Form DS-6004 APPLICATIONS (REEXPORTS AND RETRANSFERS)

Request to Change End User, End Use and/or Destination of Hardware

Reexport Retransfer requirements

Request to Change End User, End Use and/or Destination of Hardware

OMB: 1405-0173

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DS-6004 - 123.9(c) Applications (Reexports and retransfers)

  • Cover Page

    • Transaction ID (optional)

    • Documentation (as listed in 123.1)

      • Technical Data (optional)

      • Brochures (optional)

      • Purchase Order documentation (At least one of the following is required)

        • Purchase Order

        • Contract

        • Letter of Intent

      • DSP-83 (conditional - if USML is SME)

      • 22 CFR 126.13 Certification by a responsible official empowered by the applicant (required)

      • 22 CFR 130 Certification (optional)

      • Part 130 Letter (optional)

      • Contracts (optional)

      • Other (optional)

  • Block 1 - 2 – Basic Information

    • 1. Date Prepared [auto generated]

    • 2. Application Information

      • Name

      • Attention

      • Address

      • City

      • State

      • ZIP Code

      • Country

      • Telephone #

      • Extension

  • Block 3 – 4 – Change Information

    • 3. Previous Authorization/License Number (required)

    • 4. 123.9(c) Type (required, must select one)

        • Reexport

        • Retransfer

        • Disposition

  • Block 5 - 6 – Commodity Information

    • 5. Item Information (required)

      • Quantity

      • Commodity Description

      • USML Category

      • Unit Price

      • Line item total [auto calculated]

      • Add Button

    • 6. Total Value [auto calculated]

Block 7 - 9 – Describe changes

    • 7. Entities

      • Type

        • End User (required and default selection)

        • Foreign Consignee

        • Foreign Intermediate Consignee/Freight Forwarder

        • Manufacturer of Commodity

        • Source of Commodity

        • U.S. Seller

        • U.S. Consignor/Freight Forwarder

      • Name

      • Address

      • City

      • State/Province

      • Country

      • Zip/Postal Code

    • 8. Description of new End-Use (required)

    • 9. New Country of Ultimate Destination (conditionally required – only if type is reexport)


On successful submission, assign case number. Numbering convention is GC-####-YY. Number resets yearly back to 001.


Follow same rules for internal business rule validation...

  • Verify registration code is valid (exists, name and code match and not expired)

  • Run names through watchlist

  • Flag any licensing warnings (countries)

  • Assign case based on USML category



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File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCarlton, Meredith J
File Modified0000-00-00
File Created2021-01-22

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