Ad435 Form PDF Details

The AD-435 form is issued by the United States Department of Agriculture (USDA) for annual employee performance appraisals. It collects core employee data including name, Social Security number, grade or pay level, and the appraisal period dates. The form covers each performance element as either critical or non-critical. Ratings range from Outstanding to Unacceptable, based on USDA evaluation standards.

Once all elements are rated, the supervisor calculates a summary rating for the appraisal period. The supervisor, reviewing official, and approving official must all sign the completed form. Employees review and acknowledge the appraisal in a separate acknowledgment section. The document also explains the grievance procedures available for employees who dispute the outcome. For related federal appraisal resources, the ACF performance progress report is also available on FormsPal.

QuestionAnswer
Form NameAd435 Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesad435 form, ad435, ad 435 usda, ad 435 usda fillable

Form Preview Example

 

United States Department of Agriculture

 

1 Social Security No.

 

 

2 Position Number

 

 

 

 

 

3 Pay Plan

 

4 Occup. Series

 

Performance Appraisal

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5 Name (Last, first, Middle Initial)

 

 

 

 

 

6 Grade/Step or Pay Level

 

7 Appraisal Period

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

 

 

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8 Official Position Title

 

 

 

 

 

9 Organization Structure Code

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10 Duty Station

 

 

11 Funding Unit

 

 

 

 

 

12 Agency Use

 

 

 

13 NFC Use

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Instructions

 

 

 

 

 

 

 

Blocks 15B, 15C., 15D. Rate actual performance by entering

 

 

 

 

 

Blocks 1 through 10, completed by NFC,

 

 

 

 

 

 

 

2 for critical elements and 1 for non-critical elements

 

 

 

 

 

should be reviewed and, if necessary, corrected.

 

 

 

 

 

in appropriate column.

 

 

 

 

 

 

 

 

 

 

 

Block 11. enter funding unit number.

 

 

 

 

 

 

 

Blocks 15E, 15F, 15G. Enter total of each column.

 

 

 

 

 

 

 

Block 14. Enter brief description of performance elements.

 

 

Block 15H. Enter total from 15E, 15F and 15G.

 

 

 

 

 

 

 

Block 15A. Check performance elements identified

 

 

Block 16A. Check off the correct summary rating described in decision

 

 

as critical

 

 

 

 

 

 

 

table (16B).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Blocks 17 through 22. Self-explanatory.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15A

 

15B

 

 

15C

 

15D

 

 

14

 

 

 

 

 

 

 

 

 

Critical

 

Exceeds

 

 

Meets

 

Does Not

 

Performance Elements

 

 

 

 

 

Element

 

Fully

 

 

Fully

 

Meet Fully

 

 

 

 

 

 

 

 

 

 

 

 

()

Successful

 

Successful

Successful

1)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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4)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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6)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

9)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

10)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

16B Decision Table (check off Summary Rating in block 16A)

 

 

 

 

 

 

15E Exceeds

 

15F Meets

 

15G Does Not

 

Rating of Outstanding if 15E equals 15H.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Meet

 

Rating of Unacceptable 1/ if any critical element is rated in 15D.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rating of Superior if no element is rated in 15D; 15F is greater

 

 

 

 

 

 

0

 

 

 

0

 

0

 

than zero; and 15E is greater than 15F.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rating of Marginal 2/ if 15G is greater than 15E, and no critical

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15H

 

element is rated in 15D.

 

 

 

 

 

 

 

 

 

 

 

15H Enter total

 

 

 

 

 

 

 

 

Rating of Fully Successful if none of the above apply.

 

 

 

 

 

 

15E + 15F + 15G = 15H

 

 

 

0

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1/Unsatisfactory for SES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2/Minimally Satisfactory for SES

 

 

 

 

 

 

 

 

 

 

 

 

16A Summary rating (See Decision table in 16B)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

17.

Employee (Check off appropriate box)

 

 

 

 

 

 

 

 

 

 

 

 

 

Outstanding

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

 

 

 

 

 

Superior

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I have a copy of USDA and Agency regulations on employee

 

 

 

 

 

 

 

 

 

Fully successful

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

responsibilities and conduct; I have discussed them with my

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

supervisor and questions have been answered to my satisfaction.

 

 

No

 

 

 

 

 

Marginal

2/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Unacceptable 1/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

18 Employee's Signature

Date

 

 

 

If employee did not sign, state reason.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1/ Unsatisfactory for SES

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2/ Minimally Satisfactory for SES 17 Employee

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(Check off appropriate box)

 

 

(Instructions for resolutions of disputes are on the reverse of employee copy.)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

19a.

Supervisor's Signature

 

 

 

 

 

Date

 

 

 

19b.

Supervisor’s Name (Print)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20a. Reviewer's Signature

 

 

 

 

 

Date

 

 

 

20b. Reviewer’s Name (Print)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

21

Approving Official's or

 

 

 

 

 

Date

 

 

 

 

 

22. FOR SES ONLY

 

 

 

 

 

 

Funding Unit Manager's Signature (optional)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PLA to ES

 

 

 

 

Bonus Amount

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check6JKUHQTOYCUFGUKIPGFappropriateWUKPI9QTF2GTHGEVcopy designationHQT9KPFQYU.

 

ORIGINAL

PERSONNEL

EMPLOYEE

SUPERVISOR

Form AD-435 (10/94)

 

 

 

 

75(5#

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GRIEVANCE PROCEDURES

Performance Management Recognition System (PMRS) Employees - Employees covered under the PMRS shall follow the agency Dispute Resolution Procedures.

Non-PMRS Employees - Employees not covered by the PMRS shall follow the agency administrative or negotiated grievance procedures, but not both.

SES Employees - Grievance procedures do not apply to SES employees. For procedures related to a dispute of an initial rating, see DPM Chapter 430, Appendix C.

Contact your servicing Personnel Office for specific instructions or applicable procedures for resolving performance appraisal disagreements.

How to Edit Ad435 Form Online for Free

You can complete the AD-435 performance appraisal form quickly using FormsPal's free online PDF editor. The steps below walk you through each section of the document.

Step 1: Click the "Get form" button at the top of this page to open the AD-435 form in the online editor.

Step 2: Fill in the employee identification section. Enter the employee's full name, Social Security number, grade or pay level, and the start and end dates of the appraisal period.

Step 3: Complete the performance elements section. Rate each critical and non-critical performance element using the USDA rating scale, which ranges from Outstanding to Unacceptable.

Step 4: Enter the summary rating. The overall rating is calculated based on the individual element scores following USDA guidelines.

Step 5: Collect required signatures. The supervisor, reviewing official, and approving official must each sign the form. The employee acknowledgment section must also be completed.

Step 6: Click "Done" to download or print the finished form. You may also pair it with an employee performance log or a 90-day performance review form for ongoing appraisal tracking.

AD-435 Form: Common Questions

What is the AD-435 form used for? The AD-435 is the official USDA performance appraisal form. It documents an employee's ratings across critical and non-critical work elements, records the summary rating, and captures signatures from supervisors and reviewing officials.

Who fills out the AD-435 form? The supervisor or rating official fills out most sections. The employee completes the acknowledgment section to confirm they have received and reviewed the appraisal results.

How long does it take to complete the AD-435? Most supervisors complete the form in 15 to 30 minutes once performance ratings are determined. The review and signature process may take additional time depending on agency workflow.

What other federal performance forms are available? FormsPal also provides an ACF performance progress report and a 2045 appraisal form for federal agency use.

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