FGIS 992 Service Performed Report

*

This is a fillable form.
= Calculated Field

UNITED STATES DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND
STOCKYARDS ADMINISTRATION
FEDERAL GRAIN INSPECTION SERVICE

Form Approved: OMB 0580-0013
1. Field Office

SERVICE PERFORMED REPORT
Instructions: Send original to the field office, one copy to the testing laboratory and retain one copy.
2. Sample Type (Check one)
FSA
DSCP
VA
Submitted
Supervision
6. Commodity Code
5. Date Sampled
4. Sample or Lot No.
3. Contract No.

9. Name and Address of Applicant

Other(Specify)
7. Location Code

8. Applicant No.

10. Commodity
Domestic
Export
11. Location of Commodity
13. Seal Numbers

12. Identification of Carrier

17. Gross Weight

14. Inspection Point

15. Destination

16. Number and Kind of Containers/ Laboratory Instructions

29. Sampler

Tare Weight

30. Date

31.Time (mil)
Start xx:xx

32. Time
Stop

33. Hours * 34. Activity
Worked

21. Weight
Empty Inner
Containers

# of containers = # of containers =

Boxes 19. and 21. are the
total number of empty
containers randomly
selected (minimum 10).
Boxes 20. (outer) and 22.
(inner) are the total weights
of the number indicated in
boxes 19. or 21.

*

18. Total
Gross Wt

20. Total

*

24. Tare

*

25. Net

Estimated Weight of Lot
26. Gross

*

27. Tare

*

*

39. Results Received

40. Vendor Called

36. Comments of Sampler

22. Total

Weight Per Container
23. Gross

35. Total Hours

Times must have colons (:)!

19. Weight
Empty Outer
Containers

Count No. in this box

28. Net

*
*

37. Name(s)

38. Sample Mailed

41. Cert. Mailed

Warning: Sec 203(h) of the Agricultural Marketing Act of 1946 (7 U.S.C. 1622 (h)) provides that anyone causing a false certificate to be issued shall be
subject to a $1,000 fine or imprisonment for not more than 1 year, or both. 18 U.S.C. 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.
Form Approved OMB NO. 0580-0013: According to the Paperwork Reduction Act of 1995,DQDJHQF\PD\QRWFRQGXFWRUVSRQVRUDQGDSHUVRQLVQRWUHTXLUHG
WRUHVSRQGWRDFROOHFWLRQRIinformation unless it displays a valid OMB control number.7KHYDOLG20%FRQWUROQXPEHUIRUWKLVLQIRUPDWLRQFROOHFWLRQLV
7KHWLPHUHTXLUHGWRcomplete this information collection is estimated to average 20 minutes per response and 3.3 hours yearly per recordkeeper, this includes the
WLPHIRUreviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of informatio
FORM FGIS-992 (11-04) Edition of (11-92) may be used. ([SLUHV-DQXDU\

Clear Form

Print Distribution

Sampler

FSA Commodity Codes
WBUE20
WBUD10
WBUE10
RCED10
WCED10
CBLE10
CMKE20
CMKE10
CCME20
CCMD10
CCME10
CCMD20
WFAD20
WFLD10
WFLE10
WFLD20
WFLD25
WFLD30
WFLD15
WFLD40
WFLE30
WFLD35
WFLE20
WFLD45
CFLE10
CFLD10
WFLD50
WFLD55
SFLE10
WFLD60
CCED20
RCED20

Bulgur, Soy Fortified- Exp
Bulgur-Dom
Bulgur-Exp
Cereal, Rice, Instant-Dom
Cereal, Whole Wheatmeal-Dom
Corn Soy Blend-Dom
Corn Soy Milk, Instant-Exp
Corn Soy Milk-Exp
Cornmeal, Soy Fortified-Exp
Cornmeal-Dom
Cornmeal-Exp
Cornmeal Regular-Dom
Farina-Dom
Flour, All Purpose-Dom
Flour, All Purpose-Exp
Flour, Bakers, Hd Wht Hearth Style-Dom
Flour, Bakers Soft Wht Bl-Dom
Flour, Bakers Soft Wht Unbl-Dom
Flour, Bred Bakers Hd Wht-dom
Flour, Bread, Hearth Style-Dom
Flour, Bread, Wheat, Soyfort 12%-Exp
Flour, Bread-Dom
Flour, Bread-Exp
Flour, Cake-Dom
Flour, Corn Soya Masa Instant-Exp
Flour, Corn Masa Instant-Dom
Flour, Durum-Dom
Flour, Pastry-Dom
Flour, Soy, Defatted-Exp
Flour, Whole Wheat-Dom
Fortified Corn Cereal-Dom
Fortified Rice Cereal-Dom

CCMD90
WEGD90
WEGD95
WFAD90
WFAD95
WFLD90
CRGD90
WPAD95
NCMD90

Cornmeal, Degummed, Enriched
Egg Noodles, Ribbon Shaped
Egg Noodles, Ribbon, Shaped, Yolk
Farina Enriched Malt Low Sodium
Farina wheat Enriched, Quick-Dom
General Purpose Wheat Flour
Hominy Grits, Enriched, Quick-Cook
Macaroni, Enriched, Elbow, Regular
Noodles Chow Mein

MSHU90
MSHU95
MBRU20
MBRU25
MBRU10
MCCU10
MCCU40
MCCU50
MCCU35
MCCU25
MCCU15
MCCU45
MCCU20
MCCU30
MCBU10
MCBU15
MCBU20
MCBU25
TCOU10
CSTU10
CSTU20
CSTU30
CCMU10
CCMU15
CCMU20
CCMU25
WCRU30
WCRU10
WCRU20
UDUP10
UDUP20
UDUP30
WFAU10
WFLU20
WFLU30
WFLU40
WFLU10
MCBU35
CGRU20
UICU10
UICU30
UICU20
WPAU10
WPAU20
UMAU10
UMAU20
UMAU30
MMXU45
MMXU03

Bakery Mix Shortening, Unemulsified
Bakery Mix Shortening, Emulsified
Bread, White, Enriched, Canned
Bread, Shelf Stable, MRE
Brownies, Type I
Cake, Canned, Apple Coffee, Type II
Cake, Canned, Blueberry, Type II
Cake, Canned, Cherrynut, Type II
Cake, Canned, Chocolate, Type II
Cake, Canned, Fruit, Type I
Cake, Canned, Marble, Type II
Cake, Canned, Orange Nut, Type I
Cake, Canned, Pound, Type II
Cake, Canned, Spice, Type II
Cereal Bars I, Cornflake
Cereal Bars II, Rice-Cornflake
Cereal Bars III, Fruit-Flv Cornflake
Cereal Bars IV, Granola
Cookies, Oatmeal, Type II
Corn Starch, Type I
Corn Starch, Type II
Corn Starch, Type III
Cornmeal, Type I, Coarse
Cornmeal, Type I, Fine
Cornmeal, Type II, Coarse
Cornmeal, Type II, Fine
Crackers, Class II
Crackers, Soda, Plain, Type I, Class A
Crackers, Soda, Salted, Type I, Class B
Dessert, Pwdr, Inst, Starch, Class 1-Choc
Dessert, Pwdr, Inst, Starch Class 2-Van
Dessert, Pwdr, Inst, Starch, Class 3-Btsc
Farina, Type I
Flour, Bread, Type I, Hd Wht
Flour, Pastry, Type IV
Flour, Type II, Cake
Flour, Type III, General Purpose
Granola Bar Type II
Grits, Hominy
Icing Mix Powder, Flavor 1 (Vanilla)
Icing Mix Powder, Flavor 3 (Other)
Icing Mix Powder, flavor 2 (Chocolate)
Lasagna, Group IV
Macaroni, Group I
Margarine, Canned
Margarine, Type I
Margarine, Type II
Mix, Angel Food, Class 1, Style F
Mix, Biscuit, Class 2, Style B

WCED20
CGRD10
CGRD20
GGRE10
WPAD10
WPAE10
WPAD20
WPAD24
WPAD25
TRGE30
TRGD20
TRGE20
TRGD30
SSHD10
SSHD20
SSHD30
SOLE40
WPAD30
CYSD10
SOLD10
SOLE10
SOLD20
SOLE20
SOLD30
SOLE30
WPAD40
WBLE10
WBLE20
WMKE10
WRGD10

Fortified Wheat Cereal-Dom
Grits, Corn, Coarse-Dom
Grits, Corn, fine-Dom
Grits-sorghum, Soy fortified-Exp
Lasagna-Dom
Macaroni, Wheat Soy-Exp
Macaroni-Dom
Macaroni, Enr, Rotelle, Reg. Cook
Macaroni, Rotini, Reg. cook
Oats, Rolled, Soy Fortified-Exp
Oats, Rolled, Instant-Dom
Oats, Rolled, Instant-Exp
Oats, Rolled, Quick-Dom
Shortening-I-Dom
Shortening-II-Dom
Shortening-III-Dom, Liquid
Soybean Oil, Crude Degummed-Exp
Spaghetti-Dom
Syrup, Corn Blend-Dom
Vegetable Oil-A-Dom
Vegetable Oil-A-Exp
Vegetable Oil-B-Dom
Vegetable Oil-B-Exp
Vegetable Oil-C-Dom
Vegetable Oil-C-Exp
Vermicelli-Dom
Wheat Protein Concentrate Blend-Exp
Wheat Soy Blend-Exp
Wheat Soy Milk-Exp
Wheat Rolled-Dom

VA Commodity Codes
TRGD90
SOLD90
SSHD90
SSHD95
WPAD90
CSYD90
MSYD90
WCED90

Rolled Oats, Quick Cooking
Salad Oil, Type A
Shortening Type I
Shortening Type III
Spaghetti, Enriched, Long Form, Regular
Syrup, Type III, Blended and Ref.
Syrup, Type VIII, Class 2, Thick
Whole Wheat Cereal, Malt Quick-Cook

DSCP Commodity Codes
MMXU63
MMXU18
MMXU27
MMXU33
MMXU48
MMXU21
MMXU51
MMXU30
MMXU39
MMXU09
MMUX54
MMUX06
MMUX36
MMUX57
MMUX60
MMUX42
MMUX12
MMUX15
NCMU10
WEGU10
WEGU20
MCBU30
MCBU90
TRGU40
TRGU50
TRGU30
TRGU20
TRGU10
CGNU20
CGNU30
CGNU40
CGNU50
MSOU10
MSOU20
MSOU30
MSHU10
MSHU20
MSHU45
WPAU30
USYU10
USYU20
USYU30
USYU40
USYU50
USYU80
USYU60
USYU70
WPAU40

Mix, Cheesecake (Unbaked)
Mix, Cookie, Chocolate, Type I
Mix, Cookie, Oatmeal, Type III
Mix, Cookie, sugar, Type II
Mix, Devil’s Food, Class I, Style C
Mix, Doughnut, Class 3
Mix, Gingerbread, Class 1, Style D
Mix, Pancake & Waffle, Class 2, Style G
Mix, Pancake & Waffle, Class 2
Mix, Pancake & Waffle, Buckwheat, Class 2, Style F
Mix, Pound Cake, Class 1, Style E
Mix, Roll, Class 4, Style A
Mix, Sweetdough, Class 4, Style B
Mix, White Cake, Class 1, Style A
Mix, Yellow cake, Class 1, Style B
Mix, Yellow Cornbread, Class 2, Style A
Mix, Brownie, Butterscotch, Class 5, Style B
Mix, Brownie, Chocolate, Class 5, Style A
Noodles, Chow Mein
Noodles, Egg, Type I
Noodles, Egg, Type I, Egg yolk
Oatmeal Cookie Bar, Type I
Oatmeal Cookie and Granola Bar
Oats, Instan, Flavored
Oats, Instant, Flavored, Tray - Pack
Oats, Rolled, Instant, Type I I I
Oats, Rolled, Quick, Type I I
Oats, Rolled, Regular, Type I
Popcorn, Type I, Fancy
Popcorn, Type I, No. 1
Popcorn, Type I I, Fancy
Popcorn, Type I I, No. 1
Salad Oil, Type A
Salad Oil, Type B
Salad Oil, Type C
Shortening-I
Shortening- I I
Shortening-I I I
Spaghetti, Group I I
Syrup, Type I
Syrup, Type I I
Syrup, Type I I I
Syrup, Type V
Syrup, Type V I
Syrup, Type V I I
Syrup, Type V I I I , Class 1, Thin
Syrup, Type V I I I, Class 2, Thick
Vermicelli, Group I I I

Instructions for completing the Service Performed Report Form FGIS-992
A.

Action by person performing inspection. Complete items 1 through 37.
1.

Field office performing the service.

2.

Type of sample, check one; or specify if you check "other".

3.

Contract number assigned by the contracting party when applicable. Include
prefix characters as part of the contract number.

4.

Sample or lot number assigned. Field offices shall specify one range of lot
numbers for each commodity location (mill point). This range shall be large
enough to accommodate the maximum number of lots inspected at that
commodity location under any one contract. Each range must begin with a
number which ends with the digit 1 (e.g., 501-1000; 2501-3000; 1-350). Lot
numbers must be numeric and cannot exceed 4 digits in length. Each lot will have
its own number (e.g., 501; 502; 503; etc.). To identify new original inspections,
either reserve the first digit of the four digit lot code number for this purpose or
use the next available lot number for each contract. Julian date codes may be
used for DSCP.

5.

Date sampled (MM/DD/YY).

6.

Commodity code (sees reverse side of form for codes, or contact the testing
laboratory for codes not listed).

7.

Location code from the list of numbers provided to the field office.

8.

Applicant number derived by using the last six numbers of the NFC applicant
number.

9.

Name and address of applicant.

10.

Type of commodity and whether domestic or export.

11.

Location of commodity if other than the applicant’s address. If the location is the
same as block 9, show “Same”.

12.

Car number, license number, or other identification of the carrier.

13.

Record the seal numbers applied and/or broken. If space is not adequate, show
“See Below” and place in blocks 16 or 36.

14.

Inspection point code. Field offices view the Grain and Weighing Information
System (GIWIS) under "Reports -- Active Specified Service Points" for

identifying codes, agencies and contractors must contact area field office for
codes.
15.

Destination if known. When submitting ethylene dibromide residue testing and
aflatoxin survey samples, use the destination codes provided in Grain Inspection
Handbook, Book IV, Chapter 4, Data Collection Forms, Report of Grain
Inspected and Weighed for export, Form FGIS-938.

16.

Number of containers and complete description of kind of containers (the
descriptive terms should be those used in the announcements and specifications).
Record checkloading information, such as tally or description, of how the count
was made. When submitting supervision samples, include the type of test
performed and the original results obtained. Also, include any necessary
laboratory instructions.

17.

The gross weight of each container weighed. Refer to the checkweighing
instructions in the Weighing Handbook, Chapter 4, Section 4.5, to determine the
number of containers to weigh. When not recording in pounds. Indicate the unit
of weight used. Weights should be entered as exactly displayed on the scale used.
E.G., if the scale’s smallest division size is 0.1, then 110.1, not 110.10.

18.

Record the total gross weight of the containers weighed by totaling the results in
the columns following block 17.

19.

The weight of the empty outer containers weighed. Refer to the checkweighing
instructions in the Weighing Handbook, Chapter 4, Section 4.5, for the number of
containers to weigh. Place a "1" here if the tare is not known and using a tare
value from Table 4 of Chapter 4 of the Weighing Handbook in block 20.

20.

The total weight of the empty outer containers weighed by totaling the results in
block 19 above (The tare containers are weighed together in one weighing).
Outer containers weighed individually must be handwritten by on the back of the
form and the total of all entered in block 20.

21.

The weight of empty inner containers weighed, if present. Refer to the
checkweighing instructions in the Weighing Handbook, Chapter 4, Section 4.5,
for the number of containers to weigh. When not recording in pounds, indicate
the unit of weight used (The tare containers are weighed together in one
weighing). Inner containers weighed individually must be handwritten by on the
back of the form and the total of all entered in block 22.

22.

The total weight of the empty inner containers selected, if present from block 21.

23.

Record the average gross weight of the filled containers, by dividing the results in
block 18 by the number of containers weighed. This field is automatically
calculated if completed electronically.

24.

Record the average tare weight of the empty containers. This field is
automatically calculated if completed electronically. If the empty containers are
not available for determining tare weight and the lot was previously
checkweighed (e.g., at origin), use the previously determined tare weight. If it is
not known whether the tare was previously determined use Weighing Handbook,
Chapter 4, Section 4.5, Table 4.

25.

Record the average net weight of containers by subtracting the result in block 24
from that in block 23. This field is automatically calculated if completed
electronically.

26.

Record the estimated gross weight of the lot by multiplying the number of
containers in the lot block 16 by the result in block 23. This field is automatically
calculated if completed electronically.

27.

Record the estimated tare weight of the lot by multiplying the number of
containers in the lot block 16 by the result in block 24. This field is automatically
calculated if completed electronically.

28.

Record the estimated net weight of the lot by subtracting the result in block 27
from that in block 26. Some commodity instructions say to certify using the
labeled or intended amount for certification if the lot complies, but for the
purposes of this worksheet use the sampled calculations for block 28. This field
is automatically calculated if completed electronically.

29.

The name of the sampler(s).

30.

Date service was performed.

31.

Starting time to the nearest ¼ hour. For the automatic calculating feature to work
column 33 the time must be entered in military time and with a ":" (colon)
separating the hours from minutes. Shifts exceeding a calendar day 24-hour
period (00:15-24:00) must be split between two entries.

32.

Stopping time to the nearest ¼ hour. For the automatic calculating feature to
work column 33 the time must be entered in military time and with a ":" (colon)
separating the hours from minutes. Shifts exceeding a calendar day 24-hour
period (00:15-24:00) must be split between two entries.

33.

The total hours for each period of time recorded. If more than one lot is worked
simultaneously, prepare an FGIS-992, for each. Record the time worked on each
form; however, do not attempt to prorate and divide the time between different
lots. This field is automatically calculated if completed electronically.

Place asterisks by the hours worked and under the "comments of sampler,"
identify the other lots worked simultaneously. When billing, field office
personnel shall divide the time equally between the lots worked simultaneously or
use the following method to prorate the time worked on each lot.
a.

Total the hours worked on each lot individually during a 1-day (24 hour)
period.

b.

Total the hours worked on all lots during the 1-day (24 hour) period.

c.

Divide the hours worked on each individual lot by the total hours worked
on all lots.

d.

Multiply this amount by the actual clock hours worked for the day (24
hours) and round to the nearest ¼ hour.

34.

The type of service performed (abbreviations are acceptable; i.e.,
S-sampling, C-condition, CW-checkweighing, CC-checkcount, SB-stand by, etc).

35.

The total hours worked. This field is automatically calculated if completed
electronically.

36.

Special services, unusual conditions, events, or observations concerning the lot.
When necessary, give an explanation of the time recorded when other lots are
worked simultaneously or condition of the carrier when found to be unfit to
maintain the quality of the product.

37.

Name(s) of person(s) performing services.

B. Action by person(s) in the field office confirming information. Complete items 38
through 41.
38.

Date sample was mailed.

39.

Date the field office received the results from the testing laboratory.

40.

Date the results were called to the vendor.

41.

The date the certificate was mailed.

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 completed form should also be mailed to this location.
For further information on the Form FGIS-992 “Service Performed Report” contact:
Andrew S. Greenfield
Policies, Procedures and Market Analysis Branch
Field Management Division
1400 Independence Avenue, SW, Room 2409 N
Washington, DC 20250-3630
Telephone:
Fax:
Email:

(202) 720-0277
(202) 720-1015
[email protected]