SWL-SIQ Softwood Lumber---Shipment/Import Quarterly Rept.

OMB No. 0581-0093
Payment Due On or Before: ________________
SOFTWOOD LUMBER RESEARCH, PROMOTION, CONSUMER EDUCATION AND INDUSTRY INFORMATION
ORDER
(7 CFR 1217)
SHIPMENT/IMPORT QUARTERLY REPORT
For the _____ Quarter, 20XX
(Quarters are as follows: 1 = Jan, Feb, Mar; 2 = Apr, May, Jun; 3 = Jul, Aug, Sep; 4 = Oct, Nov, Dec)
The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 552a) and the Paperwork Reduction Act of 1995. The
authority for requesting this information to be supplied on this form is the Commodity Promotion, Research, and Information Act of 1996, Pub. L.
104-127, 110 Stat. 1032 (7 U.S.C. 7411-7425). Furnishing the requested information is necessary for the administration of this program.
Submission of the Tax Identification Number is mandatory, and will be used to determine affiliation or entity identification.

Company Name: _______________________________________________ Tax ID# or Importer ID#: _____________________
Address: _______________________________________________________________________________________________
City: _____________________________ State/Province:_________________ Postal Code: _____________________________
Contact Person: _________________________________________________________ Title: ____________________________
E-mail:_____________________________________________________ Telephone Number: ____________________________

LINE 1: Enter the total board feet of softwood lumber manufactured and
shipped within the United States during the applicable quarter.1 Do not
include softwood lumber exported from the United States:

1) ____________________

LINE 2: Enter the total board feet of softwood lumber imported to the
United States during the applicable quarter:

2) ____________________

LINE 3: Add lines 1 + 2.

3) ____________________

LINE 4: Each year a company may exempt the first 15 million board feet
of softwood lumber shipped domestically or imported into the United
States. Enter how much of this exemption your company is using this
quarter: (Yearly exemption must not exceed 15 million board feet)

4) ____________________

TOTAL NUMBER OF BOARD FEET ON WHICH
ASSESSMENT IS DUE (Subtract line 4 from line 3):

5) _____________________

Assessment rate is $0.XX per thousand board feet
Payment must be made in U.S. Dollars
TOTAL ASSESSMENT DUE (U.S. Dollars):

6) __________________ ___

1

1 cubic meter = 423.7760007 board feet

SWL-SIQ (rev. 03/17) Destroy previous edition.

OMB No. 0581-0093

I certify that the above information is true and correct to the best of my knowledge and the attached payment represents $0.XX per
thousand board feet of softwood lumber shipped or imported during this reporting period for which I am required to pay the
assessment. I also certify that I am authorized to sign this report.
__________________________________________________________________________________________________
Print Name and Title of Person Completing this Report
__________________________________________________________________________________________________
Signature
Date
INSTRUCTIONS:
Please make your assessment check payable to the Softwood Lumber Board and mail this form with your check to the lockbox
address below:

Softwood Lumber Board
Street
City, State Zip Code
U.S. manufacturers and importers of softwood lumber are required to pay assessments and file this report no later than the thirtieth
calendar day of the month following the end of the quarter in which the softwood lumber was shipped. The fiscal year runs from
January through December. There are four quarters in each fiscal year. Quarter 1 covers January, February and March. Quarter 2
covers April, May, and June. Quarter 3 covers July, August, and September. Quarter 4 covers October, November, and December.
Assessments for softwood lumber shipped during Quarter 1 are due by April 30; for Quarter 2 by July 30; for Quarter 3 by October
30, and for Quarter 4 by January 30. All reports are held in strict confidence by the staff of the Board and the U.S. Department of
Agriculture (USDA).

NOTE: This report is required by law [7 U.S.C. 7416, 7 CFR Part 1212.52 and 7 CFR Part 1212.70]. The making of any false statement or representation on this form, knowing it to be
false, is a violation of Title 18, Section 1001 United States Code, which provides for the penalty of a fine of $10,000 or imprisonment of not more than five years, or both.
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 0581-0093. The time required to complete this information collection is estimated to average 30
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.
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) 6329992. 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.

SWL-SIQ (rev. 03/17) Destroy previous edition.