WA-470-4 Addendum tot he Provider Agreement to Electronically Fil

WA-470-4 (04-01-02)

WA-470-4 U.S. DEPARTMENT OF AGRICULTURE Form Approved - OMB No. 0560-0120

(04-01-02) Farm Service Agency

United States Warehouse Act

FARM SERVICE AGENCY

ADDENDUM TO THE PROVIDER AGREEMENT

TO ELECTRONICALLY FILE AND MAINTAIN UNITED STATES

WAREHOUSE ACT TOBACCO INSPECTION AND/OR WEIGHT CERTIFICATES

This Addendum between

     

(hereafter "Provider") and the Farm Service Agency (hereafter "FSA") authorizes the Provider to establish and maintain a database and system for the purpose of electronically filing tobacco inspection and weight certificates issued under the United States Warehouse Act (hereafter "USWA") in a central data filing system (hereafter "central filing system" or "CFS"). Such electronically filed certificates are hereafter referred to herein as "electronic tobacco inspection and/or weight certificates (ETIWCs)."

This Addendum sets forth the Provider's minimum requirements for ETIWC record formatting, reporting requirements, and the protocols to be used in the transmission of such information.

I. Document Record Data Requirements

FSA, in administration of the USWA, the regulations found at 7 CFR Part 735, the Provider Agreement To Electronically File And Maintain Electronic Warehouse Receipts and United States Warehouse Act Documents and this Addendum, may at any time require the Provider to furnish information beyond the minimum requirements shown in this Addendum.

A. Required Information

The Provider shall, at a minimum make the elements listed below available to every USWA warehouse operator issuing ETIWCs in the CFS. The Provider shall ensure that all of these fields are completed by all warehouse operators. It is each individual warehouse operator's responsibility to supply the necessary data to complete each element. This Addendum does not restrict the number of fields that may be made available to warehouse operators.

License number

Certificate number

Issuance date

Name of warehouse

Location of warehouse (City)

Location of warehouse (State)

Type of certificate (inspection, grade, weight or combination)

In or out of warehouse

The location of the tobacco at the time of this service

Grade, type, form and condition

The identification of each sample, if graded upon sample

Package identification

Remarks (for condition or weight)

The keeping quality or condition

Gross weight of each package of tobacco

Tare weight of each package of tobacco

Net weight of each package of tobacco

Name of person authorized to sign certificate

Terms and conditions (These terms and conditions that apply to each ETIWC must be furnished by the individual warehouse operator issuing the ETIWCs. Refer to Item 11 for required statements).

B. Additional Information

The Provider shall, at a minimum make the elements listed below available to every USWA warehouse operator issuing ETIWCs in the CFS. The Provider shall ensure that all of these fields are completed by all warehouse operators. It is each individual warehouse operator's responsibility to supply the necessary data to complete each element. This Addendum does not restrict the number of fields that may be made available to warehouse operators. FSA may allow a user of the Providers system to modify the elements listed below without being the holder of the certificate. The Provider shall notify the current holder of the certificate of any changes.

Holder

Warehouse Code

Paper certificate number (if applicable)

License Type, US if Federally Licensed, NL if not licensed and the two letter Postal abbreviation if state licensed, will precede or follow the certificate number

C. Converting Electronic to paper

When converting from an electronic to a paper certificate, the Provider shall advise the warehouse operator to print on the face of the paper certificate the ETIWC number.

II. Transmission of Data

Upon request by FSA, all transmissions of data shall be secured and transmitted via telecommunications hardware and software according to the requirements described in Attachment I Provider Specifications for interfacing with Warehouse Examiners’ Communications Software (WECS).

III. Terms and Conditions for USWA Licensed Warehouse Operators

The following information must be shown on all ETIWCs.

The statements:

“United States Warehouse Act, Tobacco Inspection, Grade and/or Weight Certificate”

“Certificate issued by a inspector, grader and/or weigher licensed under the United States Warehouse Act and the regulations thereunder”

     

Provider

     

Signature

     

Title

     

Date

     

Director, Kansas City Commodity Office, FSA

     

Date

______________________________________________________________________________

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and martial or family status. (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 USDA, Office of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TDD). USDA is an equal opportunity provider and employer.

The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a) and the Paperwork Reduction Act of 1995, as amended. The authority for requesting the following information is the regulations at 7 CFR 735. The information will be used to complete the terms of a license and contract between the warehouse operator and the Deputy Administrator Commodity Operations. Furnishing the requested information is voluntary, however, without it, eligibility to become a provider under the United States Warehouse Act and the decision as to the applicant’s eligibility for a provider agreement must be made in part on the basis of the information provided. This information may be provided to other agencies, IRS, Department of Justice, or other State and Federal law enforcement agencies, and in response to a court magistrate or administrative tribunal. The provisions of criminal and civil fraud statutes, including 18 U.S.C. 286, 287, 371, 641, 651, 1001; 1014, and 31 U.S.C. 3729, may be applicable to the information provided.

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 an OMB control number. The valid OMB control number of this information collection is 0560-0120. The time required to complete this information collection is estimated to average 30 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. RETURN THIS COMPLETED FORM TO THE KANSAS CITY COMMODITY OFFICE, POST OFFICE BOX 419205, KANSAS CITY, MO 64141-6205.

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