Form 3461 Entry/Immediate Delivery Application

DEPARTMENT OF HOMELAND SECURITY

OMB No. 1651-0024
Exp. 01-31-2012

U.S. Customs and Border Protection
ENTRY/IMMEDIATE DELIVERY
19 CFR 142.3, 142.16, 142.22, 142.24

1. ARRIVAL DATE

2. ELECTED ENTRY DATE 3. ENTRY TYPE CODE/NAME

5. PORT

6. SINGLE TRANS. BOND

7. BROKER/IMPORTER FILE NUMBER

8. CONSIGNEE NUMBER
10. ULTIMATE CONSIGNEE NAME

12. CARRIER CODE

4. ENTRY NUMBER

9. IMPORTER NUMBER
11. IMPORTER OF RECORD NAME

13. VOYAGE/FLIGHT/TRIP 14. LOCATION OF GOODS-CODE(S)/NAME(S)

15. VESSEL CODE/NAME
16. U.S. PORT OF UNLADING

17. MANIFEST NUMBER

18. G.O. NUMBER

19. TOTAL VALUE

20. DESCRIPTION OF MERCHANDISE
21. IT/BL/AWB
CODE

22. IT/BL/AWB NO.

23. MANIFEST QUANTITY

27. CERTIFICATION

I hereby make application for entry/immediate delivery. I certify that the above
information is accurate, the bond is sufficient, valid, and current, and that all
requirements of 19 CFR Part 142 have been met.
SIGNATURE OF APPLICANT

PHONE NO.

DATE
29. BROKER OR OTHER GOVT. AGENCY USE

24. H.S. NUMBER

25. COUNTRY
OF ORIGIN

26. MANUFACTURER NO.

28. CBP USE ONLY
OTHER AGENCY ACTION REQUIRED, NAMELY:

CBP EXAMINATION REQUIRED.
ENTRY REJECTED, BECAUSE:

SIGNATURE
DELIVERY
AUTHORIZED:

DATE

PAPERWORK REDUCTION ACT NOTICE: This information is to determine the admissibility of imports into the United States and to provide the necessary
information for the examination of the cargo and to establish the liability for payment of duties and taxes. Your response is necessary. The estimated average
burden associated with this collection of information is 15 minutes per respondent depending on individual circumstances. Comments concerning the accuracy
of this burden estimate and suggestions for reducing this burden should be directed to U.S. Customs and Border Protection, Asset Management, Washington,
DC 20229, and to the Office of Management and Budget, Paperwork Reduction Project (1651-0024), Washington, DC 20503.

CBP Form 3461 (01/09)