Form Information

For assistance see

FAQs and Downloading Instructions

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

FORM NUMBER:

SD416

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

TITLE:

SECURITY TERMINATION STATEMENT, DEPARTMENT OF DEFENSE

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

EDITION DATE:

19641001

CANCELLATION DATE:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

AVAILABLE FILE FORMATS:

PLEASE

Fillable Adobe:

If no hyperlink appears next to a format, the form is not available

Perform Pro:

electronically. To obtain hard copies of current forms not available in

Form Flow 2.0:

electronic format, please contact your own Military Service or DoD

Form Flow 99:

Component Forms Management Officer. Cancelled forms are not

Other:

available in electronic formats. Click on link for a list of Forms

Forms Management POCs

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

REMARKS:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

ISSUANCES:

DOD 5200.2-R

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

SPONSOR / POC:

USD(I)

SUB-SPONSOR:

NUMBER OF PAGES:

2

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

USERS*:

POL

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

PRESCRIBED OR ADOPTED?:

DISPOSITION:

FUNCTION CODE:

5200

FORM CONTROLLED:

MANDATORY PRINT SPECIFICATIONS:

RCS:

IRCN:

OMB:

PRIVACY ACT

N

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

---------

* All revisions and/or cancellations must be coordinated through these USERS.

DISPOSITION: S = Do NOT use previous edition. U = Use previous edition until supply is depleted.