9540-1 Import Inspection Application and report

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U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE
OFFICE OF FIELD OPERATIONS

1.

Items 1 thru 22,
24, 25 & 26 are to
be completed by
the customs
broker or
applicant

IMPORT INSPECTION APPLICATION
AND REPORT
(Meat, Poultry & Meat or Poultry Products)

2. HEALTH CERT. NO.
ORIGINAL
CONTINUATION

3. U.S. POINT OF ENTRY
4. NAME & ADDRESS OF CUSTOMS BROKER OR APPLICANT

6a. NAME & ADDRESS OF IMPORTER OF RECORD (IR):

5a. BROKER/APPLICANT PHONE NUMBER

5b. FACSIMILE NUMBER

6b. IR NUMBER

9. COUNTRY OF ORIGIN

10. EXPORTING EST. NO.

7. CUSTOMS ENTRY NO. (XXX - XXXXXXX - X)
8. REFERENCE NO.

11. PRODUCING EST. NO.

IN CONSIDERATION of the U.S. Director of Customs granting me/us permission to transfer the packages of foreign food product described on this form
which are offered for entry into the United States, I/we agree, under bond filed with said director of Customs and subject to penalties prescribed in laws
enacted by Congress and regulations issued there under by the Secretary of the Treasury, to hold the said food product intact at the location indicated
below until it has been inspected and passed by a food inspector from the Food Safety and Inspection Service or has been otherwise disposed of under
the supervision of a U.S. Customs Officer or a FSIS inspector.
12. NAME & ADDRESS OF FSIS IMPORT EST.

13. IMPORT EST. NO.

14. SPECIES

1
LOT
6
NO.
.

15. PROCESS CATEGORY

17.
DESCRIPTION OF PRODUCT

18.
SHIPPING
MARKS

24. PRINT NAME OF CUSTOMS BROKER OR APPLICANT

TO BE
COMPLETED
BY FSIS

19. PACKAGE
TYPE
Sides Pkgs. Cans

20.
NO. OF
UNITS

21.
NO. OF
UNITS PER
CARTON

25. SIGNATURE

27. SIGNATURE (FSIS Import Inspector)

Product has been
forwarded to the
designated I-house
Product has been
inspected and passed:

29. SIGNATURE (FSIS Import Inspector)

22.
NET
WEIGHT

Completed
by FSIS
23. AIIS
LOT ID NO.

26. DATE

28. DATE
30. DATE

31. REMARKS

FSIS FORM 9540-1 (01/13/2010)

REPLACES FSIS FORM 9540-1 (9/96) AND FSIS 9510-1 (9/96) WHICH ARE OBSOLETE.

Designed on FormFlow software

I. PREPARATION

INSTRUCTIONS FOR FSIS FORM 9540-1

A. BROKER/APPLICANT

The Broker/Applicant is responsible for preparing the FSIS Form 9540-1 and submitting it to the inspector at the time of reinspection. This form
must
accompany the original foreign inspection (health)
certificate.
Block 1 - Original or Continuation (check one)
Select "original" for the first 9 lots certified on the foreign health certificate for a specific foreign establishment number, species, or process
category.
Select "continuation" if the health certificate contains more than 9 lots or more than one producing establishment, resulting in more than one FSIS
Form
9540-1 being submitted. NOTE: a separate 9540-1 is required for each species, process category or foreign establishment number certified on the
health
certificate.
Block 2 - Health Certificate Number
The serial number assigned by the foreign inspection service and preprinted on the foreign health
certificate.
Block 3 - U.S. Point of Entry
The location where the product first enters the United States. In the case of Canadian or Mexican product, the border crossing point
should
be
identified.
Block 4 - Name and Address of Customs Broker or Applicant
Enter the complete name, address (street, city, state, and zip code) of the Customs Broker or
Applicant.
Block 5 - ( a) Customs Broker or Applicant Telephone Number and ( b) Facsimile Number
Enter the Broker (or applicant's) business phone and facsimile
number
Block 6 - (a) Name and Address of the Importer of Record (IR) and (b) Importer of Record (IR) Number
Enter the complete name and address (street, city, state, zip code) of the importer recorded with U.S. Customs. Enter the IR number of the
importer of
record.
Block 7 - Customs Entry Number
Enter the eleven (11) digit (alpha-numeric) number assigned by U.S. Customs Service to a particular shipment of imported product. Note the
three
digits at the start of the number is used to identify the Customs Broker filing entry into the United States. (NOTE: Shipments filed entry in
American
Samoa, Guam and Saipan do not file entry with U.S. Customs. The Entry Number assigned by the local Customs service should be entered in
this
block.)
Block 8 - Reference Number (Optional)
Enter the identification number assigned by the broker or applicant to a particular shipment of imported product, if applicable. This is an
internal
reference number that brokers/applicants can
provide.
Block 9 - Country of Origin
Enter the name of the country where the product originated. This must be the same country that issued the foreign inspection (health)
certificate.
Block 10 - Exporting Establishment
Enter the establishment number that identifies the foreign establishment from where the shipment is
exported.
Block 11 - Producing Establishment Number
Enter the number that identifies the foreign establishment that produced the product. This must be the same establishment number that is
listed oninspection
the
foreign
(health) certificate, as well as on the product. A separate FSIS Form 9540-1 must be completed for each producing
establishment
certified on the foreign health certificate. Complete a separate FSIS Form 9540-1 for each producing establishment certified on the foreign
health
certificate.
Block 12 - Name and Address of FSIS Import Establishment
Enter the complete name, street, city, state, and zip code of the FSIS import establishment where the product will be offered for reinspection.
Contact
the Technical Services Center for a current list of these facilities.
Block 13 - Import Establishment Number
Enter the FSIS number assigned the import
establishment.
Block 14 - Species
Enter the applicable species or species combination (or meat derived from the
species)
MEAT : Bovine (Beef, Veal), Porcine (Pork), Ovine (Lamb, Mutton), Caprine (Goat) , Equine (horse); Red Meat combination;
POULTRY : Chicken, Turkey, Guinea/Squab, Duck/Geese, Ratite; Poultry combination; Red Meat/Poultry
Combination
Block 15 - Process Category
Enter the applicable process category as identified by the producing establishment or foreign inspection
service.
03B - Raw ground; 03C-Raw - Not ground; 03D - Thermally processed - commercially sterile; 03E - Not heat treated - shelf stable; 03F - Heat
treated - shelf stable; 03G - Fully cooked - not shelf stable; 03H - Heat treated but not fully cooked - not shelf stable;03I - Products with secondary
inhibitors - not shelf stable

A. BROKER/APPLICANT CONTINUED
Block 16 - Lot Number
Enter a sequential number grouping the product by type of product and packaging type, beginning with
"1".
Block 17 - Description of Product
Enter the description or name of the
product.
Block 18 - Shipping Marks
Enter the unique identifying mark certified on the foreign health certificate and which is applied to the product shipping containers in the foreign
country
(this may be the serial number of the health
certificate.)
Block 19 - Package Type
Enter the appropriate type of container the product is packaged
in.
Sides - to be used for carcasses only and may represent quarters, of which 2 quarters equal one Packages- to be used for products packaged
side; containers contained in a shipping carton, tray or pallet (including combos); Cans - to be used for
inproducts packaged in cans,
immediate
or
whether
contained in a shipping carton, tray or
pallet.
Block 20 - Number of Units
Enter the number of sides, carcasses, cartons, or combos in the
lot.
Block 21 - Number of Units Per Carton
Enter the number of cans or packages in each shipping carton, if
applicable.
Block 22 - Net Weight
Enter the total net weight for each lot, in
pounds.
Block 24 - Print Name of Customs Broker/Applicant
This is name of the broker/applicant or their representative signing in Block
25.
Block 25 - Signature
This is the signature of broker or applicant.
Block 26 - Date
Enter the date (month, day and year) that this form is completed and
signed.

B. FSIS INSPECTOR
Block 23 - AIIS Lot ID Number (assigned by FSIS)
Entered by the FSIS import inspector after entry is made into the AIIS for an inspection assignment. This is a unique, system-generated number
used to
track
import information
records.
Block 27 - Signature and Block 28 - Date
If the Canadian shipment is presented at an import establishment other than the establishment designated in Blocks 12 and 13, and an
inspectionbyisthe AIIS, the inspector shall sign his/her name in "Block 27" and enter the date (month, day and year) in "Block 28." The shipment
assigned
must
proceed to the designated import
establishment.
Block 29 - Signature and Block 30 - Date
If the product is inspected and passed, the inspector shall sign his/her name in "Block 29" and enter the date (month, day, and year) in "Block 30".
The
shipment will be released into
commerce.
Block 31 - Remarks
Enter any comments related to the
shipment.

II. ACCEPTANCE
Prior to reinspection, inspectors shall carefully review FSIS Form 9540-1 to ensure proper completion by the broker/applicant. This form should accompany
the
foreign inspection (health) certificate and
as applicable, the same information as the health certificate. Accuracy for completing this application is
contain,
the the two documents, the application should be returned to the import
responsibility of the broker/applicant. If differences exist between
establishment
plantwill return it to the broker/applicant for correction. All corrections must be made prior to drawing an inspection assignment. Note
management, who
that the
information
on the health certificate takes precedence. Inspection personnel shall refer to the Import Procedures Manual memorandum Part 4,
Section
2, Examination and Identification of Imported Product," dated April 1, 2002, concerning acceptable and unacceptable health certificates and FSIS
"Documents
Form
9540-1.

Inspectors shall follow the guidelines listed below when reviewing FSIS Form 9540-1:
A. Make sure that all applicable sections of the form have been completed and is signed by the broker/
applicant.
B. Make sure that the information,as applicable, is identical to the information on the foreign inspection (health)
certificate.
C. If any section of FSIS Form 9540-1 is incomplete or in error, return the form to the import establishment plant
management,
who will return it to the broker/applicant for correction prior to
reinspection.

III. DISTRIBUTION
The distribution of the FSIS Form 9540-1 is outlined below.
A. Prior to submission to the inspector, the broker/applicant should have distributed a copy to the U.S. Customs official at port of
entry.
B. After reinspection, the inspector shall distribute copies as follows:
1. Original Copy - Retain at import establishment with the original health certificate in the official
file.
2. Photocopy - Submit to broker/applicant, if requested. Import plant management may make a copy and return the
original
signed 9540-1 to the inspector.