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Support packages are a collection of fixes that have come out after the official release of an SAP software solution.
Notice, though, that some support packages are preloaded with the system. R/3 Enterprise SR1 is a good example of that.
An add-on is a component that can be loaded into an SAP software solution.
Examples: PI, PI_BASIS, SOA 1.0 (CGVMIC).
The CGVMIC is the Management of Internal Controls add-on, which is part of the Sarbanes & Oxley Compliance Tool. New SAP releases come with some add-on preloaded, too. PI (Plug-In) is a good example. It's used to exchange data with other applications such as BW and APO.
A CRT (Conflict Resolution Transport) is used when you have installed an Add-on and Support Packages that conflict with each other.
Who decides about what patch should be applied and when?
That's a good question. The answer is: You, the customer.
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