GSA_Form_7437.pdf

ART-IN-ARCHITECTURE PROGRAM

NATIONAL ARTIST REGISTRY

(See Privacy Act Statement on Reverse)

OMB Number: 3090-0274 Expiration Date: 3/31/2016

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0274. We estimate that it will take 15 minutes to read the instructions, gather the facts, and number answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat (MVCB), IC 3090-0274, 1800 F Street, NW, 2nd Floor, Washington, DC 20405.

INSTRUCTIONS: Return this form with a current resume and up to 20 digital images of the artist's work created within the last five years to the address below. Please use jpeg format 10 x 7.5 inches at 72dpi. On a separate sheet, for each image please include the name of artist, title of work, date, medium/materials, and dimensions.

U.S. General Services Administration Art-In-Architecture Program 1800 F Street, NW Washington, DC 20405

DISCLOSURE OF INFORMATION ON THIS FORM TO RESEARCHERS, ART PROFESSIONALS, AND MEMBERS OF THE PUBLIC

NAME

STREET ADDRESS

HOME PHONE NUMBER

CITY

E-MAIL ADDRESS

STATE ZIP CODE

WORK/STUDIO NUMBER FAX NUMBER

GALLERY OR REPRESENTATIVE

DATE OF BIRTH

ARTIST'S WEBSITE

PLACE OF BIRTH

U.S. CITIZEN MEDIA (Check as many as apply)

MATERIALS (Check up to six)

REMARKS

GENERAL SERVICES ADMINISTRATION GSA 7437 (REV. 2/2013)

YES NO

YES

NO

PAINTING

ACRYLIC FRESCO PHOTOGRAPH

OTHER (Specify)

VIDEO

WOOD

WATER COLOR

WATER

TILE

TERRA COTTA

TEMPERA

STUCCO

STONE

STEEL

STAINED GLASS

RESIN

POLYMER

PLASTER

PENCIL

PASTELS

PAPER

OIL

MOSAIC

MIXED MATERIALS

METAL

MARBLE

LINEN

LIMESTONE

LIGHT

LACQUER

INK

GRAPHITE

GRANITE

GLASS

FIBERGLASS

FIBER

ENVIRONMENTAL/EARTH

ENCAUSTIC

ENAMEL

COR-TEN STEEL

COPPER

CONCRETE

COMPUTER GRAPHICS

CHARCOAL

CERAMIC

CAST STONE

CANVAS

BRONZE

ALUMINUM

ALABASTER

GRAPHIC TEXTILE OTHER (Specify)

POETRYARCHITECTURAL ARTSSCULPTURE

Submission of all personal information listed on the reverse of this form, i.e., address, and date and place of birth, is voluntary, and will not be used as selection criteria in awarding commissions through the Art-In-Architecure Program.

The failure to provide an address or phone number, however, would make it impossible to contact you. The primary use of the personal information you provide is to compile statistics to ensure that the pool of artists the Federal Government considers for commissions is sufficiently diverse and representative of the United States. It is collected under the general authority granted to GSA under the Federal Property and Administrative Services Act of 1949 (40 U.S.C. 471 et. Seq.) and the Public Buildings Act of 1959 (40 U.S.C. 601-616).

Information on this form may be disclosed to a Member of Congress in response to an inquiry made on your behalf.

Information may be disclosed to researchers, arts professionals, and members of the public for on-site inspections upon request. Information may also be shared with a court or adjudicative body when GSA, or a GSA employee, or the United States is party to litigation and the record is relevant, necessary, and compatible with the purpose of collecting the information. Finally, information on this form may be disclosed to an appropriate Federal, State, or local agency responsible for investigating, prosecuting, or enforcing a statute, rule, regulation or order if GSA becomes aware of any actual or potential violation of a statute, rule or regulation.

PRIVACY ACT STATEMENT

GSA 7437 (REV. 2/2013) BACK

1.3

C:\PERFORM\GSA\G7437.FRP

Barbara Williams ADOBEPS4.DRV Version 4.50 Acrobat Distiller 5.0 (Windows) D:20040122184158Z D:20040122184158Z

ART-IN-ARCHITECTURE PROGRAM

NATIONAL ARTIST REGISTRY

(See Privacy Act Statement on Reverse) OMB Number: 3090-0274 Expiration Date: 3/31/2016 Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 3090-0274. We estimate that it will take 15 minutes to read the instructions, gather the facts, and number answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat (MVCB), IC 3090-0274, 1800 F Street, NW, 2nd Floor, Washington, DC 20405.

INSTRUCTIONS: Return this form with a current resume and up to 20 digital images of the artist's work created within the last five years to the address below. Please use jpeg format 10 x 7.5 inches at 72dpi. On a separate sheet, for each image please include the name of artist, title of work, date, medium/materials, and dimensions.

U.S. General Services Administration Art-In-Architecture Program 1800 F Street, NW Washington, DC 20405 DISCLOSURE OF INFORMATION ON THIS FORM TO RESEARCHERS, ART PROFESSIONALS, AND MEMBERS OF THE PUBLIC

NAME

STREET ADDRESS

HOME PHONE NUMBER

CITY

E-MAIL ADDRESS

STATE

ZIP CODE

WORK/STUDIO NUMBER

FAX NUMBER

GALLERY OR REPRESENTATIVE

DATE OF BIRTH

ARTIST'S WEBSITE

PLACE OF BIRTH

U.S. CITIZEN

MEDIA (Check as many as apply) MATERIALS (Check up to six)

REMARKS

GENERAL SERVICES ADMINISTRATION

GSA 7437 (REV. 2/2013)

Will there be disclosure of information on this form to researchers, art professionals, and members of the public? Select Yes or No Are you a U.S. Citizen? Select Yes or No.

Submission of all personal information listed on the reverse of this form, i.e., address, and date and place of birth, is voluntary, and will not be used as selection criteria in awarding commissions through the Art-In-Architecure Program.

The failure to provide an address or phone number, however, would make it impossible to contact you. The primary use of the personal information you provide is to compile statistics to ensure that the pool of artists the Federal Government considers for commissions is sufficiently diverse and representative of the United States. It is collected under the general authority granted to GSA under the Federal Property and Administrative Services Act of 1949 (40 U.S.C. 471 et. Seq.) and the Public Buildings Act of 1959 (40 U.S.C. 601-616).

Information on this form may be disclosed to a Member of Congress in response to an inquiry made on your behalf.

Information may be disclosed to researchers, arts professionals, and members of the public for on-site inspections upon request. Information may also be shared with a court or adjudicative body when GSA, or a GSA employee, or the United States is party to litigation and the record is relevant, necessary, and compatible with the purpose of collecting the information. Finally, information on this form may be disclosed to an appropriate Federal, State, or local agency responsible for investigating, prosecuting, or enforcing a statute, rule, regulation or order if GSA becomes aware of any actual or potential violation of a statute, rule or regulation.

PRIVACY ACT STATEMENT

GSA 7437 (REV. 2/2013) BACK