9080-3 Establishment Application for Export

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number. The valid OMB control number for this information collection is 0583-0153. 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.

2. DATE OF REQUEST

UNITED STATES DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

ESTABLISHMENT APPLICATION
FOR EXPORT OF

3. COUNTRY (To which product will be exported)
4. DISTRICT OFFICE (Name and Number)

MEAT

EGG PRODUCTS

POULTRY

OTHER

5. USDA ESTABLISHMENT NO. (Specify Est. No., M, P, ID, I, etc)
(Check if Voluntary Inspection)

6. FROM: (Establishment name and address as shown on current Grant of
Inspection, FSIS Form 5200-1, and include DBA's if applicable)

9. TYPE OF
OPERATION(s)
(Check)

10. CLASS OF PRODUCT(s) TO BE EXPORTED
(Check)
03B Raw Product-Ground

Slaughter

03C Raw Product-Not Ground

Boning/Cut-up

03D Thermal Processed/Com. Sterile
03E Not Heat Treated-Shelf Stable (S.S.)

Grinding

03F Heat Treated-Shelf Stable

Processing

03G Fully Cooked/Not Shelf Stable

Cold Storage

03H Heat Treated/Not Fully Cooked-Not S.S.

Other
7. PHONE NO.

03I Product With Secondary Inhibitors-Not S.S

8. FAX NO.

WILD GAME LIST

11. SPECIES (Check all that apply)*:
Siluriformes
Fish

Beef

Bison

Buffalo

Chicken

Lamb

Duck

Emu

Horse

Turkey

Rhea

Mutton

Ostrich

Pork

Veal

Egg Products

OTHER SPECIES LIST

Antelope

Deer

Elk

Catalo

Rabbit

Pheasant

Quail

Reindeer

Guinea

Goose

Goat

Squab

Water Buffalo

12. The undersigned requests that the firm identified in Item 6 be included on the list of establishments certified by USDA as meeting the requirements of the
country specified with respect to the importation of meat/poultry or meat/poultry products.

.
..
.
.

We make this request with the understanding that, in addition to compliance with normal U.S. inspection requirements, the above-named firm voluntary agrees to
the following:

To comply with all provisions of appropriate inspection laws and regulations of the importing country when preparing
product for export to that country. These requirements have been reviewed by officials of this firm and are fully
understood.
To reimburse USDA for any inspections over and above U.S. requirements, (Reference FSIS Directive 5110.1).
To segregate and maintain identity of product eligible for export from noneligible product.
To operate in the mode to meet the importing country's requirements anytime an export audit is made by a U.S. review
team or by a foreign official.
To notify appropriate FSIS officials promptly when firm wishes to be removed from the list of plants that are eligible to
export to the country named herein (Item 3).

13. SIGNATURE OF AUTHORIZED FIRM REPRESENTATIVE
(Type or Print Name Above Signature)

14. TITLE (Type or Print)

15. DATE SIGNED

16. NAME OF CONTACT PERSON IF DIFFERENT FROM ABOVE

17. TITLE (Type or Print)

18. PHONE:

FSIS SECTION (Type or Print Name Above All Signatures)
20. I surveyed the above-named establishment on the date indicated below and in my opinion, it meets the requirements for export to

(Name of Country)

, subject to comments if any on the attached correspondence.
22. DATE SURVEYED

21. SIGNATURE OF INSPECTOR-IN-CHARGE

23. SIGNATURE OF CIRCUIT SUPERVISOR/DATE
FSIS FORM 9080-3 (08/27/2018)

24. SIGNATURE OF DISTRICT MANAGER/DATE
(PREVIOUS EDITIONS OBSOLETE)

19. FAX:

INSTRUCTIONS FOR FSIS FORM 9080-3

Purpose:
For most countries, all FSIS authorized meat, poultry and egg product establishments are eligible to
export meat, poultry and egg products, provided all requirements indicated in the FSIS Export Library
are met. Several countries however, require additional certification provided by the plant and
approved by FSIS. The country requirements listed in the FSIS Export Library will reflect the
necessity of this additional certification process if required. Plants wishing to export to such countries
must submit FSIS Form 9080-3 to the Office of Policy and Program Development in order to become
eligible.
Instructions:
FSIS Form 9080-3 is to be completed and submitted by establishment personnel using PHIS (Public
Health Information System). Effective June 29, 2018, FSIS no longer accepts the paper version of
FSIS Form 9080-3 submitted to FSIS IPP for review and approval. For establishments that do not
have access to or use PHIS, they are to send a fully completed paper copy of FSIS Form 9080-3 to
the FSIS Proxy, using one of the three options listed below. The FSIS Proxy will enter the
application information into PHIS on the applicant's behalf.
1. Email: [email protected];
2. Mail: U.S. Department of Agriculture, Food Safety and Inspection Service, FMD, Financial
Services Center, P.O. Box 9205, Des Moines, IA 50306-9948; or
3. Fax: 1-844-378-1048
Approval:
Once FSIS Form 9080-3 is approved by Office of Field Operations personnel, the Office of Policy
and Program Development will process the request with the appropriate foreign authorities. Upon
receipt of approval notification from foreign authorities, the Office of Policy and Program
Development will post the plant information in the FSIS Export Library under the list of approved
plants for the appropriate country. Users should monitor the FSIS Export Library to see when their
plant has been approved. Users may contact the Office of Policy and Program Development for an
update of the status of the application by email at [email protected] or phone at (202)
720-0082.