Department of State
Bureau of Oceans and International Environmental and Scientific Affairs

Name of Proposed International Agreement:

Please check the option below:

____ I clear the attached document.

____ I clear with changes/comments below/attached.

____ I do not clear for the reasons below/attached.

____ I recommend additional clearances-see below/attached.

____ The proposed agreement is not relevant to my agency. 

Comments:

_________________________                                  ____________________________
Signature                                                                          Department/Agency/Office

_________________________                                  ____________________________
Name                                                                                Title 

_________________________                                  ____________________________
Date                                                                                   Phone Number

Please return by close of business on:

Attention:
Fax: 202-647-2746 or 4229

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