AID 500-13 Partner Information Form

OMB APPROVAL NO. 0412-0577
EXPIRATION DATE:
ESTIMATED BURDEN: 90 MINUTES

PARTNER INFORMATION FORM
PART 1: INFORMATION ABOUT PRIME AWARD
1.1 Legal Name of Prospective Awardee (Prime Contractor/Recipient)

1.2 Address of Prospective Awardee

1.3 Alternate Address of Prospective Awardee (if applicable)

1.4 Organization Phone Number (Include
full phone number, country code, and
area/city code)

1.5 Alternate Phone Number (Include full phone
number, country code, and area/city code)

1.6 Fax Number (If applicable) (Include full
phone number, country code, and area/city
code)

1.8 U.S. Organization? ☐ Yes ☐ No

1.7 Organization Email Address

1.9(a) Value of Total Award (USD)

1.9(b) Solicitation/Award Number

PART 2: INFORMATION ABOUT SUBAWARD (to be completed if submitting a subaward)
2.1 Legal Name of Prospective Subawardee (Subcontractor/Subrecipient)

2.2 Website URL of Prospective Subawardee (if applicable)

2.3 Type of Organization
☐ Parent Organization ☐ Branch ☐ Subsidiary
2.4 Address of Prospective Subawardee

2.5 Alternate Address of Prospective Subawardee (if applicable)

2.6 Organization Phone Number (Include
full phone number, country code, and
area/city code)

AID 500-13 01/2023

2.7 Alternate Organization Phone Number (if
applicable) (Include full phone number, country
code, and area/city code)

2.8 Primary Fax Number (if applicable) (Include
full phone number, country code, and area/city
code)

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2.10 U.S. Organization? ☐ Yes ☐ No

2.9 Organization Email Address

2.11 Vetting Category

2.12 Value of Total Subaward (USD) (if
applicable)

☐ Subcontract ☐ Subgrant ☐ Training ☐ Equipment

☐ Other:
2.13 Estimated Subaward Start Date (dd-mmyyyy)

2.14 Estimated Subaward End Date (dd-mmyyyy)

2.15 Purpose of Subaward

PART 3: CERTIFICATION
The prospective awardee certifies in submitting this form that it has taken reasonable steps in accordance with sound business practices to
verify information included in this form and understands that the U.S. government may rely on the accuracy of such information to process this
request.
3.1 Authorizing Official’s Name (First name, Middle name, Last name)
3.2 Title/Organization

3.3 Signature of Authorizing Official

3.4 Date (dd-mm-yyyy)

PART 4a: KEY INDIVIDUAL INFORMATION
4a.1 Name Listed on Government-Issued Photo ID (First name, Middle
name(s), Last name)

4a.3 Village/City

4a.2 Other Names Used (Also known as, nicknames, alias, different
spelling)

4a.7 Date of Birth (dd-mm-yyyy)

4a.8 Gender

4a.4 District (if applicable)
Place of Birth

4a.5 Governorate, Province, or State
4a.6 Country

4a.9 Country of citizenship (If multiple citizenships, list all countries of
citizenship in this block and include additional ID information in the gray
boxes below)

4a.10 U.S. Citizen? ☐ Yes ☐ No
If yes, provide Passport Number below in “Government-Issued Photo
ID Number” section.

4a.11 U.S. Lawful Permanent Resident? ☐ Yes ☐ No

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4a.12 If yes, include Lawful Permanent Resident Card Number (9 digit A Number#):

4a.13 ID Country of Issuance

4a.13.1 Government-Issued Photo ID Type (please
attach clear, legible picture; preferably in color)

4a.13.2 Complete Government-Issued Photo ID Number

4a.14 ID Country of Issuance
[complete for multiple citizenship
only]

4a.14.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (please
attach clear, legible picture; preferably in color)

4a.14.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4a.15 ID Country of Issuance
[complete for multiple citizenship
only]

4a.15.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (please
attach clear, legible picture; preferably in color)

4a.15.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4a.16 Address of Residence

4a.17 Province/Region
4a.18 Tribal Affiliation (if applicable)

4a.19 Primary Personal Phone Number (Include full phone number, country
code, and area/city code)

4a.20 Alternate Personal Phone Number (if applicable) (Include full
phone number, country code, and area/city code)

Is this a cell phone number? ☐ Yes ☐ No
4a.21 Primary Personal Email Address

Is this a cell phone number? ☐ Yes ☐ No
4a.22 Alternate Personal Email Address (if applicable)

4a.23 Current Employer

4a.24 Organizational Rank or Title

4a.25 Professional Licenses and State-Issued Certifications (if applicable)

PART 4b: KEY INDIVIDUAL INFORMATION
4b.1 Name Listed on Government-Issued Photo ID (First name, Middle
name(s), Last name)

4b.3 Village/City

4b.2 Other Names Used (Also known as, nicknames, alias, different
spelling)

4b.7 Date of Birth (dd-mm-yyyy)

4b.8 Gender

4b.4 District (if applicable)
Place of Birth

4b.5 Governorate, Province, or State
4b.6 Country

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4b.9 Country of citizenship (If multiple citizenships, list all countries of
citizenship in this block and include additional ID information in the gray
boxes below)

4b.10 U.S. Citizen? ☐ Yes ☐ No

4b.11 U.S. Lawful Permanent Resident? ☐ Yes ☐ No

4b.12 If yes to either of the above questions, U.S. Passport/Lawful Permanent Resident Card Number (9 digit A Number#):

4b.13 ID Country of Issuance

4b.13.1 Government-Issued Photo ID Type (clear,
legible picture; preferably in color)

4b.13.2 Complete Government-Issued Photo ID Number

4b.14 ID Country of Issuance
[complete for multiple citizenship
only]

4b.14.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

4b.14.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4b.15 ID Country of Issuance
[complete for multiple citizenship
only]

4b.15.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

4b.15.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4b.16 Address of Residence

4b.17 Province/Region
4b.18 Tribal Affiliation (if applicable)

4b.19 Primary Personal Phone Number (Include full phone number, country
code, and area/city code)

4b.20 Alternate Personal Phone Number (if applicable) (Include full
phone number, country code, and area/city code)

Is this a cell phone number? ☐ Yes ☐ No
4b.21 Primary Personal Email Address

Is this a cell phone number? ☐ Yes ☐ No
4b.22 Alternate Personal Email Address (if applicable)

4b.23 Current Employer

4b.24 Organizational Rank or Title

4b.25 Professional Licenses and State-Issued Certifications (if applicable)

AID 500-13 01/2023

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PART 4c: KEY INDIVIDUAL INFORMATION
4c.1 Name Listed on Government-Issued Photo ID (First name, Middle
name(s), Last name)

4c.3 Village/City

4c.2 Other Names Used (Also known as, nicknames, alias, different
spelling)

4c.7 Date of Birth (dd-mm-yyyy)

4c.8 Gender

4c.4 District (if applicable)
Place of Birth
4c.5 Governorate, Province, or State
4c.6 Country
4c.9 Country of citizenship (If multiple citizenships, list all countries of
citizenship in this block and include additional ID information in the gray
boxes below)

4c.10 U.S. Citizen? ☐ Yes ☐ No
4c.11 U.S. Lawful Permanent Resident? ☐ Yes ☐ No
4c.12 If yes to either of the above questions, U.S. Passport/Lawful
Permanent Resident Card Number (9 digit A Number#):

4c.13 ID Country of Issuance

4c.13.1 Government-Issued Photo ID Type (clear,
legible picture; preferably in color)

4c.13.2 Complete Government-Issued Photo ID Number

4c.14 ID Country of Issuance
[complete for multiple citizenship
only]

4c.14.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

4c.14.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4c.15 ID Country of Issuance
[complete for multiple citizenship
only]

4c.15.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

4c.15.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4c.16 Address of Residence

4c.17 Province/Region

4c.18 Tribal Affiliation (if applicable)

4c.19 Primary Personal Phone Number (Include full phone number, country
code, and area/city code)

4c.20 Alternate Personal Phone Number (if applicable) (Include full
phone number, country code, and area/city code)

Is this a cell phone number? ☐ Yes ☐ No

Is this a cell phone number? ☐ Yes ☐ No

AID 500-13 01/2023

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4c.21 Primary Personal Email Address

4c.22 Alternate Personal Email Address (if applicable)

4c.23 Current Employer

4c.24 Organizational Rank or Title

4c.25 Professional Licenses and State-Issued Certifications (if applicable)

PART 4d: KEY INDIVIDUAL INFORMATION
4d.1 Name Listed on Government-Issued Photo ID (First name, Middle
name(s), Last name)

4d.3 Village/City

Place of Birth

4d.2 Other Names Used (Also known as, nicknames, alias, different
spelling)

4d.7 Date of Birth (dd-mm-yyyy)

4d.8 Gender

4d.4 District (if applicable)
4d.5 Governorate, Province, or State
4d.6 Country

4d.9 Country of citizenship (If multiple citizenships, list all countries of
citizenship in this block and include additional ID information in the gray
boxes below)

4d.10 U.S. Citizen? ☐ Yes ☐ No
4d.11 U.S. Lawful Permanent Resident? ☐ Yes ☐ No
4d.12 If yes to either of the above questions, U.S. Passport/Lawful
Permanent Resident Card Number (9 digit A Number#):

4C.13 ID Country of Issuance

4d.13.1 Government-Issued Photo ID Type (clear,
legible picture; preferably in color)

4d.13.2 Complete Government-Issued Photo ID Number

4d.14 ID Country of Issuance
[complete for multiple citizenship
only]

4d.14.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

4d.14.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4d.15 ID Country of Issuance
[complete for multiple citizenship
only]

4d.15.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

4d.15.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

AID 500-13 01/2023

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4d.16 Address of Residence

4d.17 Province/Region

4d.18 Tribal Affiliation (if applicable)

4d.19 Primary Personal Phone Number (Include full phone number, country
code, and area/city code)

4d.20 Alternate Personal Phone Number (if applicable) (Include full
phone number, country code, and area/city code)

Is this a cell phone number? ☐ Yes ☐ No
4d.21 Primary Personal Email Address

Is this a cell phone number? ☐ Yes ☐ No
4d.22 Alternate Personal Email Address (if applicable)

4d.23 Current Employer

4d.24 Organizational Rank or Title

4d.25 Professional Licenses and State-Issued Certifications (if applicable)

PART 4e: KEY INDIVIDUAL INFORMATION
4e.1 Name Listed on Government-Issued Photo ID (First name, Middle
name(s), Last name)

4e.3 Village/City

Place of Birth

4e.2 Other Names Used (Also known as, nicknames, alias, different
spelling)

4e.7 Date of Birth (dd-mm-yyyy)

4e.8 Gender

4e.4 District (if applicable)
4e.5 Governorate, Province, or State

4e.6 Country
4e.9 Country of citizenship (If multiple citizenships, list all countries of
citizenship in this block and include additional ID information in the gray
boxes below)

4e.10 U.S. Citizen? ☐ Yes ☐ No
4e.11 U.S. Lawful Permanent Resident? ☐ Yes ☐ No
4e.12 If yes to either of the above questions, U.S. Passport/Lawful
Permanent Resident Card Number (9 digit A Number#):

4e.13 ID Country of Issuance

AID 500-13 01/2023

4e.13.1 Government-Issued Photo ID Type (clear,
legible picture; preferably in color)

4e.13.2 Complete Government-Issued Photo ID Number

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4e.14 ID Country of Issuance
[complete for multiple citizenship
only]

4e.14.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

43.14.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4e.15 ID Country of Issuance
[complete for multiple citizenship
only]

4e.15.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

4e.15.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4e.16 Address of Residence

4e.17 Province/Region

4e.18 Tribal Affiliation (if applicable)

4e.19 Primary Personal Phone Number (Include full phone number, country
code, and area/city code)

4e.20 Alternate Personal Phone Number (if applicable) (Include full
phone number, country code, and area/city code)

Is this a cell phone number? ☐ Yes ☐ No
4e.21 Primary Personal Email Address

Is this a cell phone number? ☐ Yes ☐ No
4e.22 Alternate Personal Email Address (if applicable)

4e.23 Current Employer

4e.24 Organizational Rank or Title

4e.25 Professional Licenses and State-Issued Certifications (if applicable)

PART 4f: KEY INDIVIDUAL INFORMATION
4f.1 Name Listed on Government-Issued Photo ID (First name, Middle
name, Last name)

4f.3 Village/City

Place of Birth

4f.2 Other Names Used (Also known as, nicknames, alias, different
spelling)

4f.7 Date of Birth (dd-mm-yyyy)

4f.8 Gender

4f.4 District (if applicable)

4f.5 Governorate, Province, or State

4f.6 Country

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4f.9 Country of citizenship (If multiple citizenships, list additional
citizenships and information in gray boxes below)

4f.10 U.S. Citizen? ☐ Yes ☐ No
4f.11 U.S. Lawful Permanent Resident? ☐ Yes ☐ No
4f.12 If yes to either of the above questions, U.S. Passport/Lawful
Permanent Resident Card Number (9 digit A Number#):

4f.13 ID Country of Issuance

4f.13.1 Government-Issued Photo ID Type (clear,
legible picture; preferably in color)

4f.13.2 Complete Government-Issued Photo ID Number

4f.14 ID Country of Issuance
[complete for multiple citizenship
only]

4f.14.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

4f.14.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4f.15 ID Country of Issuance
[complete for multiple citizenship
only]

4f.15.1 Government-Issued Photo ID Type
[complete for multiple citizenship only] (clear,
legible picture; preferably in color)

4f.15.2 Complete Government-Issued Photo ID Number
[complete for multiple citizenship only]

4f.16 Address of Residence

4f.17 Province/Region
4f.18 Tribal Affiliation (if applicable)

4f.19 Primary Personal Phone Number (Include full phone number, country
code, and area/city code)

4f.20 Alternate Personal Phone Number (if applicable) (Include full
phone number, country code, and area/city code)

Is this a cell phone number? ☐ Yes ☐ No
4f.21 Primary Personal Email Address

Is this a cell phone number? ☐ Yes ☐ No
4f.22 Alternate Personal Email Address (if applicable)

4f.23 Current Employer

4f.24 Organizational Rank or Title

4f.25 Professional Licenses and State-Issued Certifications (if applicable)

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PAPERWORK REDUCTION ACT STATEMENT
Public reporting burden for this collection of information is estimated to average 90 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. The Agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a
currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing this burden, to the U.S. Agency for International Development, Office of Security (SEC), Washington, D.C. 20523-2600.

PRIVACY ACT STATEMENT
Authority: USAID derives its authority to collection information for vetting purposes from, among other sources, Executive Order 13224; Section
7034(e) of the Consolidated Appropriations Act, 2018 (P.L. 115-141), and subsequent appropriations acts; and 18 U.S.C. 2339A, 2339B, and 2339C.
Purpose: Information in this form is used to conduct screening of individuals and entities as required by applicable U.S. laws and implementing
procedures to help ensure that USAID funds do not inadvertently provide support to individuals or entities deemed a national security risk.
Routine Uses: Disclosure of the information provided on this form will be done in accordance with the Privacy Act, as well as with USAID’s System of
Records Notice concerning the Partner Vetting System (USAID-27, 86 FR 3109 (Dec. 5, 2012, modified Jan. 14, 2021)), which establishes the routine
uses and Privacy Act exceptions that apply to this system of records.
Disclosure: Providing personally identifiable information is voluntary, but failure to provide certain information may result in denial of your
application for a USAID contract, grant, cooperative agreement, or other funding.

INSTRUCTIONS
●

Complete all fields and “if applicable” fields if the information exists or applies. For “if applicable” fields, enter “N/A” if not applicable.

●

Any prospective awardee must complete a separate form for each prospective subawardee and must complete Parts 2, 3, and 4.

●

If the prospective awardee/subawardee is a branch organization, a separate form must be completed for the parent organization.

●

If the request is for trainees/individual beneficiaries please leave Part # 2 blank except cells 2.11 - 2.15

PART 1: INFORMATION ABOUT AWARD
Enter information on awardee and on award or assistance.
PART 2: INFORMATION ABOUT SUBAWARD
Enter information on subawardee and subaward if applicable.
PART 3: CERTIFICATION
The authorizing official must complete the certification section by printing their name, title and name of organization, signing their name, and
printing the date where indicated. This certifies that the signer has taken reasonable steps in accordance with sound business practices to verify
information included in this form and understands that the U.S. government may rely on the accuracy of such information to process this request.
PART 4: KEY INDIVIDUAL INFORMATION
Please see ADS 319maj, USAID Guidance on Completion of the Partner Information Form, for more information on “key individual”.

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