Appendix K Application Prep Instructions FOCI template (applicable to Demos, Risk Reduction, ARC-20).pdf

Funding Opportunity Number: DE-FOA-0002271

Appendix K

Foreign Ownership, Control or Influence (FOCI) Disclosure Template

(applicable to Demos, Risk Reduction and ARC-20)

Completing this declaration is a necessary pre-requisite to be considered for an award. All applications failing to submit this declaration will be deemed incomplete.

The Selection Official will consider foreign interest in an applicant's company or corporation in the selection of application(s) for negotiation of award.

Foreign interest is defined as: foreign government ownership, investment, interest and/or influence, as well as foreign nongovernment public, private ownership, interest and/or investment in an applicant's company or corporation.

Foreign government is defined as: a non-U.S. government.

Foreign interest applies at all levels of the corporate structure, including the executive and board levels, from parent (e.g., trust, holding company, corporation, etc.) to subsidiary, as well as ancillary levels, regardless of the applicant entity's place of incorporation and operation. Moreover, foreign interest includes, but is not limited to, political influence and participation in foreign talent recruitment programs.

Respond to the following questions regarding foreign interest/ownership in applicant’s company or corporation:

Applicant/Subapplicant Name and Address:

□Yes □ No Does a foreign government or foreign nongovernment public or private entity have any interest in your company or corporation or any parent organization, affiliate, subsidiary, or other entity within the corporate structure?

If yes, then what type of interest?

ownership in your company or corporation or any parent organization, affiliate, subsidiary, or other entity within the corporate structure?

If yes, then what percentage of ownership?

investment in your company or corporation or any parent organization, affiliate, subsidiary, or other entity within the corporate structure?

Funding Opportunity Number: DE-FOA-0002271

If yes, then what type of investment, and what percentage of shares?

□Yes □ No Does a foreign government have any influence over your company or corporation or any parent organization, affiliate, subsidiary, or other entity within the corporate structure?

If yes, then describe any type of influence that a foreign government may have over your company or corporation?

I am providing this disclosure as part of my participation in the application for the DOE Funding Opportunity Announcement DE-FOA-0002271. I certify under penalty of perjury that the information contained in this disclosure form is accurate and complete. I understand false statements, misrepresentations, half-truths, or omissions may result in civil and/or criminal penalties, including under 18 U.S.C. § 1001. I further understand and agree that (1) the statements and representations made in this certification are material; (2) this certification is ongoing and continues for one (1) year following the end of my participation in the above-identified Funding Opportunity Announcement; (3) I have an ongoing responsibility to promptly update this disclosure, as necessary, to ensure that the responses remain accurate and complete.

(applicable to Demos, Risk Reduction and ARC-20)