 3.
- Number and street address.
- City and state.
- Name of plant or facility, line 4.
- Number and street address.
- City and state.
- Name of plant or facility, line 5.
- Number and street address.
- City and state.
- Name of plant or facility, line 6.
- Number and street address.
- City and state.
- Name of plant or facility, line 7.
- Number and street address.
With the form finished, route it to the office named in not stated or in your organization's own instruction. Keep a copy first. People rarely regret having one and frequently regret not having one.
When DD Form 441-1 references another form, search on the series and number. Because DD numbers are common to every military department, the number by itself identifies exactly one document.
Be careful when a procedure pairs this form with a service form. Read the prefix, not just the digits. Service forms answer to a service proponent, while DD forms answer to not stated or an equivalent Department office, and the two sequences were never aligned. Grabbing the wrong prefix gets you a form that has nothing to do with your task.
Plan to repeat this step whenever the form comes up again. Revisions follow directive changes, changes in what data is collected, and updates to notice language. Since nobody notifies you, check not stated at download and you have covered it.
Before you go, note what is not covered here. You have the blank form and instructions for completing it; you do not have legal guidance, and no statement on this page determines what any office will do with your submission. Direct those questions to not stated, to the personnel office that serves you, or to the office designated in not stated.
Questions and answers
- What is DD Form 441-1?
- DD form 441-1, Appendage to DoD Security Agreement, 20120501 draft
- Which edition is current?
- Not stated by the publisher
- Who is responsible for this form?
- Not stated
- In which formats can it be downloaded?