Sanitary Certificate Request

Export Health Certificate Request Forms

Sanitary 100112

Export Certificates

OMB: 0581-0283

Document [docx]
Download: docx | pdf

Form Approved OMB No. 0581-NEW


U. S DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

SANITARY CERTIFICATE REQUEST


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. This valid OMB control number for this collection is 0581-NEW. The time required to complete this information collection is estimated to average 12 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 information.


  1. COMPANY

     

MAIL CERTIFICATE TO:

  1. ACCOUNT NUMBER

     

7. COMPANY

     

  1. BILLING REFERENCE

     

8. CONTACT

     

  1. E-MAIL ADDRESS

     

9. STREET

     

  1. CONTACT PHONE

     

10. CITY

     

  1. FAX

     

11. STATE

     

12. ZIP

     

EXPORTER

13. NAME

     

14. ADDRESS

     

15. CITY, STATE

     

IDENTIFICATION OF DAIRY PRODUCTS

16. DESCRIPTION OF COMMODITY

     

17. KIND OF HEAT TREATMENT(HTST;PAST)

     

18. TYPE OF PACKAGING

     

19. NUMBER OF PACKAGING UNITS

     

20. NET WEIGHT

     

21. REQUIRED TEMPERATURE DURING STORAGE AND TRANSPORTATION

     

22. EXPIRATION DATE

     

MANUFACTURER

23. NAME

     

24. CITY, STATE

     

25. PLANT NUMBER

     

PLACE OF LOADING

26. CITY, STATE

     

DESTINATION

27. NAME OF RECEIVER

     

28. CITY

     

29. COUNTRY

     

30. METHOD OF TRANSPORT

     

31. SIGNATURE OF AGENT FOR APPLICANT




32. DATE

     

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.



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorKen Vorgert Chief, Dairy Grading BranchUSDA
File Modified0000-00-00
File Created2021-01-24

© 2024 OMB.report | Privacy Policy