FGIS 945 Application for Registration

OMB Approved: OMB No. 0580-0013

UNITED STATES DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND STOCKYARDS ADMINISTRATION
COMPLIANCE DIVISION

No Certificate of Registration may be issued unless a completed application
has been received (7 U.S.C. 87f-1)

APPLICATION FOR REGISTRATION
UNDER SECTION 17A OF THE UNITED STATES GRAIN STANDARDS ACT , AS AMENDED

According to the Paperwork Reduction Act of 1995, no persons are required
to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information
collection is estimated to average 2 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.

1. Name of Applicant to be registered (individual or firm).

2a. Address (Street and number, city, state and zip code).

2b. Include mailing address if different than 2a.

3a. If a corporation or association, designate state in which
incorporated.

3b. Date Incorporated

4. Full names of directors and principal officers (include titles) for business specified in item 1 above.
Name (Last, First, Middle Initial)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Title
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

5. List names of all persons with 10% or more ownership (control relationship) in the business specified in item 1 above.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
6. List names and locations where applicant listed in item 1 above is engaged in buying, handling, weighing, or transporting grain for
sale in foreign commerce.
Name
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Address (Street & No., City and State)
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

7. Does applicant own 10% or more interest in any other business(es) engaged in buying, handling, weighing, or transporting grain
for sale in interstate commerce?
YES (If YES, answer questions 8 through 11)

Form FGIS-945 (07-04) Previous editions are obsolete.

NO (If No, skip questions 8 through 11, go to item 12)

8. List the name(s) and location(s) for any interstate commerce grain business in which applicant has a control
relationship. Attach a separate page for each such business.
Name

Address (Street & No. City and State and Zip Code)

9. List names and locations where business listed in item 8 above is engaged in buying, handling, weighing, or
transporting grain for sale in interstate commerce. (Do not repeat name and address listed in item 8)
Name
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Address (Street & No. City and State and Zip Code)
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

10. List full legal names of directors and principal officers (include titles) for the business specified in item 8 above).
Names of directors and offices
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________

Titles
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________

11. Names of all persons with 10% or more ownership interest in business specified in item 8 above.
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
12. Person to contact regarding this application
Name

Telephone No. (Include area code)

Annual Fee (See Instructions) $_________

CERTIFICATION: I certify that the answers given on this
application for registration are true and correct to the best of my
knowledge and belief.

Submit prescribed fee with completed application

Signature

Payment should be by check, draft, or money order payable to:
Federal Grain Inspection Service, USDA

Title

13. Registration Fee

Date

PRIVACY ACT STATEMENT: Statutory authority to collect the above information is contained in Section 17A of the United States Grain Standards Act, as amended, (7 U.S.C. 871-1) and is mandatory
to obtain the services, benefits or processes that you are seeking. The information furnished will be used by the Agency for the enforcement of the United States Grain Standards Act and the
regulations promulgated thereunder and to provide the Agency with specific business information on grain facilities which are subject to registration requirement of the Act. The information will be used
to issue Certificates of Registration and to evaluate possible conflicts of interest. Failure to provide all or part of the requested information will result in denial of a Certificate of Registration by the U.S.
Department of Agriculture. 18 U.S.C. 1001 provides for a fine of not more than $10,000 or imprisonment for not more than 5 years or both, for false or fraudulent statements made to an Agency of the
United States.
FAILURE TO REGISTER WHEN REQUIRED IS A VIOLATION OF THE UNITED STATES GRAIN STANDARDS ACT AND SUBJECTS THE VIOLATOR TO ADMINISTRATIVE, CIVIL AND CRIMINAL
PENALTIES SPECIFICALLY PROVIDED FOR IN THE ACT.

Form FGIS-945 (07-04) Previous editions are obsolete.

INSTRUCTIONS FOR COMPLETING APPLICATION FOR REGISTRATION
-GENERALPersons Required to Register:
Any person who buys, handles, weighs or transports grain for sale in foreign commerce in excess of 15,000 metric tons in
the preceding or current calendar year must register unless otherwise exempted by Section 17A of the United States
Grain Standards Act. Persons required to register include, but are not limited to:
(1)
(2)

Any grain elevator, warehouse, or other handling facility that loads or ships any bulk or sacked grain
in a final carrier or container in which the grain is to be transported from the United States (applicants
with more than one such facility need only register once) or,
Any person who acquires ownership of grain thereafter directly exports such grain or causes such
grain to be directly exported from the United States without further handling of such grain by a grain
elevator, warehouse, or other grain storage or handling facility.
-INSTRUCTIONS-

APPLICANT– PLEASE PRINT OR TYPE FORM
Item No.
1.

Enter the name of the individual, partnership, corporation, association, or other business entity regularly
engaged in foreign commerce grain business. Regularly engaged in foreign commerce grain business is
defined as the business of buying, handling, weighing, or transporting grain for sale in foreign commerce in
excess of 15,000 metric tons in the preceding or current calendar year. An applicant with more than one
such facility need to register only once.

2.

Enter business address of applicant (include mailing address if different).

3.

Enter the State in which the business (e.g. corporation, association, etc.) incorporated and the date.

4.

Enter the name(s) of directors and principal officers (include titles) for business specified in item 1.

5.

Enter names of individuals, partnerships, corporations, associations, or other business entities with 10
percent or more ownership interest in the business specified in item 1. Ownership interest owned by a
spouse, minor children, and relatives living in the same household must be included in determining the 10
percent ownership interest.

6.

Enter the names and location where applicant listed in item 1 is engaged in buying, handling, weighing, or
transporting grain for sale in foreign commerce.

7.

If applicant own 10 percent or more interest in any other business(es) engaged in buying, handling,
weighing, or transporting grain for sale in interstate commerce please check “yes” and complete questions
8 thru 11. If not, please check “no” then proceed to item 12.

8.

Provide the information for each business that buys, handles, weighs, or transports grain for sale in
interstate commerce in which:
a.
b.

9.

The applicant own 10 percent or more ownership interest or
The applicant has a control relationship (10 percent or more ownership interest) in any other
business in which that business has a 10 percent or more ownership in any other firm engaged
in buying, handling, weighing, or transporting grain for sale in interstate commerce. For
example, Company A ( the applicant) owns 10 percent of Company B and Company B owns 10
percent or more ownership interest in firms C, D, and E. The applicant must provide the
information for firms C, D, and E. List the firm name and address. Use a separate page to
identify each additional business.

Enter names and locations where business listed in item 8 is engaged in buying, handling, weighing, or
transporting grain for sale an interstate commerce. (Do not repeat name and address listed in item 8).

10. Enter full legal names of directors and principal officers including titles for the business specified in item 8.
11. Enter names of individuals, partnerships, corporations, associations, or other business entities with 10
percent or more ownership interest (control relationship) in the business specified in block 8. Ownership
interest owned by a spouse, minor children, and relatives living in the same household must be included in
determining the 10 percent ownership interest.
12. Please provide name and telephone number of an individual who has knowledge of information provided
on this application.
13. If the answer to item 7 is NO, the annual fee is $135.
14. If the answer to item 7 is YES, the annual fee is $270.

The United States Grain Standards Act (USGSA), 7 U.S.C. 87f-1, requires the
registration of all persons engaged in the business of buying grain for sale in foreign
commerce. In addition, those individuals who handle, weigh, or transport grain for sale
in foreign commerce must register.
The USGSA regulations, 7CFR 800.30-39, define foreign commerce grain business as
persons who regularly engage in buying for sale, handling, weighing, or transporting
grain totaling 15,000 metric tons or more during the preceding or current calendar year.
Contact: Prospective registrants should contact the Regulatory Branch of GIPSA's
Compliance Division with questions or for application forms. Interested parties must
submit registration applications in writing along with the required fee to:
USDA, GIPSA, FGIS, CP
Regulatory Branch, STOP 3604
1400 Independence Ave., SW, Room 1647-S
Washington, DC 20250-3604
Telephone: 202-720-8536
Fax: 202-690-2755
or via e-mail to: [email protected]