DA Form 2166-9-3 NCO Evaluation Report (CSM/SGM)

What Is DA Form 2166-9-3

DA Form 2166-9-3, NCO Evaluation Report, CSM/SGM is a U.S. Army form used during the evaluation of Non-commissioned officers (NCOs) ranked Command Sergeant Major (CSM) or Sergeant Major (SGM). This form is part of the DA 2166-9 series that consists of six NCA Evaluation reports in total.

The latest version of the form - sometimes mistakenly referred to as the DD Form 2166-9-3 - was issued in November 2015 by the Department of the Army (DA). An up-to-date fillable DA Form 2166-9-3 is available for download below or can be found on the Army Publications Directorate website.

The DD 2166-9-3 is a strategic report. Authorized raters and senior raters are required to provide their assessment of the CSM/SGM NCO's yearly efforts. Both the NCO and their rater are required to fill out specific sections of the five-part form. The five parts include a section with administrative data, an authentication of all participating parties, a duty description, an evaluation of performance on multiple criteria and a footnote by the senior rater.

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HQDA#:
NCO EVALUATION REPORT (CSM/SGM)
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 DATA
a. NAME (Last, First, Middle Initial)
b. SSN (or DOD ID No.)
c. RANK
d. DATE OF RANK
e. PMOSC
f. UNIT, ORG, STATION, ZIP CODE OR APO, MAJOR COMMAND
g. STATUS CODE
h. UIC
i. REASON FOR SUBMISSION
j. PERIOD COVERED
k. RATED
l. NONRATED
m. NO OF
n. RATED NCO'S EMAIL ADDRESS (.gov or .mil)
MONTHS
CODES
ENCLOSURES
FROM
THRU
YEAR MONTH DAY
YEAR MONTH DAY
PART II - AUTHENTICATION
a1. NAME OF RATER (Last, First, Middle Initial)
a3. RATER'S SIGNATURE
a4. DATE (YYYYMMDD
a2. SSN (or DOD ID No.)
a5. RANK
PMOSC/BRANCH
a6. RATER'S EMAIL ADDRESS (.gov or .mil)
ORGANIZATION
DUTY ASSIGNMENT
b1. NAME OF SENIOR RATER (Last, First, Middle Initial)
b2. SSN (or DOD ID No.)
b3. SENIOR RATER'S SIGNATURE
b4. DATE (YYYYMMDD)
b5. RANK
PMOSC/BRANCH
b6. SENIOR RATER'S EMAIL ADDRESS (.gov
ORGANIZATION
DUTY ASSIGNMENT
or .mil)
c1. SUPPLEMENTARY
c2. NAME OF SUPPLEMENTARY REVIEWER
c3. RANK
PMOSC/
ORGANIZATION
DUTY ASSIGNMENT
REVIEW REQUIRED?
(Last, First, Middle Initial)
BRANCH
YES
NO
c4. COMMENTS
c5. SUPPLEMENTARY REVIEWER'S SIGNATURE
c6. DATE(YYYYMMDD)
c7. SUPPLEMENTARY REVIEWER'S EMAIL ADDRESS
ENCLOSED?
(.gov or .mil)
YES
NO
RATED NCO: I understand my signature does not constitute agreement or disagreement with the assessments of the rater and senior rater. I further understand my signature verifies that the administrative data
in Part I, the rating officials and counseling dates in Part II, the duty description in Part III, and the APFT and height/weight entries in Part IVa and IVb are correct. I have seen the completed report. I am aware of
the appeals process of AR 623-3.
d2. RATED NCO'S SIGNATURE
d3. DATE (YYYYMMDD)
d1. COUNSELING DATES INITIAL
LATER
LATER
LATER
PART III - DUTY DESCRIPTION (Rater)
a. PRINCIPAL DUTY TITLE
b. DUTY MOSC
c. DAILY DUTIES AND SCOPE (To include, as appropriate, people, equipment, facilities, and dollars)
d. AREAS OF SPECIAL EMPHASIS
e. APPOINTED DUTIES
PART IV - PERFORMANCE EVALUATION, PROFESSIONALISM, ATTRIBUTES, AND COMPETENCIES (Rater)
a. APFT Pass/Fail/Profile:
Date:
b. Height:
Weight:
Within Standard?
(Comments required for "Failed" APFT, "No" APFT, or "Profile" when it precludes performance of duty, and "No" for Army Weight Standards.)
c. CHARACTER: (Include narrative comments
COMMENTS:
addressing Rated NCO's performance as it relates to
adherence to Army Values, Empathy, Warrior Ethos/
Service Ethos, and Discipline. Fully supports SHARP,
EO, and EEO.)
MET
DID NOT MEET
STANDARD
STANDARD
Page 1 of 2
DA FORM 2166-9-3, NOV 2015
APD LC v1.00ES
HQDA#:
NCO EVALUATION REPORT (CSM/SGM)
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 DATA
a. NAME (Last, First, Middle Initial)
b. SSN (or DOD ID No.)
c. RANK
d. DATE OF RANK
e. PMOSC
f. UNIT, ORG, STATION, ZIP CODE OR APO, MAJOR COMMAND
g. STATUS CODE
h. UIC
i. REASON FOR SUBMISSION
j. PERIOD COVERED
k. RATED
l. NONRATED
m. NO OF
n. RATED NCO'S EMAIL ADDRESS (.gov or .mil)
MONTHS
CODES
ENCLOSURES
FROM
THRU
YEAR MONTH DAY
YEAR MONTH DAY
PART II - AUTHENTICATION
a1. NAME OF RATER (Last, First, Middle Initial)
a3. RATER'S SIGNATURE
a4. DATE (YYYYMMDD
a2. SSN (or DOD ID No.)
a5. RANK
PMOSC/BRANCH
a6. RATER'S EMAIL ADDRESS (.gov or .mil)
ORGANIZATION
DUTY ASSIGNMENT
b1. NAME OF SENIOR RATER (Last, First, Middle Initial)
b2. SSN (or DOD ID No.)
b3. SENIOR RATER'S SIGNATURE
b4. DATE (YYYYMMDD)
b5. RANK
PMOSC/BRANCH
b6. SENIOR RATER'S EMAIL ADDRESS (.gov
ORGANIZATION
DUTY ASSIGNMENT
or .mil)
c1. SUPPLEMENTARY
c2. NAME OF SUPPLEMENTARY REVIEWER
c3. RANK
PMOSC/
ORGANIZATION
DUTY ASSIGNMENT
REVIEW REQUIRED?
(Last, First, Middle Initial)
BRANCH
YES
NO
c4. COMMENTS
c5. SUPPLEMENTARY REVIEWER'S SIGNATURE
c6. DATE(YYYYMMDD)
c7. SUPPLEMENTARY REVIEWER'S EMAIL ADDRESS
ENCLOSED?
(.gov or .mil)
YES
NO
RATED NCO: I understand my signature does not constitute agreement or disagreement with the assessments of the rater and senior rater. I further understand my signature verifies that the administrative data
in Part I, the rating officials and counseling dates in Part II, the duty description in Part III, and the APFT and height/weight entries in Part IVa and IVb are correct. I have seen the completed report. I am aware of
the appeals process of AR 623-3.
d2. RATED NCO'S SIGNATURE
d3. DATE (YYYYMMDD)
d1. COUNSELING DATES INITIAL
LATER
LATER
LATER
PART III - DUTY DESCRIPTION (Rater)
a. PRINCIPAL DUTY TITLE
b. DUTY MOSC
c. DAILY DUTIES AND SCOPE (To include, as appropriate, people, equipment, facilities, and dollars)
d. AREAS OF SPECIAL EMPHASIS
e. APPOINTED DUTIES
PART IV - PERFORMANCE EVALUATION, PROFESSIONALISM, ATTRIBUTES, AND COMPETENCIES (Rater)
a. APFT Pass/Fail/Profile:
Date:
b. Height:
Weight:
Within Standard?
(Comments required for "Failed" APFT, "No" APFT, or "Profile" when it precludes performance of duty, and "No" for Army Weight Standards.)
c. CHARACTER: (Include narrative comments
COMMENTS:
addressing Rated NCO's performance as it relates to
adherence to Army Values, Empathy, Warrior Ethos/
Service Ethos, and Discipline. Fully supports SHARP,
EO, and EEO.)
MET
DID NOT MEET
STANDARD
STANDARD
Page 1 of 2
DA FORM 2166-9-3, NOV 2015
APD LC v1.00ES
RATED NCO'S NAME (Last, First, Middle Initial)
SSN (or DOD ID No.)
THRU DATE
PART IV - PERFORMANCE EVALUATION, PROFESSIONALISM, ATTRIBUTES, AND COMPETENCIES (Rater)
Provide narrative comments which demonstrate performance regarding organizational/strategic competencies (i.e., providing vision, motivation, and
inspiration, leading and inspiring change, dealing with uncertainty and ambiguity, creating a positive environment to prepare for the future, expanding
knowledge in cultural and geopolitical areas, self-awareness and recognition of impact on others, building team skills and processes, allocating the right
resources, capitalizing on unified action partner assets, capitalizing on technology, accomplishing missions consistently and ethically) in the Rated NCO's
current duty position. Remaining Attributes and Competencies must be addressed in the narrative. Presence as it relates to military and professional
bearing, fitness, confident, and resilient. Intellect as it relates to mental agility, sound judgment, innovation, interpersonal tact, and expertise. Leads as it
relates to leads others, builds trust, extends influence beyond chain of command, leads by example, and communicates. Develops as it relates to creates a
positive command/workplace environment, fosters esprit de corps, prepares self, develops others, and stewards the profession. Achieves as it relates to gets
results.
d. COMMENTS:
RATER OVERALL PERFORMANCE
e. Select one box representing Rated NCO's overall performance compared to others in the same grade whom you have rated in your career. I currently rate
Army NCOs in this grade.
FAR EXCEEDED
EXCEEDED
MET
DID NOT MEET
STANDARD
STANDARD
STANDARD
STANDARD
f. COMMENTS:
PART V - SENIOR RATER OVERALL POTENTIAL
a. Select one box representing Rated
b. COMMENTS:
NCO’s potential compared to others in the
same grade whom you have rated in your
career. I currently senior rate
Army NCOs in this grade.
MOST QUALIFIED (limited to 24%)
HIGHLY QUALIFIED
QUALIFIED
NOT QUALIFIED
c. List two successive assignments and one broadening assignment (3-5 years).
2)
Successive Assignment: 1)
Broadening Assignment:
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DA FORM 2166-9-3, NOV 2015
APD LC v1.00ES

Download DA Form 2166-9-3 NCO Evaluation Report (CSM/SGM)

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DA Form 2166-9-3 Instructions

The DA Form 2166-9-2 is regulated by the Department of the Army Pamphlet 623-3 (Evaluation Reporting System) released in November 2015.

The first part of the evaluation report is filled out by the rater and requires personal information on the evaluated NCO. This includes their name, email address, social security number, unit code, their station and organization, rank, the date of rank and various other administrative information.

The second part of the form should provide identifying data on both the rater and senior rater. It requires both raters' personal information and information on their rank, branch, duty, and organization. In case a supplementary review is required during the evaluation, a separate part of the second section of the form is completed with information about a supplementary rater.

The last three sections of the form - "Duty Description", "Performance Evaluation", and "Senior Rater Overall Potential Assessment" - should be completed by the raters in charge of the evaluation. The rater is required to describe the NCO's duties stating whether or not the NCO has met Army standards, and provide an evaluation of their performance and competencies on several criteria.

DA 2166-9-3 Related Forms

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