Form GSA 7437 GSA 7437 ART IN ARCHITECTURE PROGRAM NATIONAL ARTIST REGISTRY

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ART IN ARCHITECTURE PROGRAM
NATIONAL ARTIST REGISTRY

OMB Control Number: 3090-0274
Expiration Date: 10/31/2022

(See Privacy Act Statement on Reverse)

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 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: U.S. General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, 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 10 years to
[email protected]. Please use the joint photographic experts group (jpeg) format 10 x 7.5 inches at 72 dots per inch (dpi). On
a separate sheet, for each image please include the name of the artist, title of work, date, medium/materials, and dimensions.

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NAME

ARTIST'S WEBSITE

STREET ADDRESS

STATE

CITY

ZIP CODE
TELEPHONE NUMBER

EMAIL ADDRESS

U.S. CITIZEN OR
MEDIA (Check as many as apply)
LAWFUL
DRAWING
PAINTING
PERMANENT RESIDENT

YES

NO

TEXTILE

OTHER (Specify)

SCULPTURE

ARCHITECTURAL ARTS

ENVIRONMENTAL ART

PHOTOGRAPHY

PRINT MAKING

TIME-BASED MEDIA

REMARKS (Optional)

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GENERAL SERVICES ADMINISTRATION

GSA 7437 (REV. XX/20XX)

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The following questions are optional and will not be reviewed by agency source selection officials. GSA requests this information to help
ensure the Art in Architecture program represents the diversity of the U.S. population and supports the goals of
Executive Order 13895, Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. All qualified
applicants will receive consideration in accordance with the solicitation. GSA is also committed to compliance with all procurement practices
regarding citizenship and immigration status.

I PREFER NOT TO ANSWER THESE OPTIONAL QUESTIONS.
DO YOU CONSIDER YOURSELF TO BE HISPANIC OR LATINO ETHNICITY?
(Check only one)

WHAT IS YOUR GENDER?

MALE

FEMALE

YES

NO

WHAT IS YOUR RACE? (Check one or more)

AMERICAN INDIAN OR ALASKAN NATIVE
NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER

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ASIAN

BLACK OR AFRICAN AMERICAN

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PRIVACY ACT STATEMENT
This information is collected under the general authority granted to GSA under subchapter I of chapter 5 of subtitle I and chapter
33 of subtitle II of title 40 of the United States Code. Providing your name, contact information, resume, and example artwork is
voluntary, however, failure to provide it will prevent us from being able to add an individual to the National Artist Registry for
prospective projects. Submission of gender, race, and ethnicity data is also voluntary; failure to provide it will not affect an
individual’s application, as this information will not be used in the selection process, but instead will be used for internal
management of the Art in Architecture program to ensure GSA’s outreach efforts provide a sufficiently diverse and
representative pool of artists as the Federal Government considers possible commissions.
The Systems of Records Notice (SORN) which governs the information on this form is the Museum System-TMS, available at:
https://www.federalregister.gov/documents/2021/08/20/2021-17901/privacy-act-of-1974-modify-system-of-records-notice.
Information on this form may be disclosed to a Member of Congress in response to an inquiry made on your behalf. 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.
More information on this SORN including additional routine uses can be found on GSA’s privacy page, available at:
https://www.gsa.gov/reference/gsa-privacy-program/privacy-policy-and-procedures-guide.

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GSA 7437 (REV. XX/20XX) BACK