I am currently pretty far along in the process of getting a license to ship new and repaired medical devices to Iran. Here is where I started:
Step 1. Apply for a User ID and Pin from the Bureau of Industry and Security (BIS) to use SNAP-R to apply electronically for a license, which requires that you first prepare and submit a company certification letter.
Step 2. Receive an official notification from BIS that the device is 'EAR99' (understand upfront that the ECCN for medical devices is 'EAR99', so you don't need to waste your time searching through the commerce control list to figure it out).
Step 3. Submit electronic application to Office of Foreign Assets Control (OFAC) using SNAP-R, which requires that you have already obtained official notification of EAR99 from BIS.
Step 4. Wait.....(this is where I am in the process)
This is only one of many, many things that I have on my plate right now, both professional and personal, so if you ask me questions and I don't respond in a timely manner, please don't be offended.