DA Form 5557 Individual Reliability Screening and Evaluation Record

DA Form 5557 - also known as the "Individual Reliability Screening And Evaluation Record" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 5557 - was last revised on September 1, 2009. Download an up-to-date fillable PDF version of the DA 5557 down below or look it up on the Army Publishing Directorate website.

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INDIVIDUAL RELIABILITY SCREENING AND EVALUATION RECORD
For use of this form, see AR 190-56; the proponent agency is PMG.
PART I - PERSONNEL RECORDS SCREENING
NAME OF INDIVIDUAL BEING SCREENED/EVALUATED
GRADE
Personnel records
(including personnel security/suitability records)
have been reviewed in accordance with AR 190-56.
Information
is
is not attached which may preclude assignment. The individual possesses a security
clearance of
Confidential
Secret
Top Secret based upon a
NAC
NACI
Exception
BI granted on
(NACI requested on
(date)
(date).
NAME AND GRADE OF OFFICIAL CONDUCTING
SIGNATURE
DATE
SCREENING
PART II - MEDICAL RECORDS SCREENING
Medial records
(including medical examination) have been reviewed in accordance with AR 190-56.
Information
is
is not attached which may preclude assignment.
NAME AND GRADE OF PHYSICIAN
SIGNATURE
DATE
PART III - CERTIFYING OFFICIAL'S EVALUATION
Individual has been evaluated in accordance with AR 190-56. Information reflecting possible unsuitability has been
thoroughly reviewed. Individual
was
was not interviewed. I find the individual to be
suitable
unsuitable for assignment. Temporarily suspended
See Part V
(if applicable)
(date).
if unsuitable or temporarily suspended.
NAME, GRADE AND ORGANIZATION OF CERTIFY-
SIGNATURE
DATE
ING OFFICIAL
PART IV - BRIEFING CERTIFICATE (If found suitable)
I have briefed this individual on the reliability standards and objectives contained in AR 190-56. Briefing is acknowledged by the individual.
SIGNATURE OF CERTIFYING
DATE
ORGANIZATION
SIGNATURE OF INDIVIDUAL
OFFICIAL
PART V - DISQUALIFICATION
Individual's status at time of disqualification
Being screened for employment according to AR 190-56.
Employed in a position under AR 190-56.
Reason or reasons for disqualification
(Continue on reverse side or attach additional explanation, if necessary)
PART VI - RECORDS IDENTIFICATION
This form is filed in personnel and medical records to identify an individual whose current duty, position requires a high degree of reliability,
trustworthiness, physical fitness, and emotional stability. Any information received for entry into personnel or medical records which reflects
adversely on the individual must be reported to the certifying official or commander concerned.
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.00ES
DA FORM 5557, SEP 2009

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