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Use (1) to acknowledge receipt of message and indicate planned or accomplished action or (2) to validate intelligence collection requirements. Transmittal of the message implies understanding of the received message. Reference: FM 11-1.

LINE 1 — DATE AND TIME______________________________(DTG of Report)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — ACKNOWLEDGE______________________________(Report Type)

LINE 4 — ORIGINATOR_________________________________(Originator of Report Acknowledged)

LINE 5 — SERIAL______________________________________(Serial Number or DTG of Report Acknowledged)

LINE 6 — RESPONSE___________________________________(Response to Report Acknowledged ACKNOWLEDGE, WILCO)

LINE 7 — VALIDATION STATUS_________________________(Response to Intelligence Collection Requirement: VALID, NONVALID, VALID WITH CHANGE)

LINE 8 — NARRATIVE__________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 9 — AUTHENTICATION___________________________(Report Authentication)