9080-3 Establishment Application for Export

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UNITED STATES DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

2. DATE OF REQUEST

ESTABLISHMENT APPLICATION
FOR EXPORT OF
MEAT

POULTRY

EGG PRODUCTS

TO: USDA/FSIS/OIA, EXPORT STAFF
1400 Independence Ave., SW
Room 2137S
Washington, DC 20250

3. COUNTRY (To which product will be exported)

OTHER

OFFICE OF INTERNATIONAL AFFAIRS

4. DISTRICT OFFICE (Name and Number)
5. USDA ESTABLISHMENT NO. (Specify Est. No., M, P, ID, I, etc)

PHONE: (202) 720-0082
(202) 720-7990
FAX:

6. FROM: (Establishment name and address as shown on current Grant of
Inspection, FSIS Form 5200-1, and include DBA's if applicable)

(Check if Voluntary Inspection)
9. TYPE OF
OPERATION(s)
(Check)

10. CLASS OF PRODUCT(s) TO BE EXPORTED
(Check)
03B Raw Product-Ground

Slaughter

03C Raw Product-Not Ground

Boning/Cut-up

03D Thermal Processed/Com. Sterile
03E Not Heat Treated-Shelf Stable (S.S.)

Grinding

03F Heat Treated-Shelf Stable

Processing

03G Fully Cooked/Not Shelf Stable

Cold Storage

03H Heat Treated/Not Fully Cooked-Not S.S.

Other
7. PHONE NO.

11. SPECIES (Check all that apply)*:
Beef
Duck
Mutton

03I Product With Secondary Inhibitors-Not S.S

8. FAX NO.

WILD GAME LIST

Bison

Buffalo

Chicken

Emu
Ostrich

Horse

Turkey

Pork

Veal

OTHER SPECIES LIST

Lamb

Antelope

Deer

Elk

Catalo

Rabbit

Rhea

Pheasant

Quail

Reindeer

Guinea

Goose

Egg Products

Water Buffalo

Goat

Squab

12. The undersigned requests that the firm identified in Item 6 be included on the list of establishments certified by USDA as meeting the requirements
of the country specified with respect to the importation of meat/poultry or meat/poultry products. The export requirements and other references may
be obtained from the USDA FSIS Export Library at http://www.fsis.usda.gov/Regulations & Policies/Export Information/index.asp.

.
..
.
.

We make this request with the understanding that, in addition to compliance with normal U.S. inspection requirements, the above-named firm
voluntary agrees to the following:
To comply with all provisions of appropriate inspection laws and regulations of the importing country when preparing
product for export to that country. These requirements have been reviewed by officials of this firm and are fully
understood.
To reimburse USDA for any inspections over and above U.S. requirements, (Reference FSIS Directive 5110.1).
To segregate and maintain identity of product eligible for export from noneligible product.
To operate in the mode to meet the importing country's requirements anytime an export audit is made by a U.S. review
team or by a foreign official.
To notify appropriate FSIS officials promptly when firm wishes to be removed from the list of plants that are eligible to
export to the country named herein (Item 3).
13. SIGNATURE OF AUTHORIZED FIRM REPRESENTATIVE
(Type or Print Name Above Signature)
16. NAME OF CONTACT PERSON IF DIFFERENT FROM ABOVE

14. TITLE (Type or Print)

15. DATE SIGNED

17. TITLE (Type or Print)

18. PHONE:

FSIS SECTION (Type or Print Name Above All Signatures)
20. I surveyed the above-named establishment on the date indicated below and in my opinion, it meets the requirements for export to

(Name of Country)

, subject to comments if any on the attached correspondence.

21. SIGNATURE OF INSPECTOR-IN-CHARGE

23. SIGNATURE OF CIRCUIT SUPERVISOR/DATE

FSIS FORM 9080-3 (3/3/2011)

22. DATE SURVEYED

24. SIGNATURE OF DISTRICT MANAGER/DATE
(PREVIOUS EDITIONS OBSOLETE)

19. FAX:

INSTRUCTIONS FOR FSIS FORM 9080-3
Purpose:
For most countries, all FSIS-authorized meat, poultry and egg product establishments are eligible to
export meat, poultry and egg products, provided all requirements indicated in the Library of Export
Requirements (http://www.fsis.usda.gov/Regulations & Policies/Export Information/index.asp.) are met.
Several countries however, require additional certification provided by the plant and approved by FSIS.
The country requirements listed in the Library of Export Requirements will reflect the necessity of this
additional certification process if required. Plants wishing to export to such countries should submit this
FSIS Form 9080-3 to the Office of International Affairs.
Instructions:
Complete FSIS Form 9080-3 in its entirety. All fields must be filled in order to process the request.
The completed form should be faxed or mailed to the Office of International Affairs, the contact
information for which appears on the form.

Approval:
Once submitted, the Office of International Affairs will process the request with the appropriate
foreign authorities. Upon receiving approval, the plant information will be posted on the Library of
Export Requirements under the list of approved plants for the appropriate country. Users should
check the Library of Export Requirements to see when their plant has been approved. Users may
also contact the Office of International Affairs for an update on the status of the application.