Da Form 2166 9 1 PDF Details

The Department of Defense has released a new version of the Da Form 2166 9 1, also known as the Military Service Member Verification form. This new form is designed to help military personnel and their families verify their eligibility for various benefits and services. The form can be used to verify service member information such as rank, dates of service, and type of discharge. It can also be used to confirm family members’ relationship to the service member and their dependents’ eligibility for benefits.

Before you fill out da form 2166 9 1, you'll want to understand more concerning the type of form you'll work with.

QuestionAnswer
Form NameDa Form 2166 9 1
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesda 2166 9 1, da 2166 9 1a, blank ncoer form, da form 2166 9 1

Form Preview Example

HQDA#:

Attachments Menu

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

How to Edit Da Form 2166 9 1 Online for Free

Our top level computer programmers have worked collectively to get the PDF editor which you will apply. This software allows you to complete ncoer support form fillable forms instantly and effortlessly. This is everything you should conduct.

Step 1: On this page, hit the orange "Get form now" button.

Step 2: Now you should be within the document edit page. It's possible to add, update, highlight, check, cross, add or delete fields or phrases.

The PDF file you plan to fill in will include the next areas:

part 1 to filling in da form 2166 9 1a fillable pdf

Please prepare the c COMMENTS ENCLOSED, YES, c SUPPLEMENTARY REVIEWERS SIGNATURE, c DATEYYYYMMDD, c SUPPLEMENTARY REVIEWERS EMAIL, RATED NCO I understand my, d COUNSELING DATES INITIAL, LATER, LATER, LATER, d RATED NCOS SIGNATURE, d DATE YYYYMMDD, a PRINCIPAL DUTY TITLE, PART III DUTY DESCRIPTION Rater, and b DUTY MOSC space with the essential data.

step 2 to completing da form 2166 9 1a fillable pdf

Point out the considerable data the Comments required for Failed APFT, c CHARACTER Include bullet, COMMENTS, MET STANDARD, DID NOT MEET STANDARD, DA FORM NOV, and Page of APD LC vES section.

step 3 to filling out da form 2166 9 1a fillable pdf

Spell out the rights and responsibilities of the sides in the field RATED NCOS NAME Last First Middle, SSN or DOD ID No, THRU DATE, PART IV PERFORMANCE EVALUATION, d PRESENCE Military and, COMMENTS, MET STANDARD, DID NOT MEET STANDARD, e INTELLECT Mental agility Sound, COMMENTS, MET STANDARD, DID NOT MEET STANDARD, f LEADS Leads others Builds trust, COMMENTS, and MET STANDARD.

Entering details in da form 2166 9 1a fillable pdf part 4

Check the areas g DEVELOPS Creates a positive, MET STANDARD, DID NOT MEET STANDARD, COMMENTS, h ACHIEVES Gets results, COMMENTS, MET STANDARD, DID NOT MEET STANDARD, i I currently rate COMMENTS, NCOs in this grade, RATER OVERALL PERFORMANCE, PART V SENIOR RATER OVERALL, a Select one box representing, and b COMMENTS and then fill them out.

da form 2166 9 1a fillable pdf g DEVELOPS Creates a positive, MET STANDARD, DID NOT MEET STANDARD, COMMENTS, h ACHIEVES Gets results, COMMENTS, MET STANDARD, DID NOT MEET STANDARD, i I currently rate COMMENTS, NCOs in this grade, RATER OVERALL PERFORMANCE, PART V  SENIOR RATER OVERALL, a Select one box representing, and b COMMENTS blanks to fill

Step 3: Hit the Done button to save your file. Now it is readily available for upload to your device.

Step 4: Generate duplicates of the form - it may help you remain away from possible future challenges. And don't be concerned - we are not meant to publish or see your details.

Watch Da Form 2166 9 1 Video Instruction

Please rate Da Form 2166 9 1

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .