Form CCC-105 Ocean Shipment Data-Public Law 480, Title I

Form Approved – OMB No. 0551-0005

CCC-105 U.S. DEPARTMENT OF AGRICULTURE Commodity Credit Corporation Ocean Shipment Data-Public Law 480, Title I REQUEST FOR VESSEL APPROVAL			FOR USDA USE ONLY
			1. 106 NO.		DATE 106 ISSUED
			DATE OF FIRST OR PRIOR APPROVAL
NOTE  No further monies or other benefits may be paid out under this program unless this report is completed and filed as required by existing law and regulations (7 U.S.C. 1708).
Submit the completed original and one copy of this form to P.L. 480 Operations Division, Office of the General Sales Manager, U.S. Department of Agriculture, Washington, D.C. 20250
4. NAME AND ADDRESS OF VESSEL OWNER (Include ZIP Code)			COUNTRY OF DESTINATION
			PURCHASE AUTHORIZATION NO.
7. NAME AND ADDRESS OF OPERATOR OR MANAGING AGENT OF VESSEL			TYPE OF VESSEL (Check One) [ ] Liner [ ] Dry Bulk Carrier [ ] Tanker [ ] Tug/Barge
NAME AND ADDRESS OF SUPPLIER OF COMMODITY (Include ZIP Code)
NAME OF VESSEL			FLAG OF VESSEL
COMMODITY AND PACKAGING			WEIGHT OF COMMODITY (Gross metric tons)
LOADING PORT(S)			ESTIMATED LOADING DATE(S)
DISCHARGE PORT(S) AND COUNTRY			LOADING COSTS TO BE PAID BY (Check one) [ ] Vessel [ ] Shipper
			DISCHARGE COSTS TO BE PAID BY (Check one) [ ] Vessel [ ] Consignee
OCEAN FREIGHT RATE (Per)	UNIT OF WEIGHT OR MEASUREMENT		FOR USDA USE ONLY
OCEAN FREIGHT TO BE FINANCED BY			OCEAN TRANSPORTATION ARRANGED BY
23. OTHER PERTINENT INFORMATION
24. The statements made herein have been examined by me and to the best of my knowledge are true and correct.
SIGNATURE		NAME AND TITLE		DATE

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. The valid OMB control number for this information collection is [0551-0005]. The time required to complete this information collection is estimated to average 0.50 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.