DA Form 67-10-1A Officer Evaluation Report Support Form

DA Form 67-10-1A also known as the Officer Evaluation Report Support Form is a document used during the process of Officer Evaluation within the U.S. Army. This form assists the rating chain in compiling a report for the Department of the Army HQ on the performance and potential assessments of a rated officer.

This latest edition of the support form was released in November 2015. An up-to-date and fillable DA 67-10-1A is available for download below.

The form - sometimes referred to DA Form 67 for short - should not be confused with the DD Form 67, Form Processing Action Request, with the latter being used to request a cancellation or revision of an existing form or adding a new one to the Department of Defense inventory.

What Is DA Form 67-10-1A?

The OER completion process requires the rating officials to make an assessment of the rated officer’s performance according to their assigned position and to evaluate their potential for service in positions of a higher rank.

The DA Form 67-10-1A allows the rated officer to self-evaluate themselves according to six criteria: their character, presence, intellectual abilities, leadership skills, development, and achievements. The officer is also expected to set goals for future development.

The rated officer receives their copy of the supporting form at the beginning of the rating period. It's their responsibility to fill out parts of the form and hand it to the rating chain during face-to-face counseling sessions.

At the end of the rating period, the completed form enables rated the officer to provide some personal input to completed OER.

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HQDA#:
OFFICER EVALUATION REPORT SUPPORT FORM
SEE PRIVACY ACT STATEMENT
IN AR 623-3
For use of this form, see AR 623-3 ; the proponent agency is DCS, G-1.
PART I - ADMINISTRATIVE (Rated Officer)
a. NAME (Last, First, Middle Initial)
b. SSN (or DOD ID No.)
c. GRADE/
d. DATE OF RANK (YYYYMMDD) e. BRANCH
f. COMPONENT
RANK
(STATUS CODE)
g. UNIT, ORG., STATION, ZIP CODE OR APO, MAJOR COMMAND
h. UIC CODE
i. THRU DATE OF LAST COMPLETED
EVALUATION
j. RATED OFFICER'S EMAIL ADDRESS (.gov or .mil)
k. MSAF DATE
PART II - AUTHENTICATION
a1. NAME OF RATER (Last, First, Middle Initial)
a2. SSN (or DOD ID No.)
a3. RANK
a4. POSITION
a5. EMAIL ADDRESS (.gov or .mil)
b1. NAME OF INTERMEDIATE RATER
b3. RANK
b4. POSITION
b5. EMAIL ADDRESS (.gov or .mil)
b2. SSN (or DOD ID No.)
(Last, First,Middle Initial)
c1. NAME OF SENIOR RATER (Last, First, Middle Initial)
c2. SSN (or DOD ID No.)
c5. EMAIL ADDRESS (.gov or .mil)
c3. RANK
c4. POSITION
c6. SENIOR RATER'S ORGANIZATION
c7. BRANCH
c8. COMPONENT
c9. SENIOR RATER
PHONE NUMBER
d2. RANK
d3. POSITION
d4. EMAIL ADDRESS (.gov or .mil)
d1. INDIVIDUAL TO PERFORM SUPPLEMENTARY REVIEW (Last, First, Middle Initial) -
(IF REQUIRED)
PART III - VERIFICATION OF FACE - TO - FACE DISCUSSION
MANDATORY RATER/RATED OFFICER INITIAL FACE-TO-FACE COUNSELING ON DUTIES, RESPONSIBILITIES AND PERFORMANCE OBJECTIVES FOR THE CURRENT
RATING PERIOD TOOK PLACE ON (DATE)
RATED OFFICER INITIALS
RATER INITIALS
SENIOR RATER INITIALS
RATED OFFICER ACCESS TO SUPPORT FORMS PRIOR TO INITIAL COUNSELING: RATER (Date
) SENIOR RATER (Date
)
PERIODIC RATER / RATED OFFICER FOLLOW-UP FACE-TO-FACE COUNSELINGS:
DATE
RATED OFFICER INITIALS
RATER INITIALS
SENIOR RATER INITIALS
DATE
RATED OFFICER INITIALS
RATER INITIALS
SENIOR RATER INITIALS
DATE
RATED OFFICER INITIALS
RATER INITIALS
SENIOR RATER INITIALS
PART IV - RATED OFFICER - DUTIES AND RESPONSIBILITIES
a. PRINCIPAL DUTY TITLE:
b. POSITION AOC/BRANCH:
c. STATE YOUR SIGNIFICANT DUTIES AND RESPONSIBILITIES:
PART V - PERFORMANCE OBJECTIVES AND ACCOMPLISHMENTS
a. INDICATE YOUR MAJOR PERFORMANCE OBJECTIVES:
b. LIST SIGNIFICANT CONTRIBUTIONS AND ACCOMPLISHMENTS:
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DA FORM 67-10-1A, NOV 2015
APD LC v1.00ES

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DA Form 67-10-1A Instructions

At the beginning of the rating period, the rated officer will be given two copies of the DA 67-10-1A with one belonging to the senior rater and the other to be kept by the officer.

Within 30 days after the beginning of the rating period, the rated soldier will undergo counseling. During the session, the rating officer and rated officer will discuss the scope of the rated Soldier's duty description, performance objectives and set personal developmental goals.

  1. Parts I through III are administrative and provide identifying information and authentication from all parties involved in the evaluation process.
  2. Parts IV and V are filled out by the rated officer.  Part IV is for describing their duties and responsibilities.
  3. Part V is more detailed and must include an in-depth self-evaluation of the officer’s character, military and professional bearing, fitness, confidence, mental agility, and expertise as well as an overview of leadership skills and achievements.

DA 67-10-1A Related Forms

The DA Form 67–10 series was introduced in 2014 as a replacement to the outdated DA Form 67-9 and consists of the following documents:

  1. DA Form 67–10–1 (Company Grade Plate (O1–O3; WO1 - CW2) Officer Evaluation Report) (CGP–OER) is used for 2LT through CPT and WO1 through CW2.
  2. DA Form 67–10–2 (Field Grade Plate (O4–O5; CW3–CW5) Officer Evaluation Report) (FGP–OER) is used to evaluate major (MAJ) through lieutenant colonel (LTC) and chief warrant officer three (CW3) through chief warrant officer five (CW5).
  3. DA Form 67–10–3 (Strategic Grade Plate (O6) Officer Evaluation Report) (SGP–OER) is used when evaluating colonel (COL) performance.
  4. DA Form 67–10–4 (Strategic Grade Plate General Officer Evaluation Report) (GOR–OER) is used with brigadier generals (BG) or higher.
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