Da Form 67 9 1

A fillable DA 67-9-1 Form is used to evaluate an officer of the US Army. This form is also known as an Officer Evaluation Report Support Form. It may also be used along with the Officer Evaluation Report (67-9 Form). The purpose of this form is to document the evaluation of an officer, their job duties, their assignments, and their career objectives. It may also include information related to the discussion to help the officer meet their goals.

What is a DA Form 67-9-1?

A DA Form 67-9-1 is a form used by the United States Department of the Army. The DA Form 67-9-1 is also known as an Officer Evaluation Report Support Form. It is used in conjunction with the regular 67-9 form, or Officer Evaluation Report.
This form will include more information about the evaluation that was conducted on an Army officer. It will include information about both the officer and the rater. This includes the first rater, the intermediate rater, and the senior rater. The form will verify that there was a face-to-face discussion regarding the officer’s evaluation and their job counseling.
Finally, the form has a section for specific comments from the raters in charge of the evaluation and the officer. This can include information on job duties, assignments, career objectives, and more.

How to complete a DA Form 67-9-1 (Step by Step)

To complete a DA Form 67-9-1, you will need to provide the following information:

Part I - Rated Officer Identification

  • Name of the rated officer
  • SSN
  • Rank
  • Date of rank
  • Branch
  • Designated/PMOS (WO) specialties
  • Unit, org., station zip code or APO, major command
  • Status code
  • From date
  • UIC
  • Command code
  • PSB code

Part II - Authentication

  • Name of rater, SSN, rank position
  • Name of intermediate rater, SSN, rank, position
  • Name of senior rater, SSN, rank, position

Part III - Verification of Face-to-Face Discussion

  • Mandatory rater/rated officer initial face-to-face counseling: date, initials of each party
  • Periodic rater/rated officer follow-up face-to-face counseling: date, initials of each party

Part IV - Rated Officer

  • Principal duty title
  • Position AOC/BR
  • State significant duties and responsibilities
  • Indicate major performance objectives

Part V - Rated Officer Contributions

  • APFT
  • Date
  • Height
  • Weight
  • Significant contributions
  • List any unique professional skills or areas of expertise of value to the army
  • If unable to serve in the current branch or field, which branch/career field would you prefer to serve
  • 3 future assignments for which you feel are best suited

The form must be signed and dated to be valid.

Download a PDF or Word Template

Sample Da Form 67 9 1


Sample Da Form 67 9 1

Create Da Form 67 9 1 Read Full Document