DS-4170 (2021) Fillable PDF Form – Download & Complete Online

The DS-4170 (2021) is the official Time and Attendance record used by employees of the U.S. Department of State. It captures daily work hours, overtime, leave types, and employee certifications. This page gives you a direct link to the original fillable PDF and step‑by‑step instructions for completing it online with Formize’s PDF Filler.

What Is the DS-4170 Form?

Issued by the Department of State, the DS-4170 tracks each employee’s scheduled and actual work hours, ensuring accurate payroll and compliance with federal labor regulations. The 2021 version includes updated fields for remote work and flexible scheduling.

Key Sections & Fields Explained

• Employee Name – Enter last name, first name, and middle initial exactly as they appear on your badge.
• Day / Date – Fill in the calendar day and date (MM‑DD‑YYYY) for each entry.
• Start Time & Scheduled Start – Record the actual clock‑in time and the pre‑approved start time.
• End Time & Scheduled Finish – Record the actual clock‑out time and the scheduled finish time.
• Hours Type – Check the appropriate boxes: Reg, OT, AL, SL, LWOP, Comp.
• Total & Grand Total – The form automatically sums daily totals; verify the final grand total.
• Employee Certification – Sign and date to certify accuracy.
• Supervisor Certification – Supervisor signs after review.

How to Fill the DS-4170 Form Online

Instead of downloading the PDF and opening a separate editor, simply click the Fill out this form button below. The Formize PDF Filler app loads in your browser, letting you type, select checkboxes, and add a digital signature without leaving the page.

Common Mistakes to Avoid

• Leaving any mandatory field blank – the filler will highlight missing data.
• Using the wrong date format – the form requires MM‑DD‑YYYY.
• Mixing AM/PM designations – be consistent for all time entries.
• Forgetting the employee or supervisor certification – unsigned forms are rejected.

Where to Submit the Completed Form

After you finish, download the completed PDF or email it directly to your supervisor’s official address. Keep a copy for your records. If your agency requires electronic submission, follow the internal portal instructions provided by the Department of State.