1420-17 Contractor Employee Biographical Data Sheet

OMB Control No: 0412-0520
Expiration Date: 11/30/2024

CONTRACTOR EMPLOYEE BIOGRAPHICAL DATA SHEET
PRIVACY ACT STATEMENT

Authority: Foreign Assistance Act, Pub. L. 87-165, as amended, and 48 C.F.R. § 752.7003 (2024).
Purpose: To collect, use, maintain, and disclose information to determine the qualifications of an
individual for a specific contract position and to determine the reasonableness of proposed salary or
consultant rate for the services proposed under the contract. This form is only valid with an 0ffice of
Management and Budget (OMB) Number displayed in accordance with 44 U..S..C. § 3506(c)(1)(B)(iii)(V)
(2024).
Routine Uses: The personal information is used by USAID to maintain administrative records and to
perform other administrative functions inherent to the administration of the contract. This information
will be used by USAID Contracting Officers and will not be disclosed outside USAID.
Disclosure: Contractor employees/consultants under USAID cost-reimbursement contracts must submit
personal, employment history, and educational data, and the contractor must provide the basis and
rationale for the proposed salary as specified in the form. Providing personal information is voluntary.
However, failure to provide any of the requested information may delay or prevent approval of the
individual proposed under the specific contract.
1. Name (Last, First, Middle)

2. Contractor's Name

3. Employee's Address (include ZIP code)

4. Contract Number

5. Position Under Contract

6. Proposed Salary

7. Duration of Assignment

8. Telephone Number
(include area code)

9. Place of Birth

10. Citizenship (If non-U.S. citizen, give visa status)

11. Names, Ages, and Relationship of Dependents to Accompany Individual to Country of Assignment
12. EDUCATION (include all college or university degrees)
NAME AND LOCATION
OF INSTITUTION

MAJOR

DEGREE

DATE

13. LANGUAGE PROFICIENCY
(see instructions on page 3)
LANGUAGE

SPEAKING

READING

14. EMPLOYMENT HISTORY (List last three (3) positions held by the individual)
POSITION TITLE

AID 1420-17 (10/2024)

EMPLOYER'S NAME AND ADDRESS
POINT OF CONTACT AND TELEPHONE#

DATES OF EMPLOYMENT (MMIYYYY)

From

To

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OMB Control No: 0412-0520
Expiration Date: 11/30/2024

15. SPECIFIC CONSULTANT SERVICES (give last three (3) years). Continue on a separate sheet of paper, if
required, to provide this information.
SERVICES PERFORMED

EMPLOYER'S NAME AND ADDRESS
POINT OF CONTACT AND TELEPHONE#

DATES OF EMPLOYMENT (MMIYYYY)
From
To

16. RATIONALE FOR PROPOSED SALARY (Provide the basis for the salary proposed in Block 6 with supporting

rationale for the market value of the position. Continue on a separate sheet of paper, if required.) Salary definition
– basic periodic payment for services rendered. Exclude bonuses, profit-sharing arrangements, commissions,
consultant fees, extra or overtime work payments, overseas differential or quarters, cost of living or dependent
education allowances.

17. CERTIFICATION: To the best of my knowledge, the above facts as stated are true and correct.
Signature of Employee
Date

18. CONTRACTOR'S CERTIFICATION (To be signed by responsible representative of Contractor)
Contractor certifies in submitting this form that it has taken reasonable steps (in accordance with sound business
practices) to verify the information in this form. Contractor understands that USAID may rely on the accuracy of such
information in negotiating and reimbursing personnel under this contract. Certifications that are false, fictitious, or
fraudulent, or that are based on inadequately verified information, may result in appropriate remedial action by USAID,
taking into consideration all the pertinent facts and circumstances, ranging from refund claims to criminal prosecution.

Signature of Contractor's Representative

AID 1420-17 (10/2024)

Date

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OMB Control No: 0412-0520
Expiration Date: 11/30/2024

IINSTRUCTIONS
Indicate your language proficiency in Block 13 using the following numeric lnteragency Language Roundtable levels
(Foreign Service Institute Levels). The following provides brief descriptions of proficiency levels 2, 3, 4, and 5. "S"
indicates speaking ability and "R" indicates reading ability. For more in-depth description of the levels refer to
Automated Directive System (ADS) Chapter 438 – Foreign Language Program.
Level-2. Limited working proficiency

S
R

Able to satisfy routine special demands and limited work requirements.
Sufficient comprehension to read simple, authentic written material in a form equivalent to usual
printing or typescript on familiar subjects within familiar contexts.

Level-3. General professional proficiency
S Able to speak the language with sufficient structural accuracy and vocabulary to participate effectively in
most formal and informal conversations on practical, social, and professional topics.
R Able to read within a normal range of speed and with almost complete comprehension of a variety of
authentic prose material on unfamiliar subjects.
Level-4. Advanced professional proficiency
S Able to use the language fluently and accurately on all levels normally pertinent to professional needs.
R Able to read fluently and accurately all styles and forms of the language pertinent to professional needs.
Level-5. Functionally native proficiency
S Speaking proficiency is functionally equivalent to that of a highly articulate well-educated native speaker
and reflects the cultural standards of a country where the language is natively spoken.
R Reading proficiency is functionally equivalent to that of the well-educated native reader.

PAPERWORK REDUCTION ACT INFORMATION
The information requested by this form is necessary for prudent management and administration of public
funds under USAID contracts. The information helps USAID estimate logistic support and allowances, the
educational information provides an indication of qualifications, and the proposed salary, along with the
basis and rationale for the market value is used to monitor cost and help determine reasonableness of
proposed salary.

PAPERWORK REDUCTION ACT NOTICE
Public reporting burden for this collection of information is estimated to average thirty (30) 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. Send comments
regarding this burden estimate or any other aspect of this collection of information, including suggestions
for reducing this burden, to:
United States Agency for International
Development, Bureau for Management
Office of Acquisition and Assistance
Policy Division (M/OAA/P)
Washington, D.C. 20523-7100;

AID 1420-17 (10/2024)

and

Office of Management and Budget
Paperwork Reduction Project (0412-0520)
Washington, D.C. 20523

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