Form 1144 - Support Agreement
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1
2
3SUPPORT AGREEMENT
1. AGREEMENT NUMBER
2. SUPERSEDED AGREEMENT NO.
3. EFFECTIVE DATE
4. EXPIRATION DATE
(YYYYMMDD)
(Provided by Supplier)
(If this replaces another agreement)
(May be "Indefinite")
ENTER TAT # (HD-14-0885)
Indefinite
5. SUPPLYING ACTIVITY
6. RECEIVING ACTIVITY
a. NAME AND ADDRESS
a. NAME AND ADDRESS
Defense Technical Information Center (DTIC)
Name of Requesting Agency & DODAAC
8725 John J. Kingman Road, Suite 0944
POC
Fort Belvoir, VA 22060-6218
Address
Telephone number/ Fax number
b. MAJOR COMMAND
b. MAJOR COMMAND
Assistant Secretary of Defense for Research and Engineering ASD(R&E)
Enter the Requesting Agency's Major Command in this space.
7. SUPPORT PROVIDED BY SUPPLIER
a. SUPPORT (Specify what, when, where, and how much)
b. BASIS FOR REIMBURSEMENT
c. ESTIMATED REIMBURSEMENT
DTIC will provide support under the _____(enter IAC Name
See Economy Act, Title 31,
Enter Total for required
example: HDIAC) Contract _______(enter contract number
U.S. Code section 1535
effort $
and TAT number example: HD-14-0885). ADD the DODAAC
(contains legal authority and
or DODAAC(s) of funding organizations here in block a. For
requirements for one U.S.
Provisional DTIC 1.2%
space you can delete the instructions below once you have
Governmental entity to perform
CSDC rate $
complied.
work for another), and
Financial Management
Enter Grand Total $
Effective Date (box 3) - The effective date must be completed.
Regulations (FMR), Volume
The effective date must match the date signed by comptroller
11a, Chapter 3 ('Economy Act
This agreement does not
or it must be dated after comptroller signature.
Orders'), paragraph 030303
create an obligation on
Expiration Date (box 4) - Since it may be difficult to determine
('Interagency Support').
the Receiving Activity or
the exact date of award, DTIC requests that you leave
any other funders of this
"Indefinite" in the expiration date.
[The Customer Shared Direct
project to provide the
Under Receiving Component - The Comptroller for your
Cost (CSDC) rate of 1.2% is
total funds identified as
agency must sign and date in boxes 9a-b.
provisional and may fluctuate
the Estimated
during the life of the Delivery
Reimbursement in block
The Approving Authority is the Requesting Activity and their
Order.]
7c.
contact information and signature must be completed in boxes
9c(1-5).
ADDITIONAL SUPPORT REQUIREMENTS ATTACHED:
YES
NO
8. SUPPLYING COMPONENT
9. RECEIVING COMPONENT
a. COMPTROLLER SIGNATURE
b. DATE SIGNED
a. COMPTROLLER SIGNATURE
b. DATE SIGNED
c. APPROVING AUTHORITY
c. APPROVING AUTHORITY
(1) TYPED NAME
(1) TYPED NAME
Brent Ishizaki, DoD IAC Deputy Director
(2) ORGANIZATION
(3) TELEPHONE NUMBER
(2) ORGANIZATION
(3) TELEPHONE NUMBER
Defense Technical Information Center
(703) 767-9245
(4) SIGNATURE
(5) DATE SIGNED
(4) SIGNATURE
(5) DATE SIGNED
10. TERMINATION
(Complete only when agreement is terminated prior to scheduled expiration date.)
a. APPROVING AUTHORITY SIGNATURE
b. DATE SIGNED
d. DATE SIGNED
c. APPROVING AUTHORITY SIGNATURE
DD FORM 1144, NOV 2001
PREVIOUS EDITION MAY BE USED.
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