EXPORT COMPLIANCE REVIEW OF A FOREIGN TRANSACTION (SPONSORED PROJECT) PI Name: Sponsor: Project Title: Date:
OSP No:
Export Log No.: The following foreign transactions have been identified or requested as part of the above‐referenced Project and require a review by the Office of Sponsored Programs to ensure University compliance with U.S. export laws and regulations. Please complete all applicable sections. FOREIGN TRAVEL (complete applicable sections below based on the purpose of travel)  FOREIGN TRAVEL FOR RESEARCH PERFORMANCE/COLLABORATION (complete Sections A & E)  FOREIGN TRAVEL TO ATTEND CONFERENCES/MEETINGS/SYMPOSIA (complete Section B) FOREIGN VISITORS TO PSU (complete Sections C & E) FOREIGN DELIVERY / FOREIGN SHIPMENTS (complete Sections D & E) REVIEW OF USML & CCL (complete Section E) SECTION A – Foreign Travel for Research Performance/Collaboration 1.
Traveler name(s), if currently known: 2.
Identify all countries where the research/collaborations will take place. 3.
Provide the name(s), and, if known, the nationality of all foreign persons with whom you will be collaborating, as well as their affiliated Institutions/Organizations. 4.
Identify all equipment, materials, software, or technical data that you will be taking with you or shipping abroad. 5.
Identify any items listed above that will not be returned to the U.S. when the project is complete. SECTION B – Foreign Travel to Attend Conferences/Meetings/Symposia 6.
Traveler name(s), if currently known: 7.
Provide the name and/or web link of the conference/meeting/symposia. 8.
Provide the name of the hosting entity/institution (this is typically who we are paying a registration fee). 9.
Identify the country where the conference/meeting/symposia is being held. SECTION C – Foreign Visitors to Penn State 10. Provide the name(s) and, if known, the nationality of all foreign visitors, as well as their affiliated Institutions/Organizations. 11. Identify all Penn State facilities to which foreign visitors will be provided access. 12. Identify any equipment, materials, software, or technical data that will be provided to the foreign visitors by Penn State for their use or training under this Project. 13. Identify any Penn State‐provided equipment, materials, software or technical data that will be retained by the foreign visitors after departing from Penn State. SECTION D– Foreign Delivery / Foreign Shipments 14. Other than reports, identify any goods, materials, prototypes, or services you will be providing to a foreign location. SECTION E – Assertions I have personally reviewed the U.S. Munitions List (22 CFR §121) and the Commerce Control List (15 CFR § 774, Supp. 1) (review categories 0 – 9) at the provided links in order to answer the following questions: a. Does the research being performed relate to any technologies on either the U.S. Munitions List and/or the Commerce Control List? (Please Initial) Yes______ No______ b. Are any of the items listed in Questions 4, 12, 13 or 14 above (if applicable) on the U.S. Munitions List and/or the Commerce Control List? (Please Initial) Yes______ No______ c. If either (a) or (b) above are checked “Yes” ‐ use the space below to identify the specific technologies and items (including the categories under which they fall on the above linked lists). By signing below, I certify that: 1. I have read and understood this document, have reviewed the U.S. Munitions List and/or the Commerce Control List at the links provided, and have completed the appropriate sections to the best of my knowledge and belief. 2. I understand that I may be held personally responsible for any penalties and fines – including criminal fines and imprisonment – that result from failing to comply with or attempting to evade export control law. 3. If my answers to any of the questions provided on this form change during the course of the project, I will update this form and submit it to the Office of Sponsored Programs (export‐osp@psu.edu) for review. Principal Investigator Signature Date (Revised 4.7.15 blb)