Form 9010-1 Application for Return of Exported products to the Unite

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U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

2. EXPORT CERTIFICATE NO. (Attach Copy)
(i.e., MPA-000000)

APPLICATION FOR THE RETURN OF EXPORTED PRODUCTS TO THE UNITED STATES
1. DISTRIBITION:

Applicant must submit the completed form to USDA, FSIS.
See Page 2 for address and instructions.

3. APPLICANT (Name and Address including zip code, phone number, fax number and email)

4. US PORT OF ENTRY

5. ESTIMATED DATE OF ENTRY (mm/dd/yyyy)

6. EST. NO.

8. DATE OF REQUEST (mm/dd/yyyy)

7. U.S. ESTABLISHMENT ADDRESS

9.
PRODUCT AS LABELED

15. PORTS TRANSITED

10.
MARKED
WEIGHT

11.
NO. OF
CARTONS

16. COUNTRY RETURNED FROM

12.
PRODUCTION CODE

13.
SHIPPING MARKS

(Applied at Time of Export)

14.
EST. NO.
ON PRODUCT

17. REASON FOR RETURN

18. REINSPECTION: OFFICIAL FSIS ESTABLISHMENT*

19. DATE (mm/dd/yyyy)

*Applicants should identify an official FSIS establishment for reinspection, if required, and a date for the reinspection. Approval of the establishment and reinspection date
depends on concurrence from the District Office, Office of Field Operations.
20. COMMENTS/REMARKS

21. REINSPECTION: REQUIRED

22. RELEASE IN COMMERCE
TO BE COMPLETED BY FSIS PERSONNEL ONLY

23. PRINT NAME OF STAFF OFFICER

FSIS FORM 9010-1 (08/24/2007)

24. DATE (mm/dd/yyyy)

Submit via E-mail

INSTRUCTIONS FOR PREPARATION OF FSIS FORM 9010-1
Note:

The information on the form can be typed or written to be completed by Applicant
1.

Applicant Submit to:

U.S. Department of Agriculture
Food Safety and Inpection Service
Office of International Affairs
1400 Independence Avenue SW
Room 2137-South Building
Washington, DC 20250
Phone: (202) 720-9904
FAX: (202) 720-6050
E-Mail: [email protected]

2.

Export Certificate Number - As identified on certificate and shipping cartons

3.

Applicant - Information regarding applicants company and the companies address including phone and fax numbers,
including applicants representative - name of person filling out appplication

4.

U S Port of Entry - City and State of U S Port of Entry either entering sea or ground/air

5.

Estimated Date of Entry - Estimated Date when the product is to arrive in the US (Month, Day, and Year)

6.

Originating Export Establishment - Establishment number where export originated from

7.

U S Establishment - Export Establishment Address - Full address (street, city, state and zip code ) where export originated
from

8.

Date of request - Date application is completed and faxed or e-mailed to Import Inspection Division, Headquarters at (202)
720-6050

9.

Product as labeled - Species and Product as described on Label or Export documents, e.g. "Beef Boneless Rounds"

10

Marked Weight - Weight in pounds

11.

No. of Cartons - The numeric count of product returning

12.

Production Code - Date produced

13.

Shipping Marks (Applied at Time of Export) - Export Stamp number

14.

Establishment No. on Product - Producing establishment number of the returned product

15.

Ports Transited - All ports visited by the shipment - leaving and returning to the U.S.

16.

Country Returned from - Country product was exported to as listed on export certificate

17.

Reason for Return - Reason product is returning the US (e.g. Refused for contamination, Returned because not up to
specifications, etc.)

18.

Reinspection: Official FSIS*Establishment - The FSIS Establishment proposed for reinspection, should it be required,
pending concurrence from the appropriate District

19.

Date - Estimated date the shipment will arrive for reinspection

20.

Comments/Remarks - Comments by the FSIS personnel

21.

Reinspection Required - Checked if shipment must be reinspected at location specified by applicant

22.

Release into Commerce - DATE APPROVED to move if reinspection is not required OR acceptable results are reported by
DO for reinspection

BLOCKS 23 & 24 FOR FSIS PERSONNEL USE ONLY
23.

Print Name of Staff Officer - FSIS Staff Officer handling return

24.

Date - Date action is taken by the FSIS Staff Officer