DA Form 67-9-1 "Officer Evaluation Report Support Form"

What Is DA Form 67-9-1?

DA Form 67-9-1, Officer Evaluation Report Support Form, is a document used during the process of officer evaluation along with DA Form 67-9, Officer Evaluation Report. In particular, this form provides a self-assessment of the rated officer, their evaluation of personal responsibilities, valuable skills, competence, and achievements.

In April 2014, the U.S. Army has changed its officer evaluation reporting system to a new format to analyze and rate officer performances in a manner more in line with Army doctrine, switching over from the DA 67-9 series to the DA 67-10 series. The new series will evaluate officers in different ways based on their rank. The latest printable version of the DA 67-9 Form was released by the U.S. Department of the Army (DA) on October 1, 2011, and is available for download below.

The form - sometimes referred to as DA Form 67 for short - should not be confused with DD Form 67, Form Processing Action Request. This form is used to request an addition to the Department of Defense (DoD) database or to request a revision or cancellation of an existing DD Form.

ADVERTISEMENT

DA Form 67-9-1 Instructions

The rated officer will receive their copy of the DA 67-9-1 at the beginning of the rating period. It is their responsibility to fill in Parts V and VI and to verify their participation in a face-to-face discussion by signing Part III.

The officer must enter the names of the branches they would like to serve and future assignments they feel they suit best. This is supposed to promote a top-down emphasis on leadership communication, integrating the rated officer in the performance counseling and evaluation process.

DA Form 67-9-1 is used only as a medium for preparing the report and is not forwarded to HQ along with the OER Report itself.


Not what you need? Check out these related forms:

  • DA Form 67-9, Officer Evaluation Report, plays a key part in the Officer Evaluation Process: prepared by the rating chain, this report provides the HQ with information about the rated officers' competence, their mental and physical condition, leadership abilities, and potential for promotion;
  • DA Form 67-9-1A, Developmental Support Form, is used when evaluating captains, lieutenants, and warrant officers. This form is optional when it comes to officers of any other rank. The support form is filed after a face-to-face interview and contains a development plan for the officer to follow. Generally speaking, this form is a medium in assisting junior officers in their transition to Army culture.
ADVERTISEMENT

Download DA Form 67-9-1 "Officer Evaluation Report Support Form"

Download PDF

Fill PDF online

Rate (4.6 / 5) 223 votes
FOR OFFICIAL USE ONLY (FOUO)
OFFICER EVALUATION REPORT SUPPORT FORM
SEE PRIVACY ACT STATEMENT IN
AR 623-3
For use of this form, see
; the proponent agency is DCS, G-1.
AR 623-3.
PART I - RATED OFFICER IDENTIFICATION
DESIGNATED/PMOS
NAME OF RATED OFFICER (Last, First, MI)
SSN
RANK
DATE OF RANK (YYYYMMDD)
BRANCH
(WO) SPECIALITIES
UNIT, ORG., STATION ZIP CODE OR APO, MAJOR COMMAND
STATUS CODE
FROM DATE
UIC
CMD CODE
PSB CODE
PART II - AUTHENTICATION
NAME OF RATER (Last, First, MI)
SSN
RANK
POSITION
NAME OF INTER. RATER (Last, First, MI)
SSN
RANK
POSITION
NAME OF SENIOR RATER (Last, First, MI)
SSN
RANK
POSITION
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
(Date)
Rated Soldier Initials
Rater Initials
Senior Rater Initials
CURRENT RATING PERIOD TOOK PLACE ON
(Review)
PERIODIC RATER / RATED OFFICER FOLLOW-UP FACE-TO-FACE COUNSELINGS:
Senior Rater Initials
Dates
Rated Soldier Initials
Rater Initials
(Review)
PART IV - RATED OFFICER
(Complete Part IV and Part V below for this rating period)
PRINCIPAL DUTY TITLE
POSITION AOC / BR
a. STATE YOUR SIGNIFICANT DUTIES AND RESPONSIBILITIES:
b. INDICATE YOUR MAJOR PERFORMANCE OBJECTIVES:
Page 1 of 2
DA FORM 67-9-1, OCT 2011
PREVIOUS EDITIONS ARE OBSOLETE.
APD PE v1.00ES
FOR OFFICIAL USE ONLY (FOUO)
OFFICER EVALUATION REPORT SUPPORT FORM
SEE PRIVACY ACT STATEMENT IN
AR 623-3
For use of this form, see
; the proponent agency is DCS, G-1.
AR 623-3.
PART I - RATED OFFICER IDENTIFICATION
DESIGNATED/PMOS
NAME OF RATED OFFICER (Last, First, MI)
SSN
RANK
DATE OF RANK (YYYYMMDD)
BRANCH
(WO) SPECIALITIES
UNIT, ORG., STATION ZIP CODE OR APO, MAJOR COMMAND
STATUS CODE
FROM DATE
UIC
CMD CODE
PSB CODE
PART II - AUTHENTICATION
NAME OF RATER (Last, First, MI)
SSN
RANK
POSITION
NAME OF INTER. RATER (Last, First, MI)
SSN
RANK
POSITION
NAME OF SENIOR RATER (Last, First, MI)
SSN
RANK
POSITION
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
(Date)
Rated Soldier Initials
Rater Initials
Senior Rater Initials
CURRENT RATING PERIOD TOOK PLACE ON
(Review)
PERIODIC RATER / RATED OFFICER FOLLOW-UP FACE-TO-FACE COUNSELINGS:
Senior Rater Initials
Dates
Rated Soldier Initials
Rater Initials
(Review)
PART IV - RATED OFFICER
(Complete Part IV and Part V below for this rating period)
PRINCIPAL DUTY TITLE
POSITION AOC / BR
a. STATE YOUR SIGNIFICANT DUTIES AND RESPONSIBILITIES:
b. INDICATE YOUR MAJOR PERFORMANCE OBJECTIVES:
Page 1 of 2
DA FORM 67-9-1, OCT 2011
PREVIOUS EDITIONS ARE OBSOLETE.
APD PE v1.00ES
NAME
SSN
PART V - RATED OFFICER CONTRIBUTIONS
a. APFT:
DATE:
HEIGHT:
WEIGHT:
b. LIST YOUR SIGNIFICANT CONTRIBUTIONS:
c. LIST ANY UNIQUE PROFESSIONAL SKILLS OR AREAS OF EXPERTISE OF VALUE TO THE ARMY:
d. IF UNABLE TO SERVE IN THE CURRENT BRANCH/CAREER FIELD, IN WHICH BRANCH/CAREER FIELD WOULD YOU PREFER TO SERVE?
e. LIST 3 FUTURE ASSIGNMENTS FOR WHICH YOU FEEL YOU ARE BEST SUITED:
SIGNATURE AND DATE
Page 2 of 2
DA FORM 67-9-1, OCT 2011
APD PE v1.00ES
Page of 2