Office of Research Compliance (ORC) Export Controls Questionnaire
Directions: The following are standard questions used to assess whether any further actions (e.g. application for an export controls license) are needed to ensure compliance with export controls regulations. Please answer to the best of your knowledge.
Please contact the ORC for any assistance: or (516) 465-2567
QUESTIONS
/ YES / NO1 / Are you sharing, shipping, hand carrying, transmitting or transferring Northwell Health-developed, non-commercialencryption softwarein source code* or object code*(including travel outside the country with such software)?
*Source code is generally understood to mean programming statements that are created by a programmer with a text editor or a visual programming tool and then saved in a file. Object code generally refers to the output, a compiled file, which is produced when the Source Code is compiled with a C compiler. The object code file contains a sequence of machine-readable instructions that is processed by the CPU in a computer. Operating system or application software is usually in the form of compiled object code.
2 / Do you know or have any reason to believe that the item, information or software to be shared, shipped, hand carried, transmitted or transferred will support the design, development, production, stockpiling or use of anuclear explosive device, chemical or biological weapons, or missiles?
3 / Was the item, information or software to be shared, shipped, hand carried, transmitted or transferred developed under a sponsored agreement imposingpublication restrictions beyond a brief review (up to 90 days) for patent protection and/or inadvertent release of confidential/proprietary information?
4 / Did an external sponsor, vendor, collaborator or other third party providethe item, information or software to be shared, shipped, hand carried, transmitted or transferredunder aNon-Disclosure Agreement or a Confidentiality Agreement?
4a / If YES to 4 above: Is the item, information or software provided under a Non-Disclosure Agreement or a Confidentiality Agreementcentral to the research programand/or do the disclosure restrictions affect theability to publish the research results?
5 / Is the item being shared, shipped, hand carried, transmitted or transferred adefense article*other than information or software on the ITAR'sUS Munition List(USML)?
*A defense article is specifically designed, developed, configured, adapted, or modified for a military application, and does not have predominant civil applications, anddoes not have performance equivalent (defined by form, fit and function) to those of an article or service used for civil applications;and has significant military or intelligence applicability (examples are satellites, spacecraft and their subsystems, fully field-deployable systems for military use, and space-qualified for radiation hardened microcircuits); or is on theUS Munitions List(USML, the US State Department ITAR list).
If you provide information below the ORC can check against the USML
Item information:
6 / Is the information or software being shared, shipped, hand carried, transmitted or transferredtechnical data*on the ITAR'sUS Munition List(USML)?
*Technical data means: Information, other than software, which is required for the design, development, production, manufacture, assembly, operation, repair, testing, maintenance or modification of defense articles. This includes information in the form of blueprints, drawings, photographs, plans, instructions and documentation; classified information relating to defense articles and defense services; information covered by an invention secrecy order; and software directly related to defense articles.
Technical data does NOT include information concerning general scientific, mathematical or engineering principles commonly taught in schools, colleges and universities, information in the public domain, or information generated in the course of performingfundamental research.It also does not include basic marketing information on function or purpose or general system descriptions of defense articles.
If you provide information below the ORC can check against the USML
Information or software:
QUESTIONS (Cont’d)
/ YES / NO6a / If YES to 6 above: Is the USML-listed information or software being shared, shipped, hand carried, transmitted or transferred eitherpublished, patented or generally accessible and availableto the public?
6b / If NO to 6a above: Is the USML-listed information or software to be disclosed, transmitted or transferred to aforeign personin the US, other than to qualified Northwell Health employees, or to a foreign person outside of the US?
6c / IfNO to 6b above: Is the disclosure*, shipment, hand carry, transmission, or transfer, to include laptops, tablets, smart phones and other digital devices,to an entity or person in the UN arms embargoed countries of North Korea or Iraq, to one of the countries identified by the US Department of State as a "State Sponsor of Terrorism" (Iran, Sudan, Syria) or to Cuba or the Crimea Region of the Ukraine?
* Under US export control regulations, "disclosure" includes both oral and visual disclosure.
7 / Are you shipping, hand carrying or transferring items on the Commerce Control List (CCL) of the Export Administration Regulations (EAR), other than a laptop, tablet or smart phone?
If you provide the item ECCN or informationbelow the ORC can check against the CCL
Item ECCN or information:
7a / If YES to 7 above: Is the CCL-listed item to be shipped or hand carried to a foreign country?
7b / If NO to 7a above: Is the disclosure*, shipment, hand carry, transmission, or transfer, to include laptops, tablets, smart phones and other digital devices,to an entity or person in the UN arms embargoed countries of North Korea or Iraq, to one of the countries identified by the US Department of State as a "State Sponsor of Terrorism" (Iran, Sudan, Syria) or to Cuba or the Crimea Region of the Ukraine?
* Under US export control regulations, "disclosure" includes both oral and visual disclosure.
8 / Are you sharing, hand carrying, transmitting or transferringtechnology (information) or software codeon the Commerce Control List (CCL), other than retail-level technology and softwareon a laptop, tablet or smart phone?
If you provide the technology/software code infobelow the ORC can check against the CCL
Technology or software code:
8a / If YES to 8 above: Is the Commerce Control-Listed information or software that you are going to share, ship, hand carry, transmit or transfer eitherpublished, patented or generally accessibleto the interested public in any form?
8b / If NO to 8a above: Is the Commerce Control-Listed information or software that you are going to share, ship, transmit or transfer arise during or result from industrially sponsored orthird party proprietary research, not ordinarily published and shared broadly within the scientific community(1)?
9 / Is the disclosure, shipment, hand carry, transmission, or transfer, to include laptops, tablets, smart phones and other digital devices,to an entity or person in the UN arms embargoed countries of North Korea or Iraq, to one of the countries identified by the US Department of State as a "State Sponsor of Terrorism" (Iran, Sudan, Syria) or to Cuba or the Crimea Region of the Ukraine?
If you have answered YES to any questions there may be an export control concern and the ORC may need to follow-up with you regarding your proposed activity.
I attest that the information provided on this questionnaireare true and accurate to the best of my knowledge.
Completed by: / Date:Internal/ORC Use Only
ORC Reviewer: / Date:No further review required
Requires follow-up for potential export control license
These questions have been adapted from Stanford University’s Decision Tree as they have granted us permission to adapt their content for Northwell Health’s
export controls compliance review for research.1