FGIS-907 Application for Inspection and Weighing Services

This is a fillable form; fill out, print, sign original, and mail to service area GIPSA Field Office.

U.S. DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND
STOCKYARDS ADMINISTRATION
FEDERAL GRAIN INSPECTION SERVICE
APPLICATION FOR INSPECTION AND
WEIGHING SERVICES

According to the Paperwork Reduction Act of 1995, no persons are 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 0580-0013. 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.

Pursuant to Section 7 and 7a of the United States Grain Standards Act as amended (7 U.S.C. 79 and 79a) and the regulations thereunder (7 CFR 800 et.
seq.) and/or Section 203(h) of the Agricultural Marketing Act of 1946, as amended (7 U.S.C. 1622) and the regulations and standards thereunder
(7 CFR Parts 57 and 868), we apply for services described below.

1. Type of Services (check all that apply)
Original Inspection
Reinspection
Official Weighing

Review of Weighing

Appeal Inspection

2. Where are the services to be
performed (check one)

Board Appeal Inspection

United States

Supervision of Weighing
Retest
3. Kind of Official Inspection Service Requested (check all that apply)

Canada

Official Sample Lot

Submitted Sample

Checkweigh/Checkload/Checkcount

Sampling

Official Weighing

Supervision of Weighing

Stowage Examination

Grade and Factor

Official Commercial

Condition
4. Type of Grain/Commodity

Factors Only
Other Criteria (list in remarks)
5. Location of Grain/Commodity
6. Contract Number (if applicable)

7. Carrier or Other Identification

8. Quantity (specify in pounds, bushels, etc.)

9. Contract Grade (Factor or
Specifications)

10. Number and Kind of Containers

11. Container Markings

12. Appeal Request
File Sample
New Sample

13. Name, Address and Telephone Number of Applicant (Firm Name)

14. Name and Address of Interested Party (agent, consignee)

13a. Applicant GIPSA Account Number:
15. Remarks

In submitting this application, we expressly agree that the fees and charges for the inspection and weighing services shall be assessable
to and payable by us in accordance with the fees and charges described in the regulations (7 CFR 800 et. seq.) under the United States
Grain Standards Act and/or described in the regulations (7 CFR 868) under the Agricultural Marketing Act of 1946. I declare that the
foregoing statements are true to the best of my knowledge, information and belief.
16. Date (mm/dd/yy)
17. Name of Firm
18. Signature of Person Making Application
Warning: Attempts to influence any official personnel with respect to the performance of his/her duties under the U.S. Grain Standards
Act may upon conviction thereof, be subject to imprisonment for not more than 5 years and/or a fine of not more than $20,000.
18 U.S.C. 1001 provides for a fine of not more than $10,000 or imprisonment for not more than 5 years, or both, for false or fraudulent
statements made to an agency of the United States. The offering of any gratuity, as described in 7 CFR 800.187, will be deemed an
attempt to influence official inspection personnel.
For Use by FGIS
19. Application Received By
20. Date (mm/dd/yy)
21. Field Office
22. Fees

23. Certificate No. or Nos.

24. Remarks

FORM FGIS-907 (NOV 03) previous edition obsolete. Expires January 2018. This form also replaces FORMS FGIS-908 and 955, which are obsolete.

Clear Form

25. Car Initials
and Number
or other
Identification

26. Quantity
27. Kind of
(Cargos) or
Grain and
Marked
Reason
Capacity Per
For
Carlot or
Appeal 1/
or Review
Part Carlot

28. Requested
Sample Basis
(Check)
Official
File

New

29.
Date 2/
of
Original
Service

30. Check if
Original
Certificate
For The
Service is
Attached

31. Remarks

1/ List factor(s) and/or other criteria in question. For requests filed in advance, show the scope of the inspection in
question.
2/ Show only date of inspection being appealed or weighing service being reviewed.
The conduct of all services and the licensing of (inspecting/grading/sampling) personnel under the regulations governing such
services shall be accomplished without discrimination as to race, color, religion, sex, national origin, age or handicap.
FORM FGIS-907

Reverse

Instructions for Completing Form FGIS 907
“Application for Inspection and Weighing Services.”
A.

Action by Applicant. Complete items 1 through 18. Return the original to the
appropriate FGIS field office and retain a copy for your records.
1.

Check the box for the services needed. More than one box may be checked if a
combination of services is requested.

2.

Check the appropriate box to indicate whether the service is to be performed in
the United States or Canada.

3.

Check the box indicating the kind and scope of service being requested. For
checkweigh, checkload, checkcount services use the remarks section for the
specific service requested. Also, for condition of container examinations use the
remarks section for this specific service.

4.

Enter the type of grain or commodity for the service being requested.

5.

Enter the location of the grain or commodity for the service being requested.

6.

Enter the contract number if applicable.

7.

Enter the carrier or identification for the service being requested.

8.

Enter the quantity in pounds, bushels etc., for the grain or commodity to be
inspected.

9.

For inspections during loading, enter the contract grade along with any special
grade or other contract requirements. This information is not applicable to
carriers that are to be inspected at rest.

10.

Enter the number and kind of containers.

11.

Enter the container markings, use the words: “Standard”, “Commercial”, or
“Special” for the type of markings. For “Special” enter the complete container
markings in the remarks section. If there are no markings enter “None”. For bulk
rice, enter “Bulk”.

12.

Check the box indicating the type of sample required:

13.

Enter the name and address of the applicant; i.e., the party that will be billed for
the service.

13a.

Enter the applicant’s GIPSA Account number.

B.

C.

14.

If applicable enter the name and address of the agent or person of interest if any.

15.

Enter additional information if necessary.

16.

Enter the date the application was prepared.

17.

Enter the name of the firm that is requesting the service.

18.

Enter the name and signature of the person completing the application.

Action by field office. Review Form FGIS 907. If incomplete, either return the form to
the applicant for completion or insert and initial the missing information. Complete items
19 through 24:
19.

Enter the name of the person who received the application.

20.

Enter the date the application was received.

21.

Enter the name of the field office where the application was filed.

22.

Enter the amount of fees that are to be assessed.

23.

Enter the inspection certificate(s) numbers including the lettered prefix.

24.

Enter any additional pertinent information.

Action by Applicant. For appeal, Board appeal or review services complete items 25
through 31.
25.

Use the lot, carrier, or other identification shown on the certificate for the service
in question. Identify a barge by name, number and any letterhead prefixes and
suffixes; a railcar by its initials and number; a truck or trailer by license number
and name or abbreviation of State (include time of sampling when necessary); and
a vessel its name preceded by its means of propulsion (M/T, M/V, S/S, etc.)

26.

Enter the quantity in terms of bushels, pounds, weight loaded or unloaded, or to
be loaded or unloaded for cargos. For a lot of sacked grain, also enter the type,
number, and weight of sacks; e.g., 6000, 100-lb cotton sacks. For a truckload or
trailerload, show truckload, trailerload, part-truckload or part-trailerload as the
case may be. For a railcar, enter the marked capacity of the carrier or “over
130 000 lb” or under 130 000 lb” as the case may be.

27.

Enter the grain and reason for the appeal, Board appeal, or review; e.g., the grade
determining factors or other criteria. For requests filed in advance, show the kind
of grain and contract grade.

28.

Enter the sample basis desired for the appeal inspection. All Board appeal
inspections will be performed on the basis of the official file sample.

29.

Enter the date of the original service. For applications filed in advance of loading,
enter the expected date and time of loading if possible.

30.

Indicate whether the original certificate for the inspection being appealed is
attached. If the certificate is not attached, explain in item 31.

31.

Enter any additional pertinent information.

CONTACT INFORMATION:
Contact the field office responsible for the geographic area in which the service will be provided.
Details for these locations can be found at:
http://www.gipsa.usda.gov/GIPSA/webapp?area=home&subject=fc&topic=fsp
The signed form should also be mailed to this location.
For further information on the Application for Inspection and Weighing Services contact:
Patrick J. McCluskey, Chief
Policies, Procedures, and Market Analysis Branch
Field Management Division
1400 Independence Avenue, SW, Room 2409 N
Washington, DC 20250-3630
Telephone:
Fax:
Email:

(816) 659-8403
(816) 872-1258
[email protected]