Form FV-6 Importer's Exempt Commodity Form

OMB NO. 0581-0167 SERIAL NO.

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FRUIT AND VEGETABLE PROGRAM

IMPORTER’S EXEMPT COMMODITY FORM (FV-6)

The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995. The authority for requesting the information to be supplied on this form is the Agricultural Marketing Agreement Act of 1937. The provisions of criminal and civil fraud statutes, including 18 USC 286, 287, 271, 651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to information provided on this form. NOTE: This form is used to declare intent to import an agricultural commodity exempt from grade requirements for the commodity established under section 8e of the Agricultural Marketing Agreement Act of 1937. WARNING: Any person who knowingly falsely makes, issues, alters, forges or counterfeits this form, or participates in any such actions, is subject to a fine or imprisonment for not more than five (5) years, or both.
THIS FORM MAY NOT BE DUPLICATED
INSTRUCTIONS TO COMPLETE FORM ARE PRINTED ON THE REVERSE SIDE
SECTION TO BE COMPLETED BY IMPORTER
1. PRODUCT (include variety)				2. DATE AND PLACE OF INSPECTION (if applicable)
3. LOT IDENTIFICATION				4. VEHICLE IDENTIFICATION (railroad car, truck, vessel, carrier, tag number, etc.)
5a. IMPORTER’S NAME AND COMPLETE MAILING ADDRESS (P.O. Box, Street, City, State, ZIP Code)				6a. PLACE OF ENTRY (PORT OF UNLOADING)
				6b. DATE OF ENTRY
5b. TELEPHONE NUMBER (include area code)	5c. FAX NUMBER (include area code)			7. TOTAL QUANTITY IMPORTED (pounds)
8a. RECEIVER’S NAME AND COMPLETE MAILING ADDRESS (P.O. Box, Street, City, State, ZIP Code)				9. INTENDED USE (Mark an “X” in appropriate box) Processing (describe type): ______________________________ (example: canning, dehydrating, juice) Charity Livestock/Animal Feed Other exempt use (specify): _____________________________ ___________________________________________________
8b. TELEPHONE NUMBER (include area code)	8c. FAX NUMBER (include area code)
10a. U.S. CUSTOMS AND BORDER PROTECTION ENTRY NUMBER	10b. HARMONIZED TARIFF CODE NUMBER
CERTIFICATION STATEMENT: I certify to the U.S. Department of Agriculture and U.S. Customs and Border Protection that the above is true and accurate and that none of the fruit, vegetable, or specialty crops being imported are identified above will be used for other than the purpose indicated above.
SIGNATURE (Handwritten only)		TITLE			DATE
SECTION II TO BE COMPLETED BY RECEIVER
RECEIVER’S NAME AND COMPLETE MAILING ADDRESS (P.O. Box, Street, city, State, ZIP Code)			TELEPHONE NUMBER (Include area code)
CERTIFICATION STATEMENT OF PROCESSOR, CHARITY, FEEDER OR OTHER EXEMPTED RECEIVER
I hereby certify to the U.S. Department of Agriculture that I have received the exempt commodity shipment(s) cited above and that I will dispose of the shipment(s) pursuant to the intended use specified in “9” and the commodity’s Import Regulation under 7 CFR, Parts 944, 980, or 999, and that I am one of the following: (Mark an “X” in appropriate box)  Processing (describe type): __________________________________  Charity  Livestock/Animal Feed (example: canning, dehydrating, juice)  Other exempt use (specify): _____________________________________________
SIGNATURE (Handwritten only)		TITLE			DATE
PLEASE READ INSTRUCTIONS CAREFULLY

SECTION I
TO BE COMPLETED BY THE IMPORTER – Upon completion of Section 1, the importer or the customs broker on behalf of the IMPORTER shall:

• Sign Section I certifying accuracy of the information entered in Section I and that the exempt commodity shipment is being sent to the exempt receiver listed in No. 8a.
  
  
  

• Provide the completed form to U.S. Customs and Border Protection at the time of entry
  (U.S. Customs and Border Protection may only retain Copy 1, but must return Copies 2 and 3 to the importer).
  
  
  

• Send Copy 2 to AMS not later than two (2) days after entry.
  
  
  

• Forward Copy 3 to the exempt receiver with the commodity shipment.
  
  
  

• Retain Copy 4 for your records.

SECTION II
TO BE COMPLETED BY THE RECEIVER – the EXEMPT RECEIVER shall:

• Sign Section II certifying receipt of the shipment listed in Section 1 and agreeing to dispose of the shipment in the exempt outlet specified.
  
  
  

• Send Copy 3 to AMS no later than two (2) days after receipt.

MAILING INSTRUCTION

Copies 2 and 3 shall be sent to USDA, AMS, Fruit and Vegetable Program, Marketing Order and Agreement Division, 1400 Independence Avenue SW, Room 1406-S, Stop 0237, Washington, D.C. 20250-0237. The forms may be faxed to (202) 720-5698, but must be followed up with the mailed original copy within two (2) days. For further information, call (202) 747-5394 or
(888) 551-3523.

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 0581-0167. 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.

COPY DISTRIBUTION

Copy 1 – U.S. Customs and Border Protection

Copy 2 – Import Submits to USDA/AMS

Copy 3 – Receiver Submits to USDA/AMS

Copy 4 – Retained by Importer

FV-6 (08/2014)