Form 9010-1 Application for the Return of Exported Products to the U

Import Inspection Application and Application for the Return of Exported Products to the U.S.

FSIS 9010-1 Application for the Return of Exported Products to the United States_v8RE508

Import Inspection Application and Application for the Return of Exported Products to the U.S.

OMB: 0583-0159

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2. EXPORT CERTIFICATE NO. (Attach Copy)
(i.e. MPM-000000 or US-CA-yyyy-000000)

U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

APPLICATION FOR THE RETURN OF EXPORTED PRODUCTS TO THE UNITED STATES
1. DISTRIBITION:

Applicant must submit the completed form to USDA, FSIS.
See Page 2 for address and instructions.

3. APPLICANT (Name and Address including zip code, contact name, phone number and email)

4. US PORT OF ENTRY

5. ESTIMATED DATE OF ENTRY (mm/dd/yyyy)

6. EXPORT. EST. NO.

7. U.S. EXPORT EST. NAME AND ADDRESS

9.
PRODUCT AS LABELED

15. PORTS TRANSITED

10.
MARKED
WEIGHT

11.
NO. OF
CARTONS

16. COUNTRY RETURNED FROM

8. DATE OF REQUEST (mm/dd/yyyy)

12.
PRODUCTION CODE

14.
EST. NO.
ON PRODUCT

13.
SHIPPING MARKS

(Applied at Time of Export)

17. REASON FOR RETURN

19. DATE AT EST. (mm/dd/yyyy)

18. REINSPECTION OFFICIAL FSIS ESTABLISHMENT*

*Applicants should identify an official FSIS establishment for reinspection, if required, and a date for the reinspection. Approval of the establishment and reinspection date
depends on concurrence from the District Office of Field Operations.
20. COMMENTS/REMARKS

TO BE COMPLETED BY FSIS PERSONNEL ONLY
21. REINSPECTION REQUIRED
(date and initials)

25. SIGNATURE OF STAFF OFFICER

FSIS FORM 9010-1 (05/13/2019)

22. APPLICATION DENIED
(date and initials)

23. APPLICATION CANCELLED
(date and initials)

24. RELEASED
(date and initials)

26. DATE (mm/dd/yyyy)

Submit via E-mail

INSTRUCTIONS FOR PREPARATION OF FSIS FORM 9010-1
Note:
1.

The information on the form can be typed or written to be completed by Applicant
Submit Form: Click the "Submit via E-mail" button at the bottom of the form or the form may be printed and scanned
or saved as a .pdf and emailed to: [email protected]
For assistance, please call (202) 720-9904

2.

Export Certificate Number - As identified on certificate and shipping cartons

3.

Applicant - Information regarding applicant's company, including the company's address, phone number, and email address. Include
the name of person filling out application (the applicant's representative)

4.

U S Port of Entry - City and State of U S Port of Entry either entering sea or ground/air

5.

Estimated Date of Entry - Estimated Date when the product is to arrive in the US (Month, Day, and Year)

6.

Originating Export Establishment - Establishment number where export originated from

7.

U S Establishment - Export Establishment Name and Address - Full address (street, city, state and zip code ) where export originated
from

8.

Date of request - Date application is completed and submitted

9.

Product as labeled - Species, Total Ship Weight and Product as described on Label or Export documents, e.g. "Beef Boneless Rounds"

10.

Marked Weight - Total Shipment Weight in pounds

11.

No. of Cartons - The numeric count of product returning

12.

Production Code - Date produced or other production codes. Information in this field is not required if that information is unavailable.

13.

Shipping Marks (Applied at Time of Export) - Export Stamp number

14.

Establishment No. on Product - Producing establishment number of the returned product

15.

Ports Transited - All ports visited by the shipment - leaving and returning to the U.S.

16.

Country Returned from - Country product was exported to as listed on export certificate

17.

Reason for Return - Reason product is returning the US (e.g. Refused for contamination, Returned because not up to
specifications, etc.)

18.

Reinspection: Official FSIS Establishment - The FSIS Establishment proposed for reinspection, should it be required,
pending concurrence from the appropriate District

19.

Date - Estimated date the shipment will arrive for reinspection (at the establishment listed in block 18)

20.

Comments/Remarks - Comments by the applicant and/or FSIS personnel

BLOCKS 21 through 26 FOR FSIS PERSONNEL USE ONLY
21.

Reinspection Required - Date and initials of the FSIS staff officer if shipment must be reinspected at location specified in
block 18.

22.

Application Denied - Date and initials of the FSIS staff officer if the shipment is denied entry in the US.

23.

Application Cancelled - Date and initials of the FSIS staff officer if the shipment has been cancelled by the applicant.

24.

Released - Date approved to move if reinspection is not required or acceptable results are reported by DO after
reinspection.

25.

Signature of Staff Officer - signature of FSIS staff officer completing the return.

26.

Date - date final action is taken by the FSIS staff officer.


File Typeapplication/pdf
File TitleFSIS 9010-1 Application for the Return of Exported Products to the United States
SubjectApplication, Exported Products, Return
AuthorUSDA-FSIS
File Modified2019-06-06
File Created2019-06-06

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