920-Kiwifruit Verification Form

KIWIFRUIT RESTYLE VERIFICATION FORM

OMB No. 0581-0189

INSTRUCTIONS:
Previously inspected kiwifruit that has been restyled may be shipped under a Restyle Verification Option, providing that the marked size and
grade are unchanged from the original inspection. Contact your local Federal-State Inspection Service (FSIS) to receive authorization to ship
kiwifruit under this option. You must provide FSIS with the number and type of restyled containers to be shipped. FSIS will assign a Restyle
Verification Number that must be placed on each container. This number is only authorized for use on the requested number and type of containers.
Date of Request:
Shipper Name:
Restyle Facility:

Authorization must be obtained from FSIS prior to shipping restyled fruit.
FSIS Assigned Restyle Verification Number:
RAuthorized By:

Shippers must supply the following information for all kiwifruit shipped under the assigned "R" number. Additional forms may be attached
if more space is needed. The Kiwifruit Administrative Committee will use this information to audit compliance with Marketing Order requirements.
Completed forms must be faxed or mailed to your local FSIS Office within 3 days of request.
Original Inspection Information

PLI Number(s)

Inspection
Certificate
Number(s) (when
available)

Responsible
Shipper

Fruit Size and
Grade

Restyled Containers

Number of
Containers

Container
Type

Brand (when Number of
applicable) Containers

Container
Type

I certify that all kiwifruit was restyled from previously inspected kiwifruit and that this fruit meets all requirements of the Kiwifruit Marketing Order.
The marked size and grade of the restyled product are the same as the original inspection. Additionally, the undersigned hereby certifies to
the U.S. Department of Agriculture and the Committee that the information supplied herein is complete and correct and that the above agreement
as to usage and reporting is accepted. The making of any false statement or representation on this form, knowing it to be false, is a violation of
Title 18, section 1001, United States Code, which provides for the penality of a fine of $10,000 or imprisonment of not more than 5 years, or both.
Date:
Rev. 7/10. Destroy previous editions.

Signature:

Title:

Brand (when
applicable)

Restyle Verification Option
Restyle Verification - A handler may ship previously inspected kiwifruit that has been restyled without obtaining an additional inspection if all shipments made
under the restyle verification option comply with all regulations in effect and all of the following conditions are met:
a) All kiwifruit was restyled from kiwifruit which previously have been inspected and certified as meeting Committee requirements.
b) The marked size on the restyled product is the same as the marked size on the original product.
c) The grade on the restyled product is the same as the grade on the original product.
d) The handler notifies the Federal-State Inspection Service at least 4 hours in advance of when the product will be shipped.
e) The handler provides the Federal-State Inspection Service with the number and type of restyled containers.
f) The Federal-State Inspection Service furnishes the handler with a restyle verification number which links the restyled product to the original PLI stamp, and to
an official USDA inspection certificate and supporting note sheets.
g) The handler shall plainly and conspicuously mark one end of each container with the letter "R" and the restyle verification number assigned by the FederalState Inspection Service. The letter "R" and the number shall not be less than one-half inch in height.
h) The Federal-State Inspection Service shall notify KAC upon issuing a restyle verification number.
i) Handlers will be subject to random spot-checks to verify compliance.

NOTE: 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 0581-0189. The time required to complete this information collection is estimated to average 15 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) 7206382 (TDD). USDA is an equal opportunity provider and employer.