Form 14115 (07- Form 14115 (07- Independent Researcher Listing Application

O MB Control No. 3095-0054

Expires 11-30-2015

Independent Researcher Listing Application

Type of Application New Update to Current Listing

For Use at Archival Operations facilities, Washington, DC area facilities, and Presidential Library facilities

See the back of this form for the Paperwork Reduction Act Public Burden Statement

Researcher or Company Name* If Researcher, please indicate Mr. Mrs. Miss Ms.

Street and/or Post Office Box*

City, State, Zip Code*

Public Orders Telephone Number

Fax Number

Customer Service Telephone Number

Email Address

Web Page Address

Contact Person*

Research Specialty (may list specific record groups, records media, series, subjects, topics, etc.)*

National Archives and Records Administration (NARA) facilities in which you perform research (please mark all that apply)*:

National Archives at Atlanta

Washington National Records Center (Suitland))

National Archives at Boston

Herbert Hoover Presidential Library and Museum

National Archives at Chicago

Franklin D. Roosevelt Presidential Library and Museum

National Archives at College Park

Harry S. Truman Presidential Library and Museum

National Archives at Denver

Dwight D. Eisenhower Presidential Library and Museum

National Archives at Fort Worth

John F. Kennedy Presidential Library and Museum

National Archives at Kansas City

Lyndon Baines Johnson Presidential Library and Museum

National Archives at New York City

Richard Nixon Presidential Library and Museum

National Archives at Philadelphia

National Archives at Riverside

National Archives at San Francisco

National Archives at Seattle

National Archives at Washington, DC

National Personnel Records Center (St. Louis-Civilian)

National Personnel Records Center (St. Louis- Military

Gerald R. Ford Presidential Library and Gerald R. Ford Presidential Museum

Jimmy Carter Presidential Library and Museum

Ronald Reagan Presidential Library and Museum

George H.W. Bush Presidential Library and Museum

William J. Clinton Presidential Library and Museum

George W. Bush Presidential Library and Museum

Other (Presidential Library or affiliated archive)_________________

I hereby authorize NARA to release to the public the information contained in this form for the purpose of providing a listing of independent researchers under the conditions described on the back of this form.

Signature*

Date*

Completed questionnaires may be faxed to: 202-357-5934

or mailed to: National Archives and Records Administration

RDC1, Room G-13,

RE: Independent Researcher Listing Application

700 Pennsylvania Avenue, NW,

Washington, DC 20408-0001.

For questions and comments, please feel free to telephone 202-357-5360 or email [email protected].

* Required Field

Procedures and Conditions for Inclusion in the Independent Researcher Listing for

NARA's Washington, DC, area, Regional Records Services Facilities, and Presidential Library Facilities

1. Any independent researcher who performs work at any NARA facility or NARA-affiliated archives may complete the Independent Researcher Listing Application.

2. NARA does not require a fee for inclusion on the list. However, all required fields noted on the form must be completed for inclusion on the listing.

3. The listing is compiled and disseminated as a service to the public. Copies of the listing will be available on NARA's web site and at all archival reference units at the Washington, DC; College Park, MD; Archival Operations Facilities; and Presidential Libraries.

4. Any change in an individual's listed information requires a resubmission of the form by the affected independent researcher. Updates will be made whenever new information is submitted.

5. All independent researchers who wish to remain on the listing are required to certify annually that the information we publish is current and accurate. Replies to our annual email notices must be received within 30 days. Those independent researchers who do not reply will be stricken from the listing without further notification.

6. All independent researchers using NARA facilities and NARA-affiliated archives are expected to comply with established research room procedures. Those found to be in violation of such procedures will be stricken from the listing. Severe or repeated violations may also result in suspension of research room privileges in accordance with 36 CFR 1254, subpart B.

7. Soliciting, vending, and debt collection are prohibited on NARA property.

8. Any comments or complaints NARA receives regarding any individual independent researcher on the listing will be forwarded to that researcher for resolution. However, complaints received on a regular basis regarding the business practices of any independent researcher can result in removal from the listing.

9. NARA will not be responsible for any research and/or reproduction arrangements made between the independent researcher and their clientele.

10. Inclusion on the list may not be viewed or advertised as NARA endorsement.

11. This listing is not considered part of the separate Vendor System used predominantly by NARA's Special Media Archives Services Division at College Park, MD, nor is it part of any other contractual agreement.

12. This application form is available on NARA's web site at www.archives.gov. You may also obtain a form from, and send completed application forms and updates to, the following address:

National Archives and Records Administration

RDC1, Room G-13

RE: Independent Researcher Listing Application

700 Pennsylvania Avenue, NW,

Washington, DC 20408-0001.

Or use our fax number: 202-357-5934.

PAPERWORK REDUCTION ACT PUBLIC BURDEN STATEMENT

A Federal agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. The OMB Control No. for this information collection is 3095-0054. The information requested on this form is being collected and disseminated by NARA as a courtesy to the public. Public burden reporting for this collection of information is estimated to be ten minutes per response, including time for reviewing instructions, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of the collection of information, including suggestions for reducing this burden, to the National Archives and Records Administration (ISSD), 8601 Adelphi Road, College Park, MD 20740-6001. DO NOT SEND COMPLETED FORMS TO THIS ADDRESS. PLEASE SEND COMPLETED FORMS TO THE ADDRESS SHOWN ABOVE.

NATIONAL ARCHIVES AND RECORDS ADMINISTRATION NA Form 14115 (07/15)