Attachment H - Eligibility Certification and Supplemental Info Form.pdf

This is an Eligibility Certification and Supplemental Information Form required for organizations proposing under Appendix A (80GRC026R0008), applicable to offerors and their supporting partners participating in research and technology development efforts.

The form establishes domestic eligibility requirements through five certification questions. Organizations must certify that they are for-profit entities organized under U.S. laws (with ineligibility if organized outside the United States or its territories). The form requires certification of majority ownership and control by U.S. nationals, with detailed explanation of any controlling intermediary organizations and their citizenship status. For organizations unable to meet the 50% U.S. ownership threshold, an alternative eligibility pathway exists if the organization is a subsidiary of a foreign company demonstrating substantial commitment to the U.S. market through either long-term investments in U.S.-based research, development, and manufacturing (including major components and subassemblies) or significant contributions to U.S. employment. Organizations selecting the alternative pathway must provide detailed documentation including years of corporate presence, specific facility locations, revenue percentages attributable to U.S. operations, and comprehensive employment statistics (both worldwide and U.S.-based headcount). The form includes a supplemental information section allowing organizations to submit additional relevant information regarding domestic eligibility. All responses are subject to certification by an authorized organizational representative, with explicit acknowledgment of penalties for false, fictitious, or fraudulent statements, including criminal, civil, and administrative sanctions.