Attach the documentation provided by the Requestor to the completed checklist. To the best of my knowledge, all the federal regulatory conditions required for 7 use of the exemption or exception have been successfully met: Yes No NA 8 List the provisos you (i.e., the CEA/ACEA) will apply (if none, state “None”): Requesting HEA approval to use EM/EC listed in Block 1. Requesting delegated authority for use of EM/EC: 9 (Provide the justification for delegation of authority and clearly define the scope of your request.) CEA/ACEA has delegated authority HEA or Delegated CEA/ACEA Approver (the request is Approver For HEA approved if electronic signature is present) or Date of Approval Delegated HEA/CEA Provisos / Conditions: See pages ______ [HEA fill-in] of this checklist for 10 the list of _______ [HEA fill-in] HEA mandatory provisos. Use of _________ [HEA/CEA/ACEA fills in specific EM/EC] is Approved CEA/ACEA HEA Delegation of Authority to CEA for use of _________ [HEA fills in specific EM/EC] is Approved Required Post-Approval: For After approval, the Requestor must record these dates and notify the Approver completion (HEA/CEA/ACEA) if return date is not met. Actual Ship/Transfer Date(s) If an AES filing is listed as a Mandatory Proviso, enter the AES number(s) and 11 by date(s) of the filing: Requestor AES number(s): Date of AES filing (s): For Temporary Exports: Enter Actual Return Date(s) Post- Approval Notifications to HEA
Attach the documentation provided by the Requestor to the completed checklist. 7 To the best of my knowledge, all the federal regulatory conditions required for use of the exemption or exception have been successfully met: Yes No NA 8 List the provisos you (i.e., the CEA/ACEA) will apply (if none, state “None”): 9 Requesting HEA approval to use EM/EC listed in Block 1. Requesting delegated authority for use of EM/EC: (Provide the justification for delegation of authority and clearly define the scope of your request.) CEA/ACEA has delegated authority 10 HEA or Delegated CEA/ACEA Approver (the request is approved if electronic signature is present) Date of Approval HEA/CEA Provisos / Conditions: See pages ______ [HEA fill-in] of this checklist for the list of _______ [HEA fill-in] HEA mandatory provisos. Use of _________ [HEA/CEA/ACEA fills in specific EM/EC] is Approved HEA Delegation of Authority to CEA for use of _________ [HEA fills in specific EM/EC] is Approved For HEA or Delegated CEA/ACEA Approver 11 Required Post-Approval: After approval, the Requestor must record these dates and notify the Approver (HEA/CEA/ACEA) if return date is not met. Actual Ship/Transfer Date(s) If an AES filing is listed as a Mandatory Proviso, enter the AES number(s) and date(s) of the filing: AES number(s): Date of AES filing (s): For Temporary Exports: Enter Actual Return Date(s) For completion by Requestor Post- Approval Notifications to HEA
N_AII_2190_001B_.docx