Form 309-1 CONTRACT WITH AN INDIVIDUAL FOR PERSONAL SERVICES

OMB No: 0412-0602
Expiration Date: 10/31/2023
Page 1 of_____ Pages

CONTRACT WITH AN INDIVIDUAL FOR PERSONAL SERVICES
The Privacy Act Statement is found at the end of this form

1. Name (Last, First and Middle Names) and Address

2. Citizenship

3. Contract Number

☐N
☐C
☐P

Lawful Permanent Resident of the
U.S. (Green Card Holder)
☐ Yes ☐ No
5. Country of Performance

6. Effective Date

9. Benefits Plan
☐ CCN/TCN - Local Compensation Plan (LCP)
☐ TCN - not subject to LCP
☐ U.S. – Resident Hire
☐ U.S. - Abroad
☐ U.S. - U.S.-based
12. Requisition Number

7. Estimated Completion Date

8. Contract Type
☐ U.S.
☐ CCN

10. Obligation Amount (at award)

11. Total Estimated Cost

13. Technical Office (Name, Office Symbol, Address)

15. Solicitation Number

4. Ethics Code

☐ TCN

14. Supervising Officer (Name and Title)

16. Position Title

17. Contracting Office (Name, Office Symbol, Address)

18. Administered By (If other than Contracting Office in Block 17)
19. PSC AUTHORITIES
Awarded Pursuant to:
☐ Section 636(a)(3) of the Foreign Assistance Act of 1961, as amended.
☐ Annual Foreign Operations Appropriations
☐ Other - Specify:
20. Accounting & Classification Codes:

21. Payment will be made by (Name, Office Symbol, Address)

This Contract consists of this Cover Page, the Schedule and AIDAR and FAR Clauses.

22. Signature of Contractor

UNITED STATES OF AMERICA
AGENCY FOR INTERNATIONAL DEVELOPMENT
23. Signature of Contracting Officer

24. Typed or Printed Name

25. Typed or Printed Name

26. Date

27. Date

AID 309-1 (10/2020)

The United States of America, herein called the Government, represented by the Contracting Officer executing this contract, and the Contractor agree
that the Contractor shall perform all the services set forth in the attached Schedule, for the consideration stated herein. The rights and obligations of the
parties to this contract shall be subject to and governed by the Schedule and the AIDAR and FAR Clauses. To the extent of any inconsistency between
the Schedule or the Clauses and any specifications or other provisions, which are made a part of this contract, by reference or otherwise, the Schedule
and the Clauses shall control. To the extent of any inconsistency between the Schedule and the Clauses, the Schedule shall control.

SPECIAL NOTE:
For U.S. Citizens and U.S. Resident Aliens: As an employee for purposes of Section 636(a)(3) of the Foreign Assistance Act of 1961, as
amended (22 USC 2396(a)(3)), the Contractor is generally an employee of the United States for purposes of laws other than those administered by
the Office of Personnel Management (i.e., Title 5, United States Code). This includes being an employee of the United States for the purposes of Title
26, United States Code, which subjects the Contractor to withholding for both FICA and Federal Income Tax, and precludes the Contractor from
receiving the federal earned income tax exclusion of 26 USC Section 911.

PRIVACY ACT STATEMENT
PRA Burden Statement: The collection is required to obtain or retain benefits. The estimated burden per response is fifteen minutes. The
respondent is not obligated to respond unless a valid OMB control number is displayed on the form. Any comments related to the burden
estimate can be sent to pscpolicymailbox@usaid.gov.
Authority: The authorities for the collection of information are: Foreign Assistance Act, Pub. L. 87-165, as amended; 48 CFR 37.104, Personal
services contracts; and 48 CFR Ch. 7, App. D, Direct USAID Contracts with a U.S. Citizen or a U.S. Resident Alien for Personal Services
Abroad; and 48 CFR Ch. 7, App. J, Direct USAID Contracts with a Cooperating Country National and with a Third Country National for
Personal Services Abroad.
Purpose: This form collects personal information on individuals who are awarded USAID personal services contracts. This form serves as
the cover sheet of the contract with the individual and the acceptance by the personal services contractor and the contracting officer to the
terms of the contract.
Routine Uses: In addition to those disclosures generally permitted under the Privacy Act of 1974, the information collected may be disclosed
according to the routine uses stated in the System of Records Notice titled, “USAID-34, Personal Services Contractor Records” published in
the Federal Register under 80 FR 11391.
Disclosure: Providing personal identifiable information is voluntary; however, if the requested information is not provided, it may delay or
prevent the execution of the personal services contract.

AID 309-1 (10/2020)