Form DS-6 Application for Amendment to License for Export or Impor

DSP-6 - Application for Amendment to a DSP-5 License

Block 1
*PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection
of information is estimated to average 30 minutes per response, including time required for
searching existing data sources, gathering the necessary data, providing the information required,
and reviewing the final collection. Send comments on the accuracy of this estimate of the burden
and recommendations for reducing it to: Department of State (A/GIS/DIR) Washington, D.C.
20520.
Transaction Number
Enter your internal submission company identifier for this application.
Classified Information must NOT be included, or referred to, in the form.
Classified information must be sent separately to PM/DDTC in accordance with Defense
Security Service guidelines. For issues that may pertain to classified information, contact the
DDTC Response Team.
Classified information is being sent under separate cover help
Required Documents
•

Copy of DoS License with PM/DDTC Proviso(s)

Document Type

File Name

Remove

Document Type (drop down menu)
Document to upload

Choose File
Upload

Block 2
DDTC Registration Code
Select your registration code. If no codes are displayed, confirm you have an active registration
code prior to submitting a license application.
Registration Code
Select your registration code for this application.
Block 3
Applicant

Provide all Applicant information. If you are a subsidiary provide your parent company's
information in the Applicant information and check the Subsidiary checkbox to provide your
information.
Subsidiary
Select if the applicant/requester is a subsidiary of the PM/DDTC registered company to which
the PM/DDTC registration code belongs.
Name (read-only)
Attention
Enter the first and last name of the person who is responsible for this application for the
applicant.
Address
Incomplete/imprecise addresses or use of P.O. boxes will result in your request being RWAed.
City
State (drop down menu)
Zip Code
Telephone
Extension

Block 4
Amendment to License #
I certify that the stated license has an unshipped balance and has not expired.

Block 5
Amendment in Accordance with
Amendment in Accordance with
o 22 CFR 123.25
o 22 CFR 122.4

Block 6
Applicant Point of Contact

Provide all information for individuals who are familiar with the transaction and who can respond to questions from
PM/DDTC or other government agencies. The individual(s) should be prepared to answer procedural and/or
technical questions. To enter one or more applicant contacts, click the "Add Entry" button.

* Name
* Telephone
Extension
*Email

Block 7
Summary of Amendment(s) to DSP-5
Select all block(s)/amendment type(s) being amended. The blocks that may be amended on a DSP-5 license are:
Block 2, 5, 9, 10, 12, 13, 15, 16, 17, 18, 19 and 21. To ensure the right selections have been made, only the items
selected in this block will become enabled for editing.
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DTCC Acknowledgment Letter (Modify Blocks 2, 5, 15, 17, 19, and/or 21)
Modify Applicant/Registrant Code
Modify Block 5, Applicant/Subsidiary
Correct Block 9, Quantity
Correct Block 10, Commodity Description
Correct Block 12, $ Value
Correct Block 13, Total Value
Correct Block 14, Foreign End-User
Modify Block 15, Manufacturer of Commodity
Modify Block 16, Foreign Consignee
Modify Block 17, Source of Commodity
Modify Block 18, Foreign Intermediate Consignee
Modify Block 19, Seller in U.S.
Modify Block 21, U.S. Consignor and/or U.S. Freight Forwarder

Block 8
Additional Details
Additional Details of Transaction

This application is related to a disclosure filed with Defense Trade Controls Compliance

*Enter Compliance Disclosure Number

USML Category (drop down)

Block 9
Applicant Statement
I, _____________________________, an empowered official (22 CFR 120.67) or an official of
a foreign government entity in the U.S., hereby apply for approval of the above amendment(s);
warrant the truth of all statements made herein; and acknowledge, understand and will comply
with the provisions of 22 CFR 120-130, and any conditions and limitations imposed.
I am authorized by the applicant to certify the following in compliance with 22 CFR 126.13:
1. Neither the applicant, its chief executive officer, president, vice presidents, other senior
officers or officials (e.g., comptroller, treasurer, general counsel) nor any member of its
board of directors is:
a. the subject of an indictment for or has been convicted of violating any of the
U.S. criminal statutes enumerated in 22 CFR 120.6 since the effective date of
the Arms Export Control Act, Public Law 94-329, 90 Stat. 729 , or
b. ineligible to contract with, or to receive a license or other approval to import
defense articles or defense services from, or to receive an export license or
other approval from any agency of the U.S. Government;
2. To the best of the applicant's knowledge, no party to the export as defined in 22 CFR
120.68(a) has been convicted of violating any of the U.S. criminal statutes enumerated in
22 CFR 120.6 since the effective date of the Arms Export Control Act, Public Law 94329, 90 Stat. 729 (June 30, 1976), or is ineligible to contract with, or to receive a license
or other approval to import defense articles or defense services from, or to receive an
export license or other approval from any agency of the U.S. Government.
22 CFR 126.13 Certification
a. I am authorized by the applicant to certify that the applicant and all the parties to the
transaction can meet in full the conditions of 22 CFR 126.13 as listed above.
b. I am authorized by the applicant to certify to 22 CFR 126.13. The applicant or one of the
parties of the transaction cannot meet one or more of the conditions of 22 CFR 126.13 as
listed above. A request for an exception to policy, as described in 22 CFR 127.11 of the
ITAR, is attached.

c. I am authorized by the applicant to certify to 22 CFR 126.13. The applicant or one of the
parties of the transaction cannot meet one or more of the conditions of 22 CFR 126.13 as
listed above. However that party has met the conditions imposed by the Directorate of
Defense Trade Controls in order to resume standard submission of applications, not
requiring an exception to policy as described in Section 127.11 of the ITAR.
d. I am not authorized by the applicant to certify the conditions of 22 CFR 126.13. The
applicant and all the parties to the transaction can meet in full the conditions of 22 CFR
126.13 as listed above. Please see the attached letter from an official that is authorized by
the applicant to certify to the conditions of 22 CFR 126.13.
e. I am not authorized by the applicant to certify the conditions of 22 CFR 126.13. The
applicant or one of the parties of the transaction cannot meet one or more of the
conditions of 22 CFR 126.13 as listed above. A request for an exception to policy, as
described in 22 CFR 127.11 of the ITAR, and a letter from an official that is authorized
by the applicant to certify to the conditions of 22 CFR 126.13 are attached.
f. I am not authorized by the applicant to certify to 22 CFR 126.13. The applicant or one of
the parties of the transaction cannot meet one or more of the conditions of 22 CFR 126.13
as listed above. However that party has met the conditions imposed by the Directorate of
Defense Trade Controls in order to resume standard submission of applications, not
requiring an exception to policy as described in 22 CFR 127.11 of the ITAR. Please see
the attached letter from an official that is authorized by the applicant to certify to the
conditions of 22 CFR 126.13.

Privacy Act Statement
AUTHORITIES: The information is sought pursuant to the Arms Export Control Act (22
U.S.C. 2751 et seq.), the International Traffic in Arms Regulations (22 CFR Parts 120-130) and
Executive Order 13637.
PURPOSE: The principal purpose of this information collection is to allow the Directorate of
Defense Trade Controls (DDTC) to process Applications/Licenses for Defense Articles or
Services in accordance with the Arms Export Control Act and the International Traffic in Arms
Regulations.
ROUTINE USES: The information collected may be made available to appropriate agencies for
law enforcement or pursuant to a court order. They may also be used to send required reports to
Congress about certain defense transactions. More information on the Routine Uses for the
system can be found in the System of Records Notice State-42, Munitions Control Records.
DISCLOSURE: Disclosure of this information is required to obtain benefits. Failure to provide
the information requested on this form may result in delays in considering an application or in an
application not receiving full consideration.