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 control number. The OMB control number for this information collection is 2700-xxxx and it expires on xx/xx/xxxx. We estimate that it will take about 8 hours to read the instructions, gather the facts, and answer the questions. You may send comments on our time estimate above to [email protected]. Send only comments relating to our time estimate to this address.
If the value “Personal” is selected for the field “Intended Use”, the system loads the Personal Questionnaire form.
Intended Use:
Citizenship:
Country of Residence:
Personal Phone:
Personal Physical Address:
Personal City:
Personal State/Province:
Personal Zip:
If the value “Business/Government” is selected for the field “Intended Use” and either value “U.S. Federal Government Civil Servant” or “Active Duty Military” is selected for the “You are requesting as a/an:” field, the system loads the Business/Government Questionnaire (U.S. Federal Government Civil Servant / Active Duty Military) form.
Intended Use:
Citizenship:
Country of Residence:
Personal Physical Address:
Personal City:
Personal State/Province:
Personal Zip:
Agency Name:
Work Email:
Work Phone:
Agency Address:
City:
State:
Zip Code:
What job do you have in this agency?
NASA requires the Software Usage Agreement be signed by a Supervisor, Officer, or Executive. Please provide the following information for an appropriate signatory.
Full Legal Name:
Business title:
Country:
Business Address:
Business City:
State:
Zip/Postal Code:
Business Phone:
Business Email:
If the value “Business/Government” is selected for the field “Intended Use” and the value “JPL Employee” is selected for the “You are requesting as a/an:” field, the system loads the Business/Government Questionnaire (JPL Employee) form.
Intended Use:
Work Email:
Work Phone:
Address:
City:
State:
Zip Code:
What job do you have in this business?
NASA requires the Software Usage Agreement be signed by a Supervisor, Officer, or Executive. Please provide the following information for an appropriate signatory.
Full Legal Name:
Business title:
Country:
Business Address:
Business City:
State:
Zip/Postal Code:
Business Phone:
Business Email:
If the value “Business/Government” is selected for the field “Intended Use” and the value “NASA Intern” is selected for the “You are requesting as a/an:” field, the system loads the Business/Government Questionnaire (NASA Intern) form.
Intended Use:
Citizenship:
Country of Residence:
Personal Physical Address:
Personal City:
Personal State/Province:
Personal Zip:
Company Name:
Address:
City:
State:
Zip Code:
What job do you have in this agency?
NASA requires the Software Usage Agreement be signed by a Supervisor, Officer, or Executive. Please provide the following information for an appropriate signatory.
Full Legal Name:
Business title:
Country:
Business Address:
Business City:
State:
Zip/Postal Code:
Business Phone:
Business Email:
If the value “Business/Government” is selected for the field “Intended Use” and the value “Business or Non-Profit” is selected for the “You are requesting as a/an:” field, the system loads the Business/Government Questionnaire (Business) form.
Intended Use:
Citizenship:
Country of Residence:
Personal Physical Address:
Personal City:
Personal State/Province:
Personal Zip:
Company Name:
Is this a U.S. owned or licensed company?
What job do you have in this business?
What job do you have in this agency?
NASA requires the Software Usage Agreement be signed by a Supervisor, Officer, or Executive. Please provide the following information for an appropriate signatory.
Full Legal Name:
Business title:
Country:
Business City:
State/Provice:
Zip/Postal Code:
Business Phone:
Business Email:
If the value “Academic” is selected for the field “Intended Use”, the system loads the Academic Questionnaire form.
Intended Use:
Citizenship:
Country of Residence:
Personal Physical Address:
Personal City:
Personal State/Province:
Personal Zip:
Institution Name:
Is this a U.S. educational institution?
What job do you have in this institution?
NASA requires the Software Usage Agreement be signed by a Supervisor, Officer, or Executive. Please provide the following information for an appropriate signatory.
Full Legal Name:
Business title:
Country:
Business Address:
Business City:
State:
Zip/Postal Code:
Business Phone:
Business Email:
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |