Export Declaration of Defense Technical Data or Services

OMB Approval No. 1405-0157

EXPIRATION DATE: 6-30-2013

*ESTIMATED BURDEN: 30 minutes

U.S. Department of State

Instructions for Form DS-4071 – Export Declaration

of Defense Technical Data or Services

Block 1 – File Name: This is the name of the text file you would like to save your export information to for later transmission to the Directorate of Defense Trade Controls (DDTC).

Block 2 – Registration Type Code: This is the first letter in your DDTC Registration Code, either an “M” for manufacturer/exporter, or “K” for broker.

Block 3 – Registration Number: The remainder of your DDTC registration code. This should be either a dash (-) followed by four digits or no dash and five digits.

Block 4 – License Type: The DSP form number of the license (or the type of agreement) you are using to export (e.g., 05, 85, TA, MA, AG, etc.).

Block 5 – License Number: The license number or agreement number you are exporting against.

Block 6 – ITAR Exemption Number: If shipping pursuant to an ITAR exemption, provide the section number of 22 CFR you are citing for your export (e.g., 126.5b, 125.4b, etc.).

Block 7 – Destination Country: The country of ultimate destination for your export. Select from a drop down list of countries.

Block 8 – Port or Method of Export: If technical data is being shipped through a U.S. port, enter the city name of that port. If it is being transmitted via oral, visual, or electronic means, cite the method of export.

Block 9 – Export Date: The date the export will take place (mm/dd/yyyy).

Block 10 – Value of Goods: The commercial value of the technical data you are providing or the defense services you are rendering.

Block 11 – SME: If the technical data or defense service being exported qualifies as significant military equipment under 22 CFR §120.7, please check this box.

*PAPERWORK REDUCTION ACT STATEMENT: Public reporting burden for this collection is estimated to average 15 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, DC 20520.

DS-4071 Instruction Page 1 of 2

Block 12 – Eligibility Certification: By checking this box, you are certifying that you, and all other parties to this transaction, are eligible to engage in defense trade pursuant to 22 CFR §120.1.

Block 14 – Unit of Measure: Appropriate unit of measure for the physical packaging of technical data being exported. Not required for defense services or oral, visual or electronic transmission of technical data.

Block 15 – Quantity: Quantity corresponding to the unit of measure in Block 14 describing the physical packaging of technical data being exported. Not required for defense services or oral, visual or electronic transmission of technical data.

Block 16 – Commodity Description: Free text description of the technical data exported or defense service rendered.

Block 17 – USML Code: The category and subparagraph (e.g., VIIIi) of the U.S. Munitions List (USML), 22 CFR 121.1, which describes the technical data exported or defense service rendered.

Block 18 – Commodity Code (reserved for future use): Select from the drop down list the commodity characterization that best describes the technical data or defense service being rendered.

Block 19 – Foreign End-User: The name, address, and contact information for the ultimate end-user of the technical data exported or defense service rendered.

Block 20 – Foreign Consignee: The name, address, and contact information for the foreign consignee (if any) of the technical data exported or defense service rendered.

Block 21 – Foreign Intermediate Consignee: The name, address, and contact information for the foreign intermediate consignee (if any) of the technical data exported or defense service rendered.

Block 22 – U.S. Consignee: The name, address, and contact information for the U.S. consignee/freight forwarder (if any) of the technical data exported or defense service rendered.

DS-4071 Instruction Page 2 of 2