UTMB RECORD OF EXPORT CONTROL REVIEW FORM
For Confidential Disclosure Agreements
Name of UTMB Faculty Member:
___________________________________
Department:
_______________________________________________
Title:
_______________________________________________
Date:
_______________________________________________
Technical Review (To be completed By UTMB Faculty)
Are you the Disclosing Party or the Receiving Party?____________________________________________
Please provide complete information of the Receiving Party:
Name: _________________________________________________________________________
Address:________________________________________________________________________
________________________________________________________________________
Briefly describe technical know-how information that will be transferred to the Receiving Party (attach page if
necessary). If the discussion will involve the transfer of information biological materials, please clarify the cellular
component or the complete organism.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Will you or the UTMB representative in the talk:
Yes
No
Disclose technology * (see definition) involving the
development* (see definition)
or production* (see definition) of said Material
to a foreign national/person?
____
____
-If yes, is the technology published or publicly available?
Disclose research information or software that could be used
in the development of weapons of mass destruction
(nuclear, biological, chemical) or their delivery systems?
____
____
____
____
By signing below, I certify that I have read this document and completed the appropriate sections to the best of my
knowledge and belief:
______________________________
Faculty signature
_________________________
Date
Please return completed form by fax, scan, or email to:
Office of Technology Transfer
magrove@utmb.edu
Fax: (409) 772-0370
Phone: (409) 772-0376
*This document must accompany the CDA in UTMB CTD files*
Definitions of EAR Part 772
TECHNOLOGY- (General Technology Note) – Specific information necessary for the “development”, “production”,
or “use” of a product. The information takes the form of a product. The information takes the form of “technical data”
or “technical assistance.”
“Technical Assistance”- may take forms such as instruction, skills, training, working knowledge, consulting services.
NOTE: “Technical assistance” may involve transfer of “technical data.”
“Technical data”- may take forms such as blueprints, plans, diagrams, models, formulae, tables, engineering designs and
specifications, manuals and instructions written or recorded on other media or devices such as disk, tape, read-only
memories.
DEVELOPMENT-(General Technology Note)- “Development” is related to all stages prior to serial production, such
as: design, design research, design analyses, design concepts assembly and testing of prototypes, pilot production
schemes, design data, process of transforming design data into a product, configuration design, integration design,
layouts.
PRODUCTION- (General Technology Note) Means all production stages, such as: product engineering, manufacture,
integration, assembly (mounting), inspection, testing, quality assurance.
REQUIRED- As applied to “technology” or “software”, refers to only that portion of “technology” or “software”
which is peculiarly responsible for achieving or exceeding the controlled performance levels, characteristics or
functions. Such “required” “technology” or “software” may be shared by different products.
For a full list of Materials that are controlled, go to this link.: http://www.access.gpo.gov/bis/ear/pdf/ccl1.pdf
Most of UMTB’s infectious material is listed under ECCN 1C351