CLDP Export Control Request Form- template.pdf
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- Solicitation number
- 80JSC025REQ_SAFETY_TIM
About this file
The document is an Export Control Request Form template used by NASA's Commercial Low Earth Orbit (LEO) Development Program to obtain access to export-controlled scientific and technical information. The form requires comprehensive company and individual details, including full company name, address, CAGE code, point of contact information, and specific individual data such as citizenship status and nationality.
The form emphasizes strict compliance with U.S. export regulations, mandating that companies verify the accuracy of submitted information. For non-U.S. persons, additional requirements include potential Individual Technology Transfer Control Plans (I-TTCP) and Non-Disclosure Agreements (NDA), particularly for foreign nationals from designated countries. The template is designed to ensure rigorous screening and documentation of individuals seeking access to sensitive export-controlled data, with the ultimate responsibility for regulatory compliance resting with the submitting company.
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OBTAINING ACCESS TO EXPORT CONTROLLED CONTENT:
Individuals requesting access to the export controlled scientific and technical information must provide the following information to the Contracting Officer through an authorized manager of their company’s Security or Human Resources Offices. That authorized individual shall verify that the information provided to NASA is correct, complete, and accurate. Companies are responsible for ensuring their compliance with all U.S. export regulations:
1. Full Company Name:
2. Company Address:
3. Is this a corporation, business association, partnership, society, trust, or any other entity, organization or group that is incorporated to do business in the United States? Yes No
4. Commercial and Government Entity (CAGE) Code:
5. Company Security or Human Resources Point of contact(s) providing/verifying information about the individual requesting access
a. Name and Title:
b. Phone Number:
c. e-mail:
6. List the names of all individuals requesting access to the export-controlled data including:
a. Name:
b. The individual (s) named above is/are or is/are not a U.S. person as defined in Title
22, Code of Federal Regulations, Section 120.15
c. If the individual is not a U.S. person what is their citizenship?
ALTERNATE 6b: Citizenship: Specify Citizenship
Non-U.S. Persons must list any other countries to which individual claims citizenship:
List Place of Birth:
All foreign nationals from designated countries covered by a Programmatic Technology Transfer Control Plan (P-TTCP) or requiring access to export controlled information are required to have an Individual Technology Transfer Control Plan (I-TTCP) with a Non-Disclosure Agreement (NDA). Foreign nationals from non-designated countries requiring access to export-controlled information covered by a P-TTCP are required to comply with the International Partner or Foreign National Certification contained in the P-TTCP.
Point of Emphasis:
The Company is responsible for ensuring compliance with the export regulations.
Points of Contacts:
Organization Export Control Representative if assigned.
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