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Blank Da 2166 9 1 PDF Form

The DA Form 2166-9-1 is an essential document used for evaluating the performance of Non-Commissioned Officers (NCOs) in the United States Army. This form facilitates a structured assessment of an NCO's abilities, responsibilities, and overall potential, ensuring that evaluations are consistent and comprehensive. For those needing to complete this evaluation, please click the button below to fill out the form.

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The DA 2166 9 1 form serves as a critical tool in the evaluation of Non-Commissioned Officers (NCOs) in the United States Army, specifically for the rank of Sergeant. This form is utilized to assess an NCO’s performance over a defined period, capturing essential administrative data such as the individual’s name, Social Security Number, rank, and unit information. It is structured into multiple parts that facilitate a comprehensive review process, beginning with administrative data and moving through sections that require authentication by the rater and senior rater. The form emphasizes the importance of accurate documentation, as it includes a section for the rated NCO to acknowledge the correctness of the information presented. Performance evaluation is central to the DA 2166 9 1, where raters assess key attributes such as character, presence, intellect, leadership, development, and achievement, each accompanied by specific comments and ratings. Furthermore, the senior rater provides an overall potential assessment, comparing the rated NCO to peers and outlining future assignment recommendations. The form not only promotes accountability but also reinforces the Army's commitment to professional development and the adherence to core values. Understanding the nuances of this evaluation process is vital for both raters and rated individuals, as it can significantly impact career progression and opportunities within the military structure.

Sample - Da 2166 9 1 Form

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NCO EVALUATION REPORT (SGT)

For use of this form, see AR 623-­3 and DA PAM 623-­3 the proponent agency is DCS, G-­1.

SEE PRIVACY ACT STATEMENT

IN AR 623-­3

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

FROMTHRU

YEAR MONTH DAY

YEAR MONTH DAY

k.RATED MONTHS

l.NONRATED CODES

m. NO OF ENCLOSURES

n. RATED NCO'S EMAIL ADDRESS (.gov or .mil)

PART II AUTHENTICATION

a1. NAME OF RATER (Last, First, Middle Initial)

a2. SSN (or DOD ID No.)

a3. RATER'S SIGNATURE

a4. DATE (YYYYMMDD)

a5. RANK

PMOSC/BRANCH

ORGANIZATION

DUTY ASSIGNMENT

a6. RATER'S EMAIL ADDRESS (.gov or .mil)

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

ORGANIZATION

DUTY ASSIGNMENT

b6. SENIOR RATER'S EMAIL ADDRESS (.gov 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.

d1. COUNSELING DATES INITIAL

LATER

LATER

LATER

d2. RATED NCO'S SIGNATURE

d3. DATE (YYYYMMDD)

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.) Reset Item a. APFT/Pass/Fail/Profile

c.CHARACTER: (Include bullet 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

COMMENTS:

DA FORM 2166-­9-­1, NOV 2015

Page 1 of 2

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)

d. PRESENCE: (Military and professional

COMMENTS:

bearing, Fitness, Confidence, Resilience.)

 

MET

DID NOT MEET

 

STANDARD

STANDARD

 

e. INTELLECT: (Mental agility, Sound judgment, COMMENTS:

Innovation, Interpersonal tact, Expertise.)

MET

DID NOT MEET

STANDARD

STANDARD

f. LEADS: (Leads others, Builds trust, Extends COMMENTS:

influence beyond the chain of command, Leads by

example Communicates.)

 

MET

DID NOT MEET

STANDARD

STANDARD

g. DEVELOPS: (Creates a positive command/ COMMENTS:

workplace environment, Fosters esprit de corps,

Prepares self, Develops others, Stewards the

profession.)

 

MET

DID NOT MEET

STANDARD

STANDARD

 

 

h. ACHIEVES: (Gets results.)

COMMENTS:

MET

DID NOT MEET

STANDARD

STANDARD

 

 

 

 

 

 

RATER OVERALL PERFORMANCE

 

i. I currently rate

NCOs in this grade.

 

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

 

 

NCOs in this grade.

 

 

 

 

 

 

 

 

 

 

 

 

MOST QUALIFIED

 

 

 

 

 

 

HIGHLY QUALIFIED

 

 

QUALIFIED

 

 

 

 

 

 

NOT QUALIFIED

 

 

 

 

 

 

 

 

 

c. List two successive assignments and one broadening assignment (3-­5 years).

 

Successive Assignment:

1)

 

 

2)

Broadening Assignment:

 

 

 

DA FORM 2166-­9-­1, NOV 2015

 

Page 2 of 2

 

 

 

 

 

 

 

APD PE v1.00ES

Document Breakdown

Fact Name Description
Form Purpose The DA 2166-9-1 is used for evaluating the performance of Non-Commissioned Officers (NCOs) at the rank of Sergeant.
Governing Regulations This form is governed by Army Regulation (AR) 623-3 and DA Pamphlet (PAM) 623-3.
Privacy Act Statement The form includes a Privacy Act Statement, which is referenced in AR 623-3.
Administrative Data Part I requires essential administrative data, including name, SSN, rank, and unit information.
Authentication Section Part II involves the authentication by the rater, senior rater, and any supplementary reviewers.
Performance Evaluation Part IV assesses various performance attributes, including character, presence, intellect, leadership, development, and achievement.
Signature Requirement The rated NCO must sign to acknowledge understanding of the report's content, but this does not indicate agreement.
Overall Potential Assessment Part V allows the senior rater to assess the rated NCO's potential compared to peers and list future assignments.
Effective Date The current version of the form is dated November 2015, and it is subject to updates as regulations change.

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Misconceptions

Understanding the DA Form 2166-9-1 is crucial for both NCOs and their evaluators. However, several misconceptions can lead to confusion about its purpose and usage. Here are four common misconceptions:

  • This form is only for negative evaluations. Many believe that the DA Form 2166-9-1 is solely used to document poor performance. In reality, it serves to evaluate both positive and negative aspects of an NCO's performance, providing a comprehensive overview of their contributions and areas for improvement.
  • Only the rater completes this form. Some assume that the responsibility for filling out the form lies entirely with the rater. However, the rated NCO must also provide input, particularly in verifying the accuracy of administrative data and acknowledging the evaluation process.
  • Signatures indicate agreement with the evaluation. A common misconception is that the rated NCO's signature signifies agreement with the rater's assessment. In fact, the signature simply confirms that the NCO has seen the completed report and understands the evaluation process, not that they necessarily agree with it.
  • The form is not important for career advancement. Some individuals may think that the DA Form 2166-9-1 has little impact on their career. On the contrary, this evaluation is a key factor in determining promotions, assignments, and overall career progression within the military.

Clarifying these misconceptions can help ensure that all parties involved understand the significance of the DA Form 2166-9-1 and its role in the evaluation process.

Documents used along the form

The DA 2166-9-1 form is commonly used for evaluating non-commissioned officers (NCOs) in the U.S. Army. Several other forms and documents often accompany this evaluation report to ensure a comprehensive assessment of an NCO's performance and potential. Below is a list of these related documents, each described briefly.

  • DA Form 1059: This form is used for the Academic Evaluation Report. It records an individual’s performance during military training courses and is essential for assessing educational achievements.
  • DA Form 4856: The Developmental Counseling Form is utilized for documenting counseling sessions. It helps leaders provide feedback to soldiers and track their progress over time.
  • DA Form 67-9: This is the NCO Evaluation Report for higher ranks. It serves a similar purpose as the DA 2166-9-1 but is designed for evaluating staff sergeants and above.
  • DA Form 705: The Army Physical Fitness Test Scorecard records an individual's physical fitness test results. It is vital for evaluating physical readiness and overall fitness levels.
  • For a thorough evaluation, having a Lease Agreement form can clarify the terms between parties involved in a rental situation.
  • DA Form 5500/5501: These forms are used to assess body composition. They help determine if a soldier meets Army weight standards, which is crucial for maintaining overall health and readiness.
  • DA Form 4187: This is the Personnel Action Form. It documents various personnel actions, such as promotions, reassignments, or requests for training, and is important for maintaining accurate personnel records.
  • DA Form 20: The Soldier’s Qualification Record provides a comprehensive overview of a soldier's military history, including assignments, training, and qualifications. This document is essential for understanding an NCO's background and experience.

These forms and documents play a significant role in the evaluation process of NCOs. They ensure that all aspects of a soldier's performance, training, and qualifications are considered, providing a well-rounded view of their capabilities and potential for future assignments.