UMass Dartmouth

Annual Certification in Support of EAR99 and/or

No License Required (NLR) Form

This form is used for more than one international shipment of the same item(s) to the same individual or organization, where all items have been subjected to an export license review and have been determined to qualify for export under either EAR99 and/or NLR as set forth by the Export Administration Regulations (EAR). EAR99 products may require a license depending on the customer and NLR shipments are not necessarily EAR 99. By filing this document with the Office of Research Compliance, the PI asserts that all such shipments:
a) relate to a fundamental research activity and
b) qualify for EAR99 and/or NLR status.
The information provided below is to document the item's eligibility for export under EAR99 and/or NLR (if the items is not EAR99, include the ECCN to support that it is NLR). Submit this form to nd retain a copy in your project files. In addition to filing this annual certification, departments must keep copies of all related shipping documents for 5 years, and provide them to the Office of Research Compliance upon request.

For unrestricted research, UMD conforms to both 15 CFR 734.3(b) (EAR) and 22 CFR 120.11(8) (ITAR) requirements for public domain and “fundamental research” may be considered excluded from those regulations. The research and development being performed falls within the parameters of fundamental research exclusion for technology/technical data established by National Decision Security Directive 189, as implemented by the pertinent export control regulations. However, UMD may accept research funding that imposes access, dissemination, or participation restrictions on the conduct, products, or results of its research. When restrictions are accepted, the research does not qualify for a Fundamental Research Exclusion if it involves items and activities subject to the EAR. A Technology Control Plan must also be in place for such research projects.

Project Title:

PI Name:

Department:

Contact Information (email, phone, address):

Describe briefly the item to be exported for this research activity:

Known end-user:

End-user organization:

Country of end-use:

ECCN (if not EAR99 but NLR):

Description of research in support of fundamental research and purpose of export:

Have you accepted restrictions on this research? Yes No

If yes, complete a Request to Ship Materials or Equipment Outside the U.S. form and submit to to determine whether a license or other action is required.

Principal Investigator Assurance

The item to be shipped outside the borders of the United States does not include encryption source code or software;

The item to be shipped will be used in support of fundamental research in other than an embargoed, sanctioned, or prohibited country(Cuban, Iran, N. Korea, Sudan, and Syria and for additional sanctions, check

The shipments of any chemical or biological materials will conform to all applicable laws governing their handling; such materials relate to the conduct, products or results of fundamental research;

The Institutional Compliance Office will receive a signed end user statement in advance of filing this document to screen for specific persons or entities subject to export prohibitions.

The following person will maintain copies of all relevant shipping documents for 5 years, specifying the end use and the end user for each shipment:

Name:Title:

Location: Phone ext.: Email Address:

PI Signature: Date: