FV-16 Notice for Hold for Re-Examination

REPRODUCE LOCALLY Include form number and edition data on all reproductions. OMB 0581-0234

UNITED STATES DEPARTMENT OF AGRICULTURE Agricultural Marketing Service Fruit and Vegetable Programs			NOTICE FOR HOLD FOR RE-EXAMINATION
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 0581-0234. The time required to complete this information collection is estimated to average 5 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. The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (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 to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.
______ _____________________ Applicant Hold Number _______________________________________________ Address (Include Number, Street, City, State, and Zip Code _______________________________________________
PRODUCT	QUANTITY		CODE MARK(S)
LABEL			WAREHOUSE LOCATION
REASON FOR HOLD
We require that the above lot not be shipped pending further examination. The code mark(s) have been marked "hold" on inspection records pending further action. Control of this product must be maintained. If the product with the above code mark(s) is shipped prior to re-examination or prior to corrective action taken under USDA observation, it will be necessary to notify the Food and Drug Administration.
DATE		USDA INSPECTOR (Signature)
Mark an "X" in the block that indicates the course of action that will be taken. Sign, date, and return a copy to the inspection or to the USDA office address by .  Re-examination of code mark(s)  Dispose for nonfood use  Re-examination after segregation  Re-examination after reworking  Other action (specify)___________________
DATE		PLANT OFFICIAL (Title and Signature)
USDA REPORT OF RE-EXAMINATION We have completed the re-examination of the above merchandise. Re-examination results indicate the product is .
DATE		USDA INSPECTOR (Signature)
Control must be maintained on Grade Not Certified (GNC) products in order to preclude reporting to the Food and Drug Administration. On GNC product, please indicate the appropriate steps that will be taken. Sign, date, and return a copy to the inspector or to the USDA office address by _________________ .
APPLICANT - Complete by marking an "X" in appropriate block(s) and return:  SEGREGATION  RECONDITIONING  DISPOSAL of (product) by ____________  OTHER ACTION (Specify)
DATE		PLANT OFFICIAL (Title and Signature)

FV-16 (9-15-10) (Previous editions are to be destroyed)