PPQ 950 Importation Actions on Wood Packaging Material (Statemen

OMB Approved 0579-0055
Exp XX/XXXX

Please see reverse for completion instructions.
UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
PLANT PROTECTION AND QUARANTINE

IMPORTATION ACTIONS ON WOOD
PACKAGING MATERIAL

1. ORIGINATING OFFICE TELEPHONE
NUMBER

2.. CONTROL NUMBER (5 Digits)

3. SERVICE DATE

4. IRS TAX ID NUMBER

(Statement of Services/Invoices/Receipt)

5. REMITTER’S NAME

6. REMITTER’S ADDRESS

7. REMITTER’S TELEPHONE
NUMBER

NOTE: Partial units must be in quarter increments (e.g., 15 minutes = 1; 30 minutes = 2; 45 minutes = 3)
8. INSPECTION PERIOD

9. UNIT COST
FOR HOURS
FOR QUARTERS

Normal Tour of Duty

$56.00

$14.00

Sunday/Holiday

$74.00

$18.50

Other than Sunday/Holiday

$65.00

$16.25

Commuted Travel Time

$65.00

$16.25

10. NUMBER OF UNITS
FOR HOURS
FOR QUARTERS

11. TOTAL DOLLARS

OUTSIDE NORMAL TOUR OF DUTY

(2-Hour Minimum Charge Required by 7 CFR § 354.1)

(If applicable under 7 CFR § 354.2)

12. TOTAL AMOUNT
DUE
13. TYPE OF INSPECTION

Manipulation

Validation of Mark

Validation of Treatment

Other

14. IDENTIFICATION OF CARGO
Carrier

Bill of Lading Number

Broker Reference Number (If Applicable)

15. REMARKS

16. PLANT PROTECTION AND QUARANTINE OFFICER’S SIGNATURE

17. SIGNATURE DATE

PAYMENT INFORMATION
18. DATE RECEIVED

19. AMOUNT RECEIVED

20. PAYMENT TYPE
Cash

*Customers using credit Cards on a

Money Order (Number)

Credit Card (Where Applicable):

Check (Number)
Account Number
Expiration Date

regular basis may have a signature on
file accepting payment terms.

Authorized Signature*

NOTICE TO PAYER
Payment is due at time of service. If payment of invoice is other than cash or U.S. postal money order, this invoice will not be considered paid in full until such
tender has been cleared. If you have any questions, please contact the originating office listed above.
PPQ Form 950
AUG 2014

INSTRUCTIONS FOR COMPLETION OF PPQ FORM 950, STATEMENT OF SERVICES/INVOICES/RECEIPT
Item 1 – ORIGINATING OFFICE TELEPHONE NUMBER – Enter issuing Office’s telephone number.
Item 2 – CONTROL NUMBER – This is a five digit sequential numbering of documents for each office starting with 00001.
Item 3 – SERVICE DATE – Date service is provided. If the service extends over 2 days, enter the beginning date.
Item 4 – IRS TAX ID NUMBER – The taxpayer identification number (TIN) is an IRS assigned employer identification number. All
Federal agencies are required to obtain a TIN number from each person doing business with that agency.
Item 5 – REMITTER’S NAME – Customer’s name.
Item 6 – REMITTER’S ADDRESS – Customer’s complete mailing address.
Item 7 – REMITTER’S TELEPHONE NUMBER – Customer’s telephone number including area code.
Item 8 – INSPECTION PERIOD – Inspection timeframe.
Item 9 – UNIT COST – This is the current hourly and quarterly cost for each service.
Item 10 – NUMBER OF UNITS – Fill in the number of units next to the service provided. For example, if service is provided outside
the normal tour of duty on a Sunday and takes 2 ¾ hours, enter “2” in the Hours column and “3” in the Quarters column. Complete
the Commuted Travel Time column following 7 CFR § 354.2.
Item 11 – TOTAL DOLLARS – This represents the total amount for that particular line. Multiply the cost per unit by the number of
units, and the total in this block.
Item 12 – TOTAL AMOUNT DUE – Add all the amounts in item 11. “Total Dollars, and enter here.
Item 13 – TYPE OF INSPECTION – Check the appropriate box indicating the reason for the user fee charge.
Item 14 – IDENTIFICATION OF CARGO – Complete applicable information to identify specific cargo inspected.
Item 15 – REMARKS – Use this space for any additional comments.
Item 16 – PLANT PROTECTION AND QUARANTINE OFFICER’S SIGNATURE – Signature required of person completing the
inspection.
Item 17 – SIGNATURE DATE – Date of signature.
Item 18 – DATE RECEIVED – This is the date that the Plant Protection and Quarantine Office received payment for the services.
Item 19 – AMOUNT RECEIVED – Enter the amount of the payment received.
Item 20 – PAYMENT TYPE – Check the appropriate box for the form of payment. If a check or money order is received, include the
check or money order number. If paying by credit card, include the credit card number, the expiration date, and have the customer
sign by authorized signature (if the signature is not on file – as noted next to Item 20.)

Paperwork Reduction Act Notice
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 0579-0055. The time required to complete this information collection is estimated to average 6 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.

PPQ FORM 950 (Reverse)
AUG 2014