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[[Compliance Program]] | [[Compliance Hotline]] | [[Investigations by Third Parties]] | [[Research Integrity]] | [[Export Control]] | [[Code of Conduct]] | [[Use of Human Anatomical Material]] | [[Clinical Trial Fee Billing Procedures]] | [[Contracts]] | [[Conflict of Interest]] | [[Red Flag Identity Theft Prevention Program]] | [[Principles of Financial Stewardship]] | [[Human Tissue Use and Transfer]] | [[International Research Policy]] | [[Health Care Vendor Interactions]] | [[Internal Audit]]
[[Compliance Program]] | [[Compliance Hotline]] | [[Investigations by Third Parties]] | [[Research Integrity]] | [[Export Control]] | [[Code of Conduct]] | [[Use of Human Anatomical Material]] | [[Clinical Research and Clinical Trial Professional and Technical Fee Billing]] | [[Contracts]] | [[Conflict of Interest]] | [[Red Flag Identity Theft Prevention Program]] | [[Principles of Financial Stewardship]] | [[Human Tissue Use and Transfer]] | [[Disclosing Foreign Support and International Activities]] | [[Health Care Vendor Interactions]] | [[Credit Hour Definition]] | [[Whistleblower]] | [[Electronic Digital Signatures and Records]]<br />
<br /><br />Policy No.: '''8013'''<br />
<br />
Effective Date: '''03/15/2012'''<br />
Policy No.: '''8013'''<br />
Revised Date:<br />
Effective Date: '''03/15/12'''<br />
Reviewed Date: '''03/15/2012'''<br /><br />
Revised Date: ''' 07/21/23'''<br />
<big>'''Human Tissue Use & Transfer Policy'''</big>
Reviewed Date: '''07/09/24'''<br /><br />
<big>'''Human Tissue Use and Transfer Policy'''</big>
== Policy ==
== Policy ==
Human tissue obtained through clinical procedures or for research may be used within the Nebraska Medical Center campus or transferred to external organizations consistent with the Nebraska Medical Center campus mission of patient care, teaching, research and outreach. Tissue obtained for clinical and/or research purposes is the property of the Nebraska Medical Center Academic Clinical Enterprise (i.e. UNMC, UNMC Physicians and The Nebraska Medical Center). Use and transfer of human tissue shall take place in accordance with the procedures below to ensure applicable regulatory and ethical standards are met. This policy applies to physical tissue and not to tissue images.
Human tissue obtained through clinical procedures or for research may be used within the Nebraska Medical Center campus organizations or transferred to external organizations consistent with the Nebraska Medical Center campus mission of patient care, teaching, research and outreach. Tissue obtained for clinical and/or research purposes is the property of the Nebraska Medical Center Academic Clinical Enterprise (i.e. UNMC, UNMC Physicians and The Nebraska Medical Center). Use and transfer of human tissue (as defined in the Definition section below) shall take place in accordance with the procedures below to ensure applicable regulatory and ethical standards are met. This policy applies to physical tissue and not to tissue images.  
== Definitions ==
== Definitions ==
''Human tissue'' is tissue, blood products, serum, DNA and other biological materials or specimens that are obtained from (1) patients as a part of their regular clinical care that would otherwise be discarded or archived, or (2) patients or other individuals who have agreed to donate their specimens obtained specifically for research or for deposit into tissue repositories.<br />
'''''Human tissue''''' is tissue, blood products, serum, DNA and other biological materials or specimens that are obtained from patients.<br />


''Transfer'' means tissue sent outside the Nebraska Medical Center campus organizations.<br />
'''''Transfer''''' means tissue sent outside the Nebraska Medical Center campus organizations.<br />


''Use'' pertains to activities utilizing tissue within the Nebraska Medical Center campus organizations.
'''''Use''''' pertains to activities utilizing tissue within the Nebraska Medical Center campus organizations.
== Procedures ==
== Procedures ==
#'''Transfer for clinical purposes'''
===Transfer for Clinical Purposes===
#* Medical. The Nebraska Medical Center Pathology Department has responsibility and authority over clinical use of tissue. Tissue may be transferred into and out of the Nebraska Medical Center campus in accordance with The Nebraska Medical Center policy MS.11, "Removal of Specimens". Patients may also request transfer of their tissue to another health care provider for clinical purposes in accordance with Policy MS.11.
'''Medical.''' The Nebraska Medical Center Pathology Department has responsibility and authority over clinical use of Human tissue. Human tissue may be transferred into and out of the Nebraska Medical Center campus organizations in accordance with The Nebraska Medical Center Policy MS.11, [http://now.nebraskamed.com/?utm_source=default&utm_medium=ie&utm_campaign=now Removal of Specimens]. Patients may also request transfer of their Human tissue to another health care provider for clinical purposes in accordance with Policy MS.11.
#:All vendors providing pathology services to patients must be approved by The Nebraska Medical Center Board of Directors as recommended by the Medical Staff and as required by Joint Commission, CAP and CLIA standards. Health care providers who wish to utilize a new external pathology vendor must submit a proposal to the Director, Clinical Pathology. 
 
#* Genetics. The UNMC Munroe Meyer Institute Human Genetics Laboratory (HGL) and Molecular Genetics Laboratory (MGL) follow CLIA and Human Genetics Laboratory protocols. The Laboratories refer specimens for testing only to CLIA certified laboratories or laboratories meeting equivalent requirements as determined by the HGL or MGL. All specimens received by the HGL and MGL must have written orders and instructions from the referring laboratory and comply with CLIA and HGL regulations.
All vendors providing pathology services to patients must be approved by The Nebraska Medical Center Board of Directors as recommended by the Medical Staff and as required by Joint Commission, CAP and CLIA standards. Health care providers who wish to utilize a new external pathology vendor must submit a proposal to the Director, Clinical Pathology. 
#* Dental. In accordance with the UNMC College of Dentistry Infection Control Policy as revised June 2011, "extracted teeth or other removed body tissues may be given to the patient from whom they were removed if the patient requests them."
 
#:The UNMC Oral Pathology Biopsy Service, in accordance with current CLIA regulations:
'''Dental.''' In accordance with the [https://www.unmc.edu/academicaffairs/_documents/compliance/Infectious_Disease_Control_Policies.pdf UNMC College of Dentistry Infectious Disease Control Policy] as revised December 2020, "extracted teeth or other removed body tissues may be given to the patient from whom they were removed if the patient requests them and are not subject to OSHA Bloodborne Pathogens Standard."
#::i.  Refers any specimens for testing only to a CLIA-certified laboratory or a laboratory meeting equivalent requirements as determined by CMS.
 
#::ii.  If the laboratory accepts a referral specimen, written instructions must be available to the laboratory's clients and must include, as appropriate, the information specified in section 493.1242, paragraphs (a)(1) through (a)(7) as specified in the current CLIA regulations.
The UNMC Oral Pathology Biopsy Service, in accordance with current CLIA regulations:
#'''Use/Transfer for Research purposes'''
:i.  Refers any specimens for testing only to a CLIA-certified laboratory or a laboratory meeting equivalent requirements as determined by CMS.
#:The UNMC Institutional Review Board (IRB) has responsibility and authority over research use of tissue in the Nebraska Medical Center clinical enterprise. See the resources listed below or contact the IRB to obtain additional guidance in this area. The principal investigator in charge of an existing tissue bank may transfer tissue for research purposes to external individuals/organizations utilizing a material transfer agreement (MTA). The Medical Director of Anatomical Pathology or the Director of the HGL or MGL, depending on the location of the tissue, shall determine if there is sufficient tissue to meet research requests.
:ii.  If the laboratory accepts a referral specimen, written instructions must be available to the laboratory's clients and must include, as appropriate, the information specified in section [https://www.govinfo.gov/app/details/CFR-2017-title42-vol5/CFR-2017-title42-vol5-sec493-1242 493.1242], paragraphs (a)(1) through (a)(7) as specified in the current CLIA regulations.
#* IRB Resources. Refer to the following policies and IRB applications and resources for further information:   
===Use/Transfer for Research Purposes===
#::i. UNMC Human Research Protection Program Policies & Procedures #7.1, "Banking Human Biological Material for Future Research"
The UNMC Institutional Review Board (IRB) has responsibility and authority over research Use of Human tissue in the Nebraska Medical Center Academic Clinical Enterprise. See the resources listed below or contact the IRB to obtain additional guidance in this area. The principal investigator in charge of a tissue bank or other research protocol may Transfer Human tissue for research purposes to external individuals/organizations utilizing a Material Transfer Agreement (MTA). As appropriate, the Medical Director of Anatomical Pathology shall determine if there is sufficient Human tissue to meet research requests.
#::ii. UNMC IRB Human Biological Material applications and Educational Guides
 
#* Investigators leaving UNMC. Investigators who leave UNMC are prohibited from taking tissue specimens or the resultant data with them unless they have prior written approval from their department chair, College dean, IRB chair (if IRB-regulated) and the Vice Chancellor of Research. Investigators will be required to complete a Material Transfer Agreement (MTA) and submit it to the UneMed office before tissue transfers can take place. The investigator must pay all the costs of transfer, unless the MTA specifies another source of payment.
IRB Resources. Refer to the following policies and resources for further information:   
#'''Use/Transfer for Educational Purposes'''
:i. UNMC Human Research Protection Program Policies & Procedures #7.1, "Banking Human Biological Materials"
#*Use for UNMC Education:   
:ii. UNMC Human Research Protection Program Policies & Procedures #7.2, "Use of Human Biological Material in Research"
#::i. Education in this context refers to use by qualified undergraduate or graduate students in the course of the established curriculum for the UNMC, including the Colleges of Medicine (including Allied Health), Dentistry, Nursing, Pharmacy, and Public Health.
:iii. UNMC IRB Human Biological Material applications
#:: ii. Medical: Tissues obtained during the course of normal clinical practice may be used for educational purposes within the Nebraska Medical Center clinical enterprise in accordance with campus policies (including pathology HGL, MGL, and infection control policies) and State or Federal law (including the Uniform Anatomical Gift Act).
Investigators will be required to contact [https://www.unemed.com/services/material-transfer UNeMed] or Sponsored Programs Administration (SPA) with a request to have UNeMed or SPA, as appropriate, complete a Material Transfer Agreement (MTA) for any planned Human tissue Transfer. The MTA must be completed and signed by all relevant parties before the transfer can take place.
#:: iii. Dental: In accordance with the UNMC College of Dentistry Infection Control Policy as revised June 2011, "extracted teeth, oral tissues, or other tissues may be used for educational purposes in the preclinical laboratories". The decontamination of extracted teeth or other tissues for use in the preclinical laboratories is conducted in accordance with Centers for Disease Control recommendations.
===Use/Transfer for Educational Purposes===
#* Transfer for Medical/Dental Educational purposes: Transfer of tissue to an accredited educational institution outside UNMC is permitted, provided that the tissues are to be used by qualified undergraduate or graduate students in the course of an established curriculum for the institution to which they are being transferred. A Material Transfer Agreement (or similar written agreement) must be in place documenting the intended use as described above.
====Use for UNMC Education====
#'''Transfer of Tissue to Commercial Entity for Business purposes'''
:i. Education in this context refers to use by qualified undergraduate or graduate students in the course of the established curriculum for the UNMC, including the Colleges of Medicine, Allied Health, Dentistry, Nursing, Pharmacy and Public Health.
#:Transfer of Nebraska Medical Center clinical enterprise tissue to an external commercial entity for business purposes is only permitted when such business purposes are consistent with the instructional, scholarship, and research objectives of the University of Nebraska. "Business purposes" refers to exchange of tissue for money or other like compensation at cost or beyond the reasonable costs of procurement, storage, processing or shipping of tissue. "Consistent with the instructional, scholarship, and research objectives of the University of Nebraska" means that the sale of tissue must support the objectives of the University, including financial support of infrastructure necessary for those goals. For UNMC tissue, the Chancellor, Vice-Chancellor for Research, or Vice-Chancellor for Academic Affairs shall have the authority to determine if business purposes are consistent with the instructional, scholarship, and research objectives of the University of Nebraska. For The Nebraska Medical Center tissue, the Chief of Pathology and the Chief Medical Officer shall have the authority to determine if the business purposes are consistent with organizational objectives. The Medical Director of Anatomic Pathology shall determine if there is sufficient tissue to meet the requests, as applicable.
:ii. Medical: Human tissue obtained during the course of normal clinical practice may be used for educational purposes within the Nebraska Medical Center Academic Clinical Enterprise in accordance with campus policies (including pathology and infection control policies) and state or federal law (including the Uniform Anatomical Gift Act).
#'''Material Transfer Agreements (MTAs)'''
:iii. Dental: In accordance with the UNMC College of Dentistry Infectious Disease Control Policy as revised June 2014, "extracted teeth, oral tissues, or other tissues may be used for educational purposes in the preclinical laboratories". The decontamination of extracted teeth or other tissues for use in the preclinical laboratories is conducted in accordance with Centers for Disease Control recommendations.
#:MTAs shall not be required for human tissue transfers for clinical purposes, including second opinions. MTAs shall be used for tissue transfers for education and research, except when the transfer is to a research sponsor pursuant to a sponsored research agreement that incorporates tissue transfer provisions. For further information see: http://www.unemed.com/.<br />
====Transfer for Medical/Dental Educational Purposes====
Transfer of Human tissue to an accredited educational institution outside of the Nebraska Medical Center campus organizations is permitted, provided that the tissue is to be used by qualified undergraduate or graduate students in the course of an established curriculum for the institution to which they are being transferred. A Material Transfer Agreement (or similar written agreement) must be in place documenting the intended use as described above.
===Transfer of Tissue to Commercial Entity for Business Purposes===
Transfer of Nebraska Medical Center Academic Clinical Enterprise Human tissue to an external commercial entity for business purposes is only permitted when such business purposes are consistent with the instructional, scholarship and research objectives of the University of Nebraska. "Business purposes" refers to exchange of Human tissue for money or other like compensation at cost or beyond the reasonable costs of procurement, storage, processing or shipping of tissue. "Consistent with the instructional, scholarship and research objectives of the University of Nebraska" means that the sale of Human tissue must support the objectives of the University, including financial support of infrastructure necessary for those goals. For UNMC Human tissue, the Chancellor, Vice Chancellor for Research, or Senior Vice Chancellor for Academic Affairs shall have the authority to determine if business purposes are consistent with the instructional, scholarship and research objectives of the University of Nebraska. For The Nebraska Medical Center Human tissue, the Chief of Pathology and the Chief Medical Officer shall have the authority to determine if the business purposes are consistent with organizational objectives. The Medical Director of Anatomic Pathology shall determine if there is sufficient Human tissue to meet the requests, as applicable.
===Material Transfer Agreements (MTAs)===
MTAs shall not be required for Human tissue transfers for clinical purposes, including second opinions. MTAs shall be used for Human tissue transfers for education and research, except when the Transfer is to a research sponsor pursuant to a sponsored research agreement that incorporates Human tissue transfer provisions. Researchers should reach out to UNeMed or SPA, as appropriate, with any questions at the outset of an MTA. For example, if the project for which the Transfer is being requested is associated with a Sponsored Programs Administration (SPA) agreement, SPA should be contacted, otherwise UNeMed should be contacted. For further information, see [https://www.unmc.edu/spa/ Sponsored Programs Administration] or [https://www.unemed.com/services/material-transfer UNeMed Material Transfer], as applicable.
===Export Control===
Any shipment of Human tissue internationally must be reviewed for compliance with export control and related regulations in accordance with UNMC Policy No. 8005, [[Export Control]]. To facilitate this evaluation, a [https://info.unmc.edu/safety/ehs-docs/export/Export_Control_Review_Form_UNMC_UNO_2019.pdf Request for Export Controls Review Application] must be submitted in advance to the [mailto:exportcontrol@unmc.edu Export Control Compliance Office], as the request takes time to research and process. Forms and other information are available at the [https://www.unmc.edu/academicaffairs/compliance/areas/export-control/transporting-shipping/index.html Transporting & Shipping Internationally website].
==Additional Information==
==Additional Information==
Contact the [mailto:sarah.glodencarlson@unmc.edu Chief Compliance Officer]<br />
*Contact the [mailto:sarah.glodencarlson@unmc.edu Chief Compliance Officer]
*Contact the [mailto:exportcontrol@unmc.edu Export Control Office]
*UNMC Policy No. 8005, [[Export Control]]
*[https://www.unmc.edu/academicaffairs/compliance/areas/export-control/transporting-shipping/index.html International shipping information]
*[https://info.unmc.edu/safety/ehs-docs/export/Export_Control_Review_Form_UNMC_UNO_2019.pdf Request for Export Controls Review Application]
*[https://net.unmc.edu/rss/ UNMC Human Research Protection Program Policies & Procedures #7.1, "Banking Human Biological Materials"]
*[https://net.unmc.edu/rss/ UNMC Human Research Protection Program Policies & Procedures #7.2, "Use of Human Biological Material in Research"]
*[https://www.unmc.edu/academicaffairs/_documents/compliance/Infectious_Disease_Control_Policies.pdf UNMC College of Dentistry Infectious Disease Control Policy]
*[https://www.unemed.com/services/material-transfer UNeMed Material Transfer]
*Policy MS.11, [http://now.nebraskamed.com/?utm_source=default&utm_medium=ie&utm_campaign=now Removal of Specimens]
*[https://www.govinfo.gov/app/details/CFR-2017-title42-vol5/CFR-2017-title42-vol5-sec493-1242 42 CFR § 493.1242 - Standard: Specimen submission, handling and referral]


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This page maintained by [mailto:mhurlocker@unmc.edu mh].

Latest revision as of 13:49, August 19, 2024

Human Resources   Safety/Security   Research Compliance   Compliance   Privacy/Information Security   Business Operations   Intellectual Property   Faculty


Compliance Program | Compliance Hotline | Investigations by Third Parties | Research Integrity | Export Control | Code of Conduct | Use of Human Anatomical Material | Clinical Research and Clinical Trial Professional and Technical Fee Billing | Contracts | Conflict of Interest | Red Flag Identity Theft Prevention Program | Principles of Financial Stewardship | Human Tissue Use and Transfer | Disclosing Foreign Support and International Activities | Health Care Vendor Interactions | Credit Hour Definition | Whistleblower | Electronic Digital Signatures and Records

Policy No.: 8013
Effective Date: 03/15/12
Revised Date: 07/21/23
Reviewed Date: 07/09/24

Human Tissue Use and Transfer Policy

Policy

Human tissue obtained through clinical procedures or for research may be used within the Nebraska Medical Center campus organizations or transferred to external organizations consistent with the Nebraska Medical Center campus mission of patient care, teaching, research and outreach. Tissue obtained for clinical and/or research purposes is the property of the Nebraska Medical Center Academic Clinical Enterprise (i.e. UNMC, UNMC Physicians and The Nebraska Medical Center). Use and transfer of human tissue (as defined in the Definition section below) shall take place in accordance with the procedures below to ensure applicable regulatory and ethical standards are met. This policy applies to physical tissue and not to tissue images.

Definitions

Human tissue is tissue, blood products, serum, DNA and other biological materials or specimens that are obtained from patients.

Transfer means tissue sent outside the Nebraska Medical Center campus organizations.

Use pertains to activities utilizing tissue within the Nebraska Medical Center campus organizations.

Procedures

Transfer for Clinical Purposes

Medical. The Nebraska Medical Center Pathology Department has responsibility and authority over clinical use of Human tissue. Human tissue may be transferred into and out of the Nebraska Medical Center campus organizations in accordance with The Nebraska Medical Center Policy MS.11, Removal of Specimens. Patients may also request transfer of their Human tissue to another health care provider for clinical purposes in accordance with Policy MS.11.

All vendors providing pathology services to patients must be approved by The Nebraska Medical Center Board of Directors as recommended by the Medical Staff and as required by Joint Commission, CAP and CLIA standards. Health care providers who wish to utilize a new external pathology vendor must submit a proposal to the Director, Clinical Pathology.

Dental. In accordance with the UNMC College of Dentistry Infectious Disease Control Policy as revised December 2020, "extracted teeth or other removed body tissues may be given to the patient from whom they were removed if the patient requests them and are not subject to OSHA Bloodborne Pathogens Standard."

The UNMC Oral Pathology Biopsy Service, in accordance with current CLIA regulations:

i. Refers any specimens for testing only to a CLIA-certified laboratory or a laboratory meeting equivalent requirements as determined by CMS.
ii. If the laboratory accepts a referral specimen, written instructions must be available to the laboratory's clients and must include, as appropriate, the information specified in section 493.1242, paragraphs (a)(1) through (a)(7) as specified in the current CLIA regulations.

Use/Transfer for Research Purposes

The UNMC Institutional Review Board (IRB) has responsibility and authority over research Use of Human tissue in the Nebraska Medical Center Academic Clinical Enterprise. See the resources listed below or contact the IRB to obtain additional guidance in this area. The principal investigator in charge of a tissue bank or other research protocol may Transfer Human tissue for research purposes to external individuals/organizations utilizing a Material Transfer Agreement (MTA). As appropriate, the Medical Director of Anatomical Pathology shall determine if there is sufficient Human tissue to meet research requests.

IRB Resources. Refer to the following policies and resources for further information:

i. UNMC Human Research Protection Program Policies & Procedures #7.1, "Banking Human Biological Materials"
ii. UNMC Human Research Protection Program Policies & Procedures #7.2, "Use of Human Biological Material in Research"
iii. UNMC IRB Human Biological Material applications

Investigators will be required to contact UNeMed or Sponsored Programs Administration (SPA) with a request to have UNeMed or SPA, as appropriate, complete a Material Transfer Agreement (MTA) for any planned Human tissue Transfer. The MTA must be completed and signed by all relevant parties before the transfer can take place.

Use/Transfer for Educational Purposes

Use for UNMC Education

i. Education in this context refers to use by qualified undergraduate or graduate students in the course of the established curriculum for the UNMC, including the Colleges of Medicine, Allied Health, Dentistry, Nursing, Pharmacy and Public Health.
ii. Medical: Human tissue obtained during the course of normal clinical practice may be used for educational purposes within the Nebraska Medical Center Academic Clinical Enterprise in accordance with campus policies (including pathology and infection control policies) and state or federal law (including the Uniform Anatomical Gift Act).
iii. Dental: In accordance with the UNMC College of Dentistry Infectious Disease Control Policy as revised June 2014, "extracted teeth, oral tissues, or other tissues may be used for educational purposes in the preclinical laboratories". The decontamination of extracted teeth or other tissues for use in the preclinical laboratories is conducted in accordance with Centers for Disease Control recommendations.

Transfer for Medical/Dental Educational Purposes

Transfer of Human tissue to an accredited educational institution outside of the Nebraska Medical Center campus organizations is permitted, provided that the tissue is to be used by qualified undergraduate or graduate students in the course of an established curriculum for the institution to which they are being transferred. A Material Transfer Agreement (or similar written agreement) must be in place documenting the intended use as described above.

Transfer of Tissue to Commercial Entity for Business Purposes

Transfer of Nebraska Medical Center Academic Clinical Enterprise Human tissue to an external commercial entity for business purposes is only permitted when such business purposes are consistent with the instructional, scholarship and research objectives of the University of Nebraska. "Business purposes" refers to exchange of Human tissue for money or other like compensation at cost or beyond the reasonable costs of procurement, storage, processing or shipping of tissue. "Consistent with the instructional, scholarship and research objectives of the University of Nebraska" means that the sale of Human tissue must support the objectives of the University, including financial support of infrastructure necessary for those goals. For UNMC Human tissue, the Chancellor, Vice Chancellor for Research, or Senior Vice Chancellor for Academic Affairs shall have the authority to determine if business purposes are consistent with the instructional, scholarship and research objectives of the University of Nebraska. For The Nebraska Medical Center Human tissue, the Chief of Pathology and the Chief Medical Officer shall have the authority to determine if the business purposes are consistent with organizational objectives. The Medical Director of Anatomic Pathology shall determine if there is sufficient Human tissue to meet the requests, as applicable.

Material Transfer Agreements (MTAs)

MTAs shall not be required for Human tissue transfers for clinical purposes, including second opinions. MTAs shall be used for Human tissue transfers for education and research, except when the Transfer is to a research sponsor pursuant to a sponsored research agreement that incorporates Human tissue transfer provisions. Researchers should reach out to UNeMed or SPA, as appropriate, with any questions at the outset of an MTA. For example, if the project for which the Transfer is being requested is associated with a Sponsored Programs Administration (SPA) agreement, SPA should be contacted, otherwise UNeMed should be contacted. For further information, see Sponsored Programs Administration or UNeMed Material Transfer, as applicable.

Export Control

Any shipment of Human tissue internationally must be reviewed for compliance with export control and related regulations in accordance with UNMC Policy No. 8005, Export Control. To facilitate this evaluation, a Request for Export Controls Review Application must be submitted in advance to the Export Control Compliance Office, as the request takes time to research and process. Forms and other information are available at the Transporting & Shipping Internationally website.

Additional Information

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