CLDP Export Control Request Form-template

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:
Recipient certifies that neither it nor any employees to whom RECIPIENT distributes the NONPUBLIC TECHNICAL DATA is a foreign person (as defined by 22 CFR §120.16) or listed on any of the “Designated Countries List” listed in the following link. 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.