3135-0112 Individuals Acknowledgement of Rights-Holder Form and In

OMB 3135-0112
Exp. TBD

NATIONAL ENDOWMENT FOR THE ARTS

TRANSLATION FELLOWSHIP – ACKNOWLEDGMENT OF RIGHTS-HOLDER

Rights-holder:

_______________________________________

Rights-holder’s Country of Origin:

_______________________________________

Title of Work to be Translated (the “Work”):

_______________________________________

Translator:

_______________________________________

I, _______________________________________, acting as the Rights-holder or as an authorized
representative of the Rights-holder, and warranting that I have the capacity to act as such, do
acknowledge, understand, and affirm the following:
•
The Translator is seeking funds in the form of a grant from the National Endowment for the Arts
(“NEA”) to create an English-language translation of the Work (the “Translation”).
•
The NEA is an agency of the United States Government.
•
The terms of the NEA grant do not authorize or consent to the Translator publishing the
Translation without first obtaining all proper rights. The NEA specifically does not authorize or
consent to any activity that infringes on any valid rights of the Rights-holder under the laws and
treaties of the United States or the Rights-holder’s Country of Origin.
•
The Rights-holder possesses and controls all rights to the Work necessary to allow the Translator
to create the Translation.
•
The rights to translate the Work are presently available.
•
Although the Rights-holder does not object to the Translator’s creation of the Translation, the
Rights-holder has not yet entered into a final publishing rights agreement with the Translator or
any individual or entity acting in concert with the Translator to publish the Work (such as an
English-language publisher). Neither the NEA nor the United States Government will be party to
any such publishing rights agreement(s) between the Publisher and the Translator and/or any
individual or entity acting in concert with the Translator.
•
If the author(s) of the Work and the Rights-holder are not the same individual or entity, I am aware
of no objection by the author(s) to the creation of this or any English-language translation of the
Work. The Rights-holder will promptly give written notice to the NEA if it subsequently learns of
any such objection, or if it transfers its right to allow an English-language translation of the Work
to any other person or entity prior to publication of the Translation.
I am eighteen years of age or older, and by signing below I warrant that I have read, acknowledged and
affirmed the above on behalf of the Rights-holder. I understand that this acknowledgement does not mean
I have given up any rights that the Rights-holder may have in the work.
Accepted and agreed:
________________________________________
Signature
________________________________________
Print Name and Position
________________________________________
Date

_____________________________________
Address

_________________________________________
E-mail

_____________________________________
Phone
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OMB 3135-0112
Exp. TBD

Privacy Act
The following notice is furnished in accordance with the Privacy Act of 1974, 5 U.S.C. 552a:
This information is solicited under the authority of the National Foundation on the Arts and the
Humanities Act, 20 U.S.C. 951 et seq. and is used to for the purpose of application review.
Personal data including home address and home telephone number will not be released and is
exempt from disclosure under FOIA exemption (b)(6). Failure to provide the requested
information could result in rejection of your application.
Paperwork Reduction Act Statement
The public reporting burden for this collection of information is estimated at an average of one
hour per response. This includes the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection
of information. We welcome any suggestions that you might have on improving the guidelines
and making them as easy to use as possible. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden,
to: [email protected], attention: Reporting Burden. Note: Applicants are not required to
respond to the collection of information unless it displays a currently valid U.S. Office of
Management and Budget (OMB) control number.

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