Technology Partnerships Submission Form Survey Instrument

Webpage: — Doing Business with the FBI - Submit Your Idea

Technology Partnerships with the FBI – Submit Your Proposal

Technology Partnerships with the FBI

Submit Your Proposal

OMB Control Number 1103-0117

Thank you for your interest in a technology partnership with the FBI. As a federal laboratory, the FBI seeks collaboration with other federal labs, academia, corporations, and others and is interested in outreach from such partners. We welcome your proposals for patent licensing and for cooperative R&D. Your submission will be forwarded to the FBI's Office of Research & Technology Applications for further review. Please be advised that a desired licensing agreement or Cooperative Research & Development Agreement (CRADA) does not guarantee any contractual action or obligation on the part of the FBI. Your material, once submitted, will not be returned to you. If your idea is of interest to the FBI, our team will contact you to discuss further engagement.

Partnership Proposal Type:

• Patent License

• Cooperative Research and Development Agreement (CRADA)

 

If you are interested in a patent license, please indicate which Invention you are interested in licensing: [number text field with 15-character limit].

If you are interested in a Cooperative Research and Development Agreement, please indicate the CRADA topic: [open text field 1000-character limit] (If you have a specific FBI employee you are interested in partnering with for the CRADA please include their name here)

Organization or Company Name  

Organization Type

• Large business

• Small business

• Academic institution

• Government agency

• Federally funded research and development center

• Sole proprietor

• Nonprofit Organization

• General public 

Is this a U.S. based company?

• Yes

• No 

Is the company owned in whole or in part by a federal employee?

• Yes

• No

Primary point of contact (Provide first and last name)

Telephone number

Primary email address

Organization or Company’s Headquarter Address

Synopsis [open text field with 1000-character limit] (Please provide a summary of your proposal)

Existing federal contracts (Does the company/submitter have existing contracts with federal agencies or laboratories?)

• Yes

• No

I have read and understand the FBI Information Privacy Policy.

• Yes

I have read the FBI submission guidance and certify that my attachment meets all requirements.

• Yes

I certify that the content in my submission was created by (1) me; (2) my organization; and/or (3) an individual or organization who gave me permission to submit their content.

• Yes

Attachment guidelines

1. You must submit a PDF. Other formats will not be reviewed.

2. Your PDF must not include any hyperlinks. (You can include URLs in the text, but do not link them.)

3. The first page of your submission must include:

• Partnership area of interest

• Organization or individual name

• Phone number and email

• Website address (if applicable)

Add attachment

Privacy Act Statement

The FBI is authorized to collect the information on this form by one or more of the following provisions: Title 15, United States Code, Section 3710a; Title 35, United States Code, Section 207-9; 47 CFR 404.8 The information requested will assist the FBI in reviewing your submission for a licensing agreement or a CRADA. You do not have to provide the requested information. However, failure to do so may prevent the FBI from reviewing your submission for a licensing agreement or a CRADA. The information collected on this form is protected by the Privacy Act of 1974, as amended, Title 5, United States Code section 552a, and is maintained in the FBI’s Central Records System, DOJ/FBI-002, a description of which was published in the Federal Register at 63 Fed. Reg. 8671 (Feb. 20, 1998) and which may be viewed at https://www.govinfo.gov/content/pkg/FR-1998-02-20/pdf/98-4206.pdf

PRA Public Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control Number. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this voluntary. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to FBI, Office of Research & Technology Applications, 935 Pennsylvania Avenue N.W. Room 10504, Washington, D.C. 20535-0001 and reference the OMB Control Number 1103-0117. Note: Please do not return the completed certification to this address.

Submit

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