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U.S. Department of State

Directorate of Defense Trade Controls

Electronic Form Version Number: 2.0

OMB APPROVAL NO. 1405-0163
EXPIRATION DATE: 3/31/2019
* ESTIMATED BURDEN: 4 HOURS

U.S. Department of State

DS-4076 Commodity Jurisdiction (CJ) Determination Form

(SEE INSTRUCTIONS PAGE | SEE QUICK REFERENCE GUIDE)

* PAPER WORK REDUCTION ACT STATEMENT: Public reporting burden for this collection of information is estimated to average 4 hours 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 (PM/DDTC) Washington, D.C. 20037.

Classified information must not be included, or referred to, in the form. For issues that may pertain to classified information, contact the DDTC Response Team.

  1. Filer Information
  2. CJ Determination Type
  3. Commodity/Service Type
  4. Commodity/Service Basic Information
  5. Commodity/Service Detailed Description
  6. Special/Unique Characteristics and Capabilities
  7. Commodity Origin
  8. Product Development Stage
  9. Funding History
  10. Sales Information
  11. Export/Classification Information
  12. Reason for Submitting CJ Request
  13. Publication
  14. Other
  15. Applicant/Submitter's Certification
Block 1. Filer Information
Filer Type:
Point of Contact:
Point of Contact {{$index+1}}:
Technical Point of Contact:
Technical Point of Contact {{$index+1}}:
Original Equipment Manufacturer (OEM) Information:
Third Party Information:
Block 2. CJ Determination Type
Determination Type
If resubmission:
Select a reason for resubmission:
If related to a U.S. Government request:
U.S. Government Point of Contact:
U.S. Government Point of Contact {{$index+1}}:
Block 3. Commodity/Service Type
Commodity/Service Type
If software or firmware provide the following:
Block 4. Commodity/Service Basic Information
Commodity {{$index+1}}
Block 5. Commodity/Service Detailed Description
Block 6. Special/Unique Characteristics and Capabilities
Block 7. Commodity Origin
Was or is this commodity being developed with knowledge for use in or with a particular commodity (e.g., F/A-18 or HMMWV)?
Was or is this commodity being developed with knowledge for use in or with a type of commodity (e.g., aircraft or machine tool)?
Was or is this commodity being developed with knowledge that it would be used in or with defense articles enumerated
on the U.S. Munitions List?
Was or is this commodity being developed with knowledge that it would be used in or with commodities not on the
U.S. Munitions List?
Regardless of form or fit, is this commodity a fastener, washer, spacer, insulator, grommet, bushing, spring, wire, or solder?
Does this commodity have the same function and performance capabilities as another commodity used in or with an item
that is both (a) currently or formerly in production and (b) not enumerated on the U.S. Munitions List?
Do these commodities have the same or "equivalent" form and fit?
Provide information on the "like" commodity:
Commodity {{$index+1}}
Are identical or comparable products available through foreign means?
Provide information on the "like" commodity:
Commodity {{$index+1}}
Block 8. Product Development Stage
What is the current stage of product development for this item?
Block 9. Funding History
Funding History
Block 10. Sales Information
Have there been any sales in the past 5 years?
If yes, there have been sales:
Sale {{$index+1}}
If no, there have been no sales:
Block 11. Export/Classification Information
Has this commodity been previously exported?
If yes, provide export history:
Has this commodity been subject to a Department of Commerce Classification Request?
If yes, provide commerce classification:
Block 12. Reason for Submitting CJ Request
Block 13. Publication
Block 14. Other
Describe supporting documentation attached:
  • {{error}}
Block 15. Applicant/Submitter's Certification

Under Penalty According to Federal Law (See 22 CFR 127, 22 U.S.C. 2778, and 18 U.S.C. 1001).

I am the authorized employee of the company cited in Block 1, or a third party as described in Block 1 authorized to submit on behalf of the company in Block 1, and certify as to the accuracy and completeness of the information provided and have not knowingly omitted information that could have an impact on the final determination issued by the U.S. Department of State. Furthermore, I have specific authority to release for publication the text contained in Block 4.

Unless requested otherwise, DDTC will e-mail the Commodity Jurisdiction determination as well as any other information associated with this case.

Privacy Act Statement

AUTHORITIES: The information is sought pursuant to Exec. Order No. 13637, 22 U.S.C. 2778, 22 CFR § 120.3, 22 CFR § 120.4, and 22 CFR Part 121.

PURPOSE: The purpose of a commodity jurisdiction determination request is to provide the U.S. Government with information concerning the design, manufacture, export, brokering, and sale of certain defense articles which may or may not be controlled under the United States Munitions List (USML, 22 CFR Part 121) and are therefore subject to the export licensing jurisdiction of the Department of State. This information will be used to determine the correct classification of items under the USML.

ROUTINE USES: The information supplied on this form is made available to appropriate agencies for law enforcement or pursuant to a court order. It 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 Records.

DISCLOSURE: Providing this information is voluntary and designed to assist individuals and companies to properly determine the classification of certain defense articles. Failure to provide the information requested on this form may result in adverse determinations by the U.S. Government as regards the proper classification of defense articles manufactured, sold, or brokered by the respondent.