Form No form number No form number Kiwifruit Verification Form

KIWIFRUIT VERIFICATION FORM

OMB No. 0581-NEW

INSTRUCTIONS:
Previously inspected kiwifruit that has been placed into new containers may be shipped under a Verification Option, providing that the marked size and
grade are unchanged from the original inspection. Contact your local Federal-State Inspection Service (FSIS) to receive authorization to ship
kiwifruit under this option. You must provide FSIS with the number and type of new containers to be shipped. FSIS will assign a
Verification Number that must be placed on each container. This number is only authorized for use on the requested number and type of containers.
Date of Request:
Shipper Name:
Facility:

Authorization must be obtained from FSIS prior to shipping such fruit.
FSIS Assigned Verification Number:
RAuthorized By:

Shippers must supply the following information for all kiwifruit shipped under the assigned "R" number. Additional forms may be attached
if more space is needed. The Kiwifruit Administrative Committee will use this information to audit compliance with Marketing Order requirements.
Completed forms must be faxed or mailed to your local FSIS Office within 3 days of request.
Original Inspection Information

PLI Number(s)

Inspection
Certificate
Responsible
Number(s)
Shipper
(when available)

Fruit Size and Number of
Grade
Containers

New Containers

Container Brand (when Number of
Type
applicable) Containers

Container
Type

Brand (when
applicable)

I certify that all kiwifruit that was placed into new containers was previously inspected kiwifruit and that this fruit meets all requirements of the Kiwifruit
Marketing Order. The marked size and grade of such kiwifruit are the same as the original inspection. Additionally, the undersigned hereby certifies
to the U.S. Department of Agriculture and the Committee that the information supplied herein is complete and correct and that the above agreement
as to usage and reporting is accepted. The making of any false statement or representation on this form, knowing it to be false, is a violation of
Title 18, section 1001, United States Code, which provides for the penalty of a fine of $10,000 or imprisonment of not more than 5 years, or both.
Date:

Signature:

Title:

Verification Option
Verification - A handler may ship previously inspected kiwifruit that has been placed
into new containers without obtaining an additional inspection if all shipments made under the
verification option comply with all regulations in effect and all of the following conditions are met:
a) All kiwifruit that was placed into new containers was previously inspected and certified as
meeting KAC requirements.
b) The marked size on such product is the same as the marked size on the original
product.
c) The grade on such product is the same as the grade on the original product.
d) The handler notifies the Federal-State Inspection Service in advance of when the product will be
shipped.
e) The handler provides the Federal-State Inspection Service with the number and type of
new containers.
f) The Federal-State Inspection Service furnishes the handler with a verification number
which links the product to the original PLI stamp, and to an official USDA inspection
certificate and supporting note sheets.
g) The handler shall plainly and conspicuously mark one end of each container with the letter "R"
and the verification number assigned by the Federal-State Inspection Service. The letter
"R" and the number shall not be less than one-half inch in height.
h) The Federal-State Inspection Service shall notify KAC upon issuing a
verification number.
i) Handlers will be subject to random spot-checks to verify compliance.

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act
of 1995. The authority for requesting this information to be supplied on this form is the Agricultural Marketing Agreement Act
of 1937, Secs. 1-19, 48 Stat. 31, as amended, (7 U.S.C. 601-674). Furnishing the requested information is necessary for the
administration of the marketing order program.

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a valid OMB control number for this information collection is 0581-NEW. The time required to complete
this information information collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin,
age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information,
political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program (Not all prohibited bases
apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print,
audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA,
Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or
(202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.