DSP-119 Application for Amendment to License for Export/Import o

DSP-119:

Application for AMENDMENT to License
for Export/Import of Defense Articles

Required fields are in red and marked with an asterisk.

*Transaction ID:              *PIN:
1. *Date Prepared       (mm/dd/yyyy)	2. *License Type (check one)	3. *Registration Code
	DSP5 DSP61 DSP73 DSP85

5. Applicant Name & Address	6. Applicant Contact
Phone:
6. Amendment to Blk(s) # (up to 4 )	7. *Amendment to License #:

a. *Change From (original license)	Change to (as it should appear)
Reason for change
b. Change From (original license)	Change to (as it should appear)
Reason for change
c. Change From (original license)	Change to (as it should appear)
Reason for change
d. Change From (original license)	Change to (as it should appear)
Reason for change
8. DIS Security Office (DSP85 Only)	9. Amendment to be sent to
10. *Applicant's Name
I, , hereby apply for approval of the above ammendment(s); warrant the truth of all statements made herein; and acknowledge, understand and will comply with the provisions of Title 22 CFR 120-130 and any condiitons or limitations implied. Adds party such as freight fwd Freight forwarder list attached

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Applicant's Statement

The natural person submitting this application is (check one only):

a citizen of the U.S. or
lawfully admitted to the U.S. for permanent residence or
an official of a foreign government entity in the U.S.

 

OMB Approval No. 1405-0092
Expiration Date: 11-30-2011
* Estimated Burden: 1/2 Hour

* Public reporting burden for this collection of information is estimated to average 1/2 hour 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: U.S. Department of State (A/RPS/DIR) Washington, D.C. 20520-0264, and to the Office of Information and Regulatory Affairs, Office of Management and Budget, Paperwork Reduction Project (1405-0023), Washington, D.C. 20520

Privacy Act Statement

Authorities: The information solicited on this form is sought pursuant to 22 U.S.C. 2778(g)(5) and 22 CFR �120.1(c).

Purpose: The information solicited on this form is necessary to determine eligibility to obtain approval of the application to amend a license.

Routine Uses: The information on this form may be made available to appropriate agencies for law enforcement or pursuant to a court order. It may also be used to send required reports to the Congress regarding certain defense trade transactions.

Providing the information requested on this form is voluntary, but failure to do so may result in denial of the application.