SC-16 Notice for Hold for Re-Examination

REPRODUCE LOCALLY Include form number and edition data on all reproductions. OMB 0581-0125

UNITED STATES DEPARTMENT OF AGRICULTURE Agricultural Marketing Service Specialty Crops Program			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 0581-0125. 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.
______ _____________________ 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)

SC-16 (rev. 06-2016) (Previous editions are to be destroyed)

OMB 0581-0125

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English.

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by:

1. mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410;

2. fax: (202) 690-7442; or

3. email: [email protected].

USDA is an equal opportunity provider, employer, and lender.

SC-16 (rev. 06-2016) (Previous editions are to be destroyed)