7-HR001117S0011_Attachment_7_SCG_Request_Form.pdf
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- Attached to
- OFFensive Swarm Enabled Tactics (OFFSET) Amendment 5 - Swarm Sprint 4 Federal contract opportunity
- Solicitation number
- HR001117S0011
About this file
This document is a request form for a Broad Agency Announcement (BAA) addendum from the Defense Advanced Research Projects Agency (DARPA). The form collects personal information including name, nationality, Social Security number, passport number, and company information from individuals seeking access to DARPA's BAA addendums. It notes that personal information will be used to determine eligibility and conduct background checks, and may be shared with other government agencies for vetting. The related federal contract opportunity is a notice for Amendment 5 of the OFFensive Swarm Enabled Tactics (OFFSET) program. The goal of OFFSET is to design, develop and demonstrate a swarm system architecture encoded in a game environment and embodied in physical swarm platforms to advance novel swarm tactics innovation.
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Text version
DARPA Broad Agency Announcement (BAA) Addendum Request
DARPA uses personal information (including Social Security numbers (SSNs)) to conduct record checks with other U.S. Government agencies to determine the identity, citizenship status, and eligibility of individuals seeking access to DARPA BAA Addendums. All requests for personal information are made under appropriate authority. Note that due to the risk of data loss or breach, requestors should consider applying appropriate technical safeguards to protect their personal information before transmitting this form electronically. Once received by DARPA, personal information will be subject to role-based access controls and safeguarded using appropriate physical, administrative, and technical protocols.
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. 301; 15 C.F.R. 730-774; 22 C.F.R. 120-130; 40 U.S.C. 1441; 41 C.F.R. 102-81.10 and 102-81.15; DoDD
1000.25; DoD 5200.08-R; DoD 5200.1-R; DoDD 5200.27; DoDD 5205.07; DoD 5400.1-R; E.O. 9397, as amended, SSN; and, E.O. 12977
PURPOSE: DARPA will use personal information to determine the identity/eligibility of individuals requesting a BAA Addendum.
ROUTINE USES: Department of Defense "Blanket Routine Uses," consistent with the Privacy Act of 1974 (5 U.S.C. 552a), and available at http://privacy.defense.gov/blanket_uses.shtml, apply to this collection. The information will be used by - and disclosed to - DARPA personnel, contractor employees, or other agents who require the information to determine eligibility to access a DARPA BAA Addendum. DARPA may also share the information with other government agencies as necessary to determine if adverse information exists on the individual requesting the BAA Addendum.
DISCLOSURE: Furnishing this information (including your Passport information and Social Security Number if applicable) is voluntary; however, failure to furnish the requested information may delay or prevent your request.
Requestor Data
Last Name: First Name: M.I.:
Current Nationality/Citizenship: U.S. Social Security Number:
Resident Alien Permit Number: Passport Number:
Company/Organization Data
Name:
Address 1:
Address 2:
City: State: Zip Code:
Business Phone:
Cage Code (if any):
U.S. Owned Non-U.S. Owned
BAA Information
DARPA BAA# and Title: Tech Office Sponsor:
DARPA Form 105, AUG 2014
Designed using Adobe, DARPA/MSO
File details come from the government source that posted it. Updated .