AID 500-13 (Partner Information Form)


Part I

Question 1 – Self-explanatory
Question 2- Indicate the proposed type of mechanism to be utilized by placing a check mark on the line in front of the appropriate term
Question 3 – Enter the amount of award or assistance in U.S. dollars and indicate the start and end date of the program using a mm/dd/yyyy format
Question 4 – Indicate the purpose of the award or assistance. Use additional sheets and attach to page one of the vetting form if necessary
Question 5 a-e – Self-explanatory
Question 6 - “Key individual” means (i) principal officers of the organization’s governing body (e.g., chairman, vice chairman, treasurer and secretary of the board of directors or board of trustees); (ii) the principal officer and deputy principal officer of the organization (e.g., executive director, deputy director, president, vice president); (iii) the program manager or chief of party for the USG-financed program; and (iv) any other person with significant responsibilities for administration of the USG-financed activities or resources. Note that this definition differs from the definition of “key personnel” under contracts and cooperative agreements. Complete for each of these four categories or indicate “N/A” if a category does not apply.

Part II

Individual filling out form must read the Certification and print their name where indicated, sign where indicated, print their title and the name of their organization where indicated, and print the date where indicated.

Part III

This section is not for individual’s information and will be completed by the USG vetting official.

Monday, November 23, 2015 - 10:00am