UNLV Export Control Review Form

Principal Investigator:

Department:

Title of Sponsored Research:

Proposal/Award Number:

Sponsor:

PART 1: PROPOSAL/AGREEMENT REVIEW (To be completed by OSP staff; if “yes” is marked, advance this form to the Executive Director of OSP.)

Does the proposal/agreement contain any provision that:

  1. Explicitly states that U.S. export regulations apply or technology is export controlled?

Yes No If “yes,” provide details:

  1. Restricts non-U.S. entity/non-U.S. citizen participation based on country of origin?

Yes No If “yes,” provide details:

c. Specifically states that fundamental research exclusion or other exclusion available to universities does not apply?

Yes No If “yes,” provide details:

d. Technology or data appears on ITAR Munitions’ list or Commerce Department’s Control list?

Yes No If “yes,” provide details:

e. Research involves classified, secured or top secret materials?

Yes No If “yes,” provide details:

f. Includes any publication restrictions such as grants the sponsor a pre-approval right over research publications for matters other than inclusion of patent or proprietary sponsor information?

Yes No If “yes,” provide details:

g. Allows the sponsor to claim resulting research information as proprietary or trade secret?

Yes No If “yes,” provide details:

h. Includes work with or materials to any embargoed country (http://www.treasury.gov/resource-center/sanctions/Programs/Pages/Programs.aspx)?

Yes No If “yes,” provide details:

i. Award contains DFARS 252.204-7000, disclosure of information?

Yes No If “yes,” provide details:

OSP Research Administrator Completing Form:

Research Administrator Comments:

Date Completed:

If any of the questions were answered “Yes,” the Research Administrator must consult with the Principal Investigator to determine if an export control issue exists.

In such event, the Principal Investigator must complete PART 2: TECHNICAL REVIEW.

PART 2: TECHNICAL REVIEW (To be completed by Principal Investigator)

To the Principal Investigator:

The Office of Sponsored Programs (OSP) has determined that the agreement for your sponsored research project identified above contains provisions that may require university compliance with export control laws and regulations that are issued by the Department of Commerce, State and/or Treasury. (See UNLV’s Export Control website for more information.) The final determination of the applicability of these regulations will be made through a collaborative process between you, the OSP, and the Office of Research Integrity (ORI). As a first step, as PI for the project, you are most qualified to describe your research and provide information that will allow for a determination of applicability of export regulations.

This form is used for an initial project review. Additional project review must occur when personnel or regulatory changes occur.

Please complete the below information in order for OSP and ORI to assist with an analysis of any potential export control restrictions.

  • Name and description of technology/software to be utilized in this project:
  • Names and citizenship of all individuals who will have access to this technology/software:
  • Proposed shipping/transport of this technology/software to which countries:

Printed Name of Principal Investigator:

Signature of Principal Investigator:

______

Date: ______

Updated Nov. 2011