AHRQ Publishing and Communications Guidelines

Permission Form for AHRQ To Use Copyrighted Material

Use this form when requesting use of copyrighted materials from publishers or authors. Some publishers have their own forms to request use of copyrighted materials. Provide copies of signed forms to the managing editor.

Permission Form for AHRQ To Use Copyrighted Material

The undersigned hereby grants permission to the Agency for Healthcare Research and Quality (AHRQ), located at 5600 Fishers Lane, Rockville, MD 20857, to use the material specified below and copyrighted by me:

______________________________________________________________________

These copyrighted items may be used in both print and electronic formats, including future editions of print or electronic work.

The above permission to AHRQ shall in no way restrict republication by me of the copyrighted items in other works.

AHRQ will use the following credit line for each item for which I hold copyright [add lines as needed]:

______________________________________________________________________

Copyright holder: ________________________________________________________         

Date: __________________

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Release Form for Use of Previously Recorded Audiovisual Materials, Including Photographs

This form is used to obtain permission to use existing footage or photographs owned by a specific person. It is used only once, as the form notes that permission is granted in perpetuity. Because these are probably personal materials, make sure to ask if the materials need to be returned, and by what date, and include that on the form. Do not use this form to receive materials from an archival site; you will have to pay for content and will have a contract, but make sure the contract says you can use the material worldwide and in perpetuity.

Release Form for Use of Previously Recorded Audiovisual Materials, Including Photographs

I hereby provide existing recordings or photographs and grant, in perpetuity, to the Agency for Healthcare Research and Quality (AHRQ), permission to:

• Use these existing recordings, including any with my image and/or voice, on video, audio, photograph, or other medium.
• Use my name, biographical information, and other identifying information in connection with or promotion of these recordings or photographs. If AHRQ asks, I will provide the identifying information for each item.
• Include these materials in whole or in part, without restriction or limitation, for any informational, educational, or promotional purpose that AHRQ deems appropriate but only as relates to [NAME OF AHRQ PROJECT]. If the material is to be used for another AHRQ project, AHRQ will ask for additional permission.
• I do [OR do not] ask AHRQ to return the materials to me when the project is completed [or by XX date].

I hereby waive any right to inspect and approve the rough cut, draft, promotional, or finished products.

AHRQ will not provide me with royalties, compensation, or residuals for this use.

Name:   _________________________________________________________________

Address:  _______________________________________________________________

Phone Number:  ____________________________ Email:  _______________________

Signature and Printed Name:  _______________________________________________

Date:  __________________

Signature and Printed Name of Parent or Guardian of a Minor: _____________________

Date:  __________________

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Meeting Participant Release Form

A Release for Meeting Participants is used when recording large meetings for rebroadcast when certain people will be speaking and identified. This includes the official speakers and members of the audience who ask questions. If those audience members are not known before they speak, every effort should be made to have them sign the meeting participant release before they leave the room.

Meeting Participant Release Form

I do hereby authorize AHRQ, assignees, successors, and those acting pursuant to its authority to:

1. Record my participation and appearance at this meeting on videotape, audiotape, film, or photograph, on a real or digital or other medium.
2. Use my name, likeness, voice, and biographical material in connection with or promotion of these recordings.
3. Exhibit, broadcast, webcast, store and forward, copy, edit, and/or distribute such recording in whole or in part without restriction or limitation for any educational, commercial, or promotional purpose which AHRQ, assignees, successors, and those acting pursuant to its authority, deem appropriate.
4. No royalties, compensation, or residuals will be paid.
5. I hereby waive any right to inspect and approve the rough cut, promotional, or finished product.

Name:________________________________________________________________________

Address:______________________________________________________________________

Phone Number:_________________________________________________________________

Email:________________________________________________________________________

Signature:_____________________________________________________________________

Meeting Participant Sign-In Sheet

In addition to having known participants sign the Meeting Participant Form, you need to post language on the door to the meeting, as well as on a sign-in sheet for the general audience.

The audience sign-in sheet is to be sure that audience members acknowledge their awareness of the recording and that their images/voices may be recorded. You will not need an additional release unless they become a participant (in which case, you should use the Meeting Participant Release Form).

Note: This information also should be provided on the meeting room door(s), along with pens so audience members can sign it.]

Meeting Participant Sign-In Sheet

This meeting is being videotaped [or audiotaped] for public exhibition. The production will include video images [or audio recordings] of the audience. Anyone not wishing to appear in the production is hereby advised against attending this meeting. By entering the premises, you are granting permission to be included in the production for all purposes and in all media.

Thank you.

If you agree to the statement above, please print and sign your name.

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Talent Release for Actors

This form is a sample of what to use when you hire people who are not government employees as narrators, actors, or extras for a scripted video. This includes any paid and unpaid talent, if you think their participation will be recognizable in the final video. It also includes extras who happen to be employees working at your location (such as a hospital or office) if they may be seen in the background. It does not matter if, ultimately, their image is not used; you should protect the production (and the government’s property) by getting the release signed.

If you already have a form that includes the elements in the talent release form, you can use it. If your actors are being paid for their work, the specific amount of compensation should be specified. If not cost-prohibitive, negotiate a talent agreement that will not expire.

If they are represented by a talent agency, union, or other organization, the representative’s contract may substitute for this release as long as it states that the actors are being paid for “worldwide rights in perpetuity.” That is, you must have the talent release signed by the talent, but the terms are not needed if they are included in a contract. In that case, you may say here that the talent will be paid by their named talent agency for worldwide rights in perpetuity, that said agency will be paid by AHRQ's contractor, and that the talent agency will not bill AHRQ directly.

You may modify the language in this release for audio production, still photography, virtual performance, or another medium, but always specify the type of production and modify the language appropriately.

TALENT RELEASE FORM

Agency for Healthcare Research Quality (AHRQ)
U.S. Department of Health and Human Services

Project Name: [add project name here]
Name of Video: [add the name of the video, if different, here]

I hereby grant to the Agency for Healthcare Research Quality (“AHRQ”) and [list any other offices or partners if working under a partnership] their assignees, successors, and those acting in pursuant to their authority, permission and worldwide rights in perpetuity to:

1. Record my [or that of the minor child in my control] participation and appearance on video, audio, file, or photograph, on real or digital or other medium.
2. Use my [or that of my minor child] name, likeness, voice, CV, and biographical material in connection with or promotion of this production. In addition, nothing shall require AHRQ to use my [or that of my minor child] name, likeness, or voice in any manner.
3. Exhibit, broadcast, cablecast, webcast, store and forward, copy, edit, and/or distribute such recording in whole or in part without restriction or limitation for any educational, commercial, or promotional purpose that AHRQ, its assignees, successors, and those acting pursuant to its authority, deem appropriate.
4. (a) No royalties or residuals will be paid to me [or on behalf of my minor child] for my [or that of my minor child] participation. [If providing nonmonetary compensation] I will receive nonmonetary or promotional consideration only.
   OR
   (b) No royalties or residuals will be paid to me, but I will be paid a fee of $XX for my participation.
5. I hereby waive any right to inspect and approve the rough cut, promotional, or finished product.

I warrant that I am over the age of 18 and that I am free to enter into this Agreement [on behalf of my minor child].

[If a minor is used, all statements should be amended and additional signature lines should be added for a parent or guardian. Unless the participating minor cannot write, the minor also must sign the release form.]

By signing this release, I hereby agree to hold AHRQ harmless from and against any and all claims, liabilities, losses, or damages that may arise from my participation in this production.

Signature:_____________________________________________________________________

Printed Name:__________________________________________________________________

Address:______________________________________________________________________

Phone Number: (area code) xxx-xxxx     Email:_______________________________________

Date signed:___________________________________________________________________

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Location Release

This release is used to obtain official permission to record at a particular location. This is not the same thing as obtaining a government permit to record on government property, in cases when a permit(s) is required.

Location Release for [Name of the LOCATION]

For [Purpose or Name of Event]

The undersigned (“Administrator”) hereby grants to the Agency for Healthcare Research and Quality (AHRQ) and [Contractor] (collectively known as the “Producer”) the permission, right, and license to photograph, record, audiotape, and videotape at this location (known as the “Premises”) [may need to be more specific, such as floor, wing, room] located at [complete address with ZIP code] for a media production (“Project”) that is tentatively titled [INSERT NAME].

Under the terms of this agreement, Producer is permitted to occupy and use the Premises for the period beginning [date and time period if relevant]. During this period, Producer may place all necessary sets and equipment on the Premises, including possibly blocking some doors (but not emergency exits), and running extension cords through the hallways.

Producer agrees to exercise reasonable care to protect the Premises from damage and to leave the Premises in the condition in which they were found. Producer warrants that it carries liability insurance that covers the presence of production employees and the operation of equipment on the Premises. Producer further warrants that it will hold the Administrator harmless from, and indemnify against, any injury to any person(s) that may occur on the Premises as a result of Producer’s activities [this provision applies only to the Contractor]..

Under the terms of this license, unless Administrator has asked for specific exceptions, any pictures or recordings taken of the Premises, including those of any signs that may appear on the property, will become the sole and exclusive property of AHRQ in perpetuity. AHRQ will retain the full and irrevocable right to produce, copy, distribute, exhibit, and transmit the pictures and recordings by means of broadcast/cablecast, digital audio or video, DVD, print, internet, or virtually or by any other electronic or mechanical method or medium now known or hereafter invented. The Administrator’s successors and assigns shall have no right to bring legal action against Producer for any use of the pictures or recordings.

Administrator represents and warrants that Administrator has the full authorization to grant Producer the license and other rights granted herein. Administrator understands that Producer is relying on Administrator’s consent and agreement herein for Producer to proceed with preparation, production, and exhibition of the Project. Administrator agrees to indemnify and hold harmless the Producer, Producer’s employees, agents, assigns, and successors from and against any loss, damage, cost, and liability resulting from any breach by Administrator of any of the terms hereof.

[If there is any fee or other compensation being paid to the location for use of their Premises, it should be spelled out here.]

Nothing in this agreement shall obligate Producer to use the Premises for filming or recording or to include material shot on the Premises in the Project. Producer may at any time cancel this agreement by notifying Administrator in writing of its intent not to use the Premises. [Again, if there’s any compensation due, there should be something here spelling out what happens in case of cancellation by either side.]

AGREED AND ACCEPTED:

Administrator:

Printed Name and Title: ___________________________________________________

Signature: ______________________________________________________________

Date: __________________________________________________________________

For Producer:

Printed Name and Title: ___________________________________________________

Company Name: _________________________________________________________

Signature: ______________________________________________________________

Date: __________________________________________________________________

Company Address: _______________________________________________________

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HHS Presentation Agreement

Representations:  I hereby represent to (Conference Sponsor) that, with respect to the presentation titled ________________________________________________________,

• I have prepared the presentation as part of my official duties as a Department of Health and Human Services (HHS) employee.
• I have obtained permission from copyright owners of any excerpts from copyrighted works that are included in the presentation and have credited those sources in the presentation.

Copyright. 17 U.S.C § 105 states that copyright protection is not available in the United States for any work of the U.S. Government. Since the presentation was done as part of my official duties as an HHS employee, the presentation is a work of the U. S. Government and as such is in the public domain.

I hereby permit the conference sponsor to record on film, tape, digital storage medium, or otherwise, the above presentation for any and all uses, except that the conference sponsor may not give the appearance that HHS endorses any products, services, or policies of the conference sponsor or any other non-Federal entity. The conference sponsor shall not compensate me for work done as part of my official duties. 

This agreement shall be governed and construed in accordance with Federal law as interpreted by the Federal courts in the District of Columbia.

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