Domestic Associate Location 

 Gai thersburg Boulder

NIST-1296 

(REV. 10-2015)

ADMAN 5.13 

U.S. DEPARTMENT OF COMMERCE

NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY

DOMESTIC ASSOCIATE AGREEMENT AGREEMENT 

NEW EXTENSION 

THE PRIVACY ACT OF 1974 (5 U.S.C. 552A) REQUIRES THAT YOU BE GIVEN CERTAIN INFORMATION IN CONNECTION WITH THE REQUEST FOR INFORMATION ON 

THIS FORM. THE AUTHORITY FOR THE COLLECTION OF THIS DATA IS 5 U.S.C. 301. FURNISHING THIS INFORMATION IS VOLUNTARY. THE EFFECT OF NOT 

FURNISHING THE REQUESTED INFORMATION IS THAT YOU WILL NOT BE CONSIDERED AS A PARTICIPANT IN THE DOMESTIC ASSOCIATE PROGRAM. 

RELEVANT RECORDS OF THE DOMESTIC ASSOCIATE RECORD SYSTEM MAY, AS A MATTER OF ROUTINE USE, BE PROVIDED TO: (A) A FEDERAL,

STATE, LOCAL OR FOREIGN AGENCY, IN RESPONSE TO ITS REQUEST, RESPONSIBLE FOR INVESTIGATING OR PROSECUTING CONTRACTS, CRIMINAL, CIVIL 

ORREGULATORY VIOLATIONS; MAINTAINING ENFORCEMENT OR OTHER PERTINENT INFORMATION, SUCH AS CURRENT LICENSES, ISSUANCE OF SECURITY

CLEARANCES, LETTING OF CONTRACTS; FOR HIRING, RETENTION OR ASSIGNMENT ISSUES; (B) RESPOND TO FREEDOM OF INFORMATION ACT REQUESTS 

(5U.S.C. 552); (C) A CONTRACTOR OF THE DEPARTMENT HAVING A NEED FOR THE INFORMATION IN THE PERFORMANCE OF A CONTRACT; OR (D) THE 

GENERAL SERVICES ADMINISTRATOR, OR HIS DESIGNEE, DURING AN INSPECTION OF RECORDS AS A PART OF THE AGENCY’S RESPONSIBILITY TO 

RECOMMEND IMPROVEMENTS IN THE RECORDS, MANAGEMENT PRACTICES, AND PROGRAMS. 

DOMESTIC ASSOCIATES AND NIST STAFF ARE REMINDED THAT THE ECONOMIC ESPIONAGE ACT OF 1996 PROHIBITS THE THEFT OR INTENTIONAL 

CONVERSION OF TRADE SECRETS TO THE ECONOMIC BENEFIT OF ANYONE OTHER THAN THE OWNER OF THE TRADE SECRETS. PENALTIES FOR VIOLATION 

OF THIS LAW INCLUDE PRISON TERMS OF UP TO TEN YEARS AND LARGE FINES. THUS, YOU MUST NEVER KNOWINGLY DISCLOSE OR USE ANY TRADE 

SECRETS THAT YOU OBTAIN WHILE AT NIST OR FROM NIST EMPLOYEES. AT THE CONCLUSION OF YOUR ASSIGNMENT AT NIST, YOU MUST RETURN ALL

TANGIBLE COPIES OF TRADE SECRETS TO NIST. 

NAME CITIZENSHIP 

NIST BUILDING NUMBER NIST ROOM NIST ASSOCIATE TYPE NIST ASSOCIATE SUB-TYPE AGREEMENT START DATE AGREEMENT END DATE 

NIST HOST NIST HOST LOCATION NAME OF NIST HOST 

DIVISION Gaithersburg 

NIST HOST 

BUILDING NUMBER 

NIST HOST 

ROOM 

NIST HOST 

TELEPHONE 

Boulder 

EMERGENCY PERSONAL CONTACT TELEPHONE NUMBER 

LAST NAME FIRST NAME 

EMPLOYEE/HOME ORGANIZATION 

(NAME AND ADDRESS,TELEPHONE NUMBER, AND CONTACT 

PERSON) 

EMPLOYER/ HOME 

ORGANIZATION CONTACT 

SPONSOR (NAME AND ADDRESS) 

LAST 

ADDRESS ADDRESS 

FIRST

STATE 

TELEPHONE NUMBER 

STATE 

COUNTRY COUNTRY 

ZIP ZIP 

PROJECT PLAN (INCLUDE SCIENTIFIC PROJECT, FACILITIES, AND SCHEDULE OF ATTENDANCE) 

PROJECT TITLE: 

FACILITIES: 

SCHEDULE OF ATTENDANCE: 

PROJECT PLAN: 

IS THE ASSOCIATE DOING RESEARCH IN SUPPORT OF A DEGREE? YES NO 

DOES THIS RESEARCH INVOLVE THE USE OF HUMAN OR ANIMAL SUBJECTS? 

(If yes, you must attach appropriate exemption or IRB approvals) YES NO 

ESTIMATED WORK YEARS (PER FY) CAREER PATH/ BAND EQUIVALENCY SPONSOR TYPE (CODE) 

FISCAL YEAR ESTIMATED WORK YEARS 

CITY CITY 

BENEFIT TO NIST:
PAGE 2 

EDUCATION (THE HIGHEST DEGREE OF EDUCATION) 

NAME LOCATION SUBJECT STUDIED YEARS ATTENDED

DEGREES 

AWARDED 

ADDRESS FROM TO 

CITY 

PROVINCE 

STATE 

COUNTRY POSTAL CODE

EXCEPTION (TECHNOLOGY PARTNERSHIPS OFFICE USE ONLY) 

IS DOMESTIC ASSOCIATE WORKING UNDER THE AUSPICES OF A FEDERAL FUNDING AGREEMENT? 

YES 

(IF YES, CHECK APPROPRIATE AGREEMENT) 

GRANT/ 

FELLOWSHIP CONTRACT COOPERATIVE

AGREEMENT 

SIMPLIFIED

ACQUISITION

NO AGREEMENT NUMBER

(FEDRAL AGENCY) 

REQUESTING OFFICIAL 

(DIVISION CHIEF OR HIGHER) (SIGNATURE) 

DATE APPROVAL – OU DIRECTOR (SIGNATURE) DATE 

APPROVAL – TECHNOLOGY PARTNERSHIPS OFFICE

(SIGNATURE) 

DATE DOMESTIC ASSOCIATE (SIGNATURE) DATE 

 NIST-1296 

DOMESTIC ASSOCIATE CONDITIONS 

DOMESTIC ASSOCIATE. THE NATIONAL INSTITUTE OF STANDARDS AND TECHNOLOGY (NIST) ACCEPTS DOMESTIC ASSOCIATE TO WORK WITH NIST

TECHNICAL STAFF AND TO USE NIST FACILITIES UNDER THE CONDITIONS STATED IN THIS AGREEMENT. THIS DOMESTIC ASSOCIATE AGREEMENT WITH

NIST IS EFFECTIVE WHEN SIGNED BY ALL PARTIES. 

THE DOMESTIC ASSOCIATE AGREEMENT IS USED WHEN NON-NIST RESEARCHERS COLLABORATE WITH NIST ON RESEARCH AND DEVELOPMENT PROJECTS

OF MUTUAL INTEREST. 

NIST ASSOCIATES CONDUCTING RESEARCH AT NIST. INTELLECTUAL PROPERTY, PATENTS, COPYRIGHTS. THE ASSOCIATE SHALL PROMPTLY REPORT TO 

NIST, USING FORM DN-45, ANY INVENTIONS CONCEIVED IN WHOLE OR IN PART WHILE CONDUCTING RESEARCH AT NIST. JOINT INVENTIONS WILL BE 

JOINTLY OWNED. SOLE INVENTIONS WILL BE OWNED BY THE INVENTING PARTY. NIST RESERVES AND ASSOCIATE HEREBY GRANTS A NONEXCLUSIVE, 

NONTRANSFERABLE, IRREVOCABLE, PAID-UP LICENSE TO PRACTICE OR HAVE PRACTICED FOR OR ON BEHALF OF THE UNITED STATES GOVERNMENT ANY 

SUCH SOLE INVENTION THROUGHOUT THE WORLD. ASSOCIATE ACKNOWLEDGES AND AGREES THAT SOFTWARE AND DATA PREPARED BY NIST 

EMPLOYEES, AND SOFTWARE AND DATA PREPARED JOINTLY BY NIST EMPLOYEES AND ASSOCIATE ARE NOT SUBJECT TO COPYRIGHT IN THE UNITED 

STATES. THE ASSOCIATE SHALL RETAIN AS CONFIDENTIAL FOR A PERIOD OF 5 YEARS RESULTS OF CALIBRATIONS PERFORMED UNDER THE NIST 

CALIBRATION PROGRAM. ASSOCIATE PUBLICATIONS RESULTING FROM WORK UNDER THIS AGREEMENT MUST CONFORM TO NIST PUBLICATION 

POLICIES. UNLESS AN EXPLICIT EXCEPTION IS APPROVED BY NIST, THE ASSOCIATE SHALL NOT WORK AS PART OF THE NIST PROJECT TEAM OR AS AN 

INDEPENDENT RESEARCHER ON CRADA PROJECTS OR OTHER PROJECTS IN WHICH ANOTHER ORGANIZATION'S TRADE SECRETS MAY BE INVOLVED OR 

IN WHICH INTELLECTUAL PROPERTY MAY BE CREATED. 

AGREES TO COMPLY WITH NIST ADMINISTRATIVE RULES, REGULATIONS AND OTHER REQUIREMENTS INCLUDING NIST SAFETY, SECURITY AND OTHER 

DIRECTIVES.

COMPENSATION. EXCEPT FOR DOMESTIC ASSOCIATES WHO ARE U.S. GOVERNMENT EMPLOYEES OR WHO ARE WORKING UNDER THE AUSPICES OF A

FEDERAL FUNDING AGREEMENT, DOMESTIC ASSOCIATES WAIVE ANY AND ALL CLAIM FOR COMPENSATION UNDER THIS AGREEMENT FROM THE U.S. 

GOVERNMENT FOR ANY SERVICE PERFORMED. 

LIABILITY. NIST'S RESPONSIBILITY FOR THE PAYMENT OF CLAIMS FOR THE LOSS OF PROPERTY, PERSONAL INJURY OR DEATH, OR OTHERWISE ARISING OUT 

OF ANY NEGLIGENT ACT OR OMISSION OF ITS EMPLOYEES IN CONNECTION WITH THE PERFORMANCE OF WORK UNDER THIS AGREEMENT SHALL BE 

GOVERNED BY THE FEDERAL TORT CLAIMS ACT. 
PAGE 3 

Continuation Sheet For NIST-1296

Name Div Agreement Start Date Agreement End Date Agreement 

Project Title 

Project Plan 

Schedule of Attendance 

(NIST-1296 REV. 10-2015) 

-Sensitive Personal Data: Use is Restricted (Privacy Act, 5 U.S.C. 55a)- 

Benefit To NIST