Instructions(This formmust betyped).

  • ThisformmustaccompanyNAO 207-12, AppendixB,“Certification of ConditionsandResponsibilitiesforDepartmental Sponsors ofForeign National Guests”(same as DAO207-12, Attachment 2)
  • PartAand Cmustbe completedfor allrequests.PartBneedsto be completedonlyif theLO/SOhasnot completedcontrolledtechnology(CT) assessments atallfacilities. (Onlythe CTCcompletesPartB,ifnecessary)
  • If the foreign nationalwillaccess a NOAA vessel,the Marine Operations Center(MOC),a NOAA aircraft,or theAircraftOperations Center(AOC), the DSNmustcontacttheMOCorthe AOC forreportingrequirements.
  • The DSN sends these forms directlyto the LO/SO ControlledTechnologyCoordinator(CTC) or Designated Official.

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Part A. (Please complete Questions 1-6)

1. Is this a RENEWAL? Yes ☐ No☒2. Home Country:

3. Dates of Visit (Maximum one year; renew if necessary): 7/8/2017 to 8/31/2017

4. Non-NOAA Affiliation: 5. Title:

6.Justification: Please describe the collaboration andcontributions by the Foreign National (FN) Guest(named below).

Includespecific detail regardingtheFN’s affiliations (contract/organization/ government/education),qualifications,expertise,scope ofwork, andhowthis workwill further NOAA’smission. (NO ACRONYMS,includingNOAAoffices.)

  1. Collaborations and Contributions: [Name of Foreign National]has been invited to participate in the National Oceanic and Atmospheric Administration (NOAA) supported Gulf of Mexico Ecosystems and Carbon (GOMECC-3) cruise aboard the NOAA Ship Ronald H. Brown by the ocean acidification group at NOAA’s Atlantic Oceanographic and Meteorological Laboratory.
  2. Affiliation Contractor/Organization/Government/Education:
  3. Qualifications:
  4. Expertise:
  5. Scope of Work:
  6. How this work will further NOAA’s mission: The GOMECC-3 cruise is in direct support of the NOAA ocean acidification program, a cross-matrix program between four NOAA line offices (Office of Oceanic and Atmospheric Research, National Environmental Satellite, Data and Information Service, National Ocean Service, and National Marine Fisheries Service) to fulfill key objectives in Climate and Ecosystem portfolios.

I certify the benefits to be gained from hosting Foreign National’s Name will further NOAA's mission and have been balanced against the need to protect sensitive assets at NOAA and the risks associated with failure to protect these assets. I signed Appendix B to NAO 207-12, "Certification of Conditions and Responsibilities for Departmental Sponsors of Foreign National Guests," and I accept the responsibility for performing the duties set forth in Appendix B in order to manage the risks involved with sponsoring foreign nationals in federal facilities. In this regard, I will take all reasonable steps to ensure that my Guest will not have unauthorized physical, visual, or virtual access to classified, Sensitive But Unclassified (SBU), export controlled, proprietary, or not-for-public-release data, information, or technology.

Andrew J. Stefanick

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Click here to enter a date.

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R/V Ronald H. Brown

Printed Name of DSN

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Signature of DSN

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Date

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(Office/Lab/Program and Facility/Location Name-No Acronyms)

Optional:AdditionalPointofContactforthis request(emailaddress only):

Part B. (For LO/SOs thathave not completedCTassessments at allfacilities).A controlledtechnologyinventoryandAccess ControlPlanisinplace atthe site(s),identifiedon Appendix B, tobeaccessed bytheforeign nationalguest.Ihave advisedtheDSN ofaccesscontrolmeasures topreventtheunauthorizedreleaseof controlledtechnology.

CTC Name / / Click here to enter a date.
Printed Name CTC / Signature of CTC / Date

Part C. I concur that the value of collaboration and contributions gained by providing access to NOAA facilities, staff and information to the above named foreign national has been balanced with the need to protect classified, SBU, export controlled, or otherwise controlled, proprietary or not-for-public-release data, information, or technology. A controlled technology inventory has been completed and an Access Control Plan, documenting measures to prevent unauthorized release of controlled technology, is in place for the locations to be accessed by the foreign national.

Name / / Click here to enter a date.
Printed Name CTC or Designated LO/SO Official / Signature of CTC or Designated LO/SO Official / Date

The CTC forwards the complete ESF/Appendix B to the Chief Administrative Officer via .