VS 16-28 Approved Warehouse Request And Agreement To Handle Restr

Clear Form
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 numbers for this information collection are 0579-0245, 0579-0040, 0579-0307, and
0579-0015. The time required to complete this information collection is estimated to average 1 hour 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
VETERINARY SERVICES
1. Agreement Date:

APPROVED WAREHOUSE REQUEST AND AGREEMENT
TO HANDLE RESTRICTED ANIMAL BYPRODUCTS
(HUNTING TROPHIES & MUSEUM SPECIMENS)

2. Agreement Type:





OMB Approved
0579-0245, 0579-0040, 0579-0307,
and 0579-0015

3. Approval Number:

Initial
Renewal
Update

4. Approved Warehouse Name:

5. Warehouse Physical Address:

6. Warehouse Mailing Address:

7. Warehouse Phone Number:

8. Warehouse Email Address:

 Same as Physical Address

9. Name and Title of Authorized Warehouse Official:

10. Storage Capabilities:



Refrigerated



Non-refrigerated

11. List Products Used to Clean and Disinfect Contaminated Areas per Written Protocol (mark all that apply):



Soap and Hot Water



Sodium Hydroxide



Bleach



4% Sodium Carbonate



1-Stroke Environ



Other:___________________________________



Virkon-S

12. Briefly Describe Disposal Methods for any Damaged Packing:

13. I understand the following conditions:
a)

Any restricted trophy shipped to and received at the approved warehouse shall be unloaded and handled in accordance with
provisions of 9 CFR 94, 95, or 96 and as directed by a USDA inspector.

b)

USDA shall be notified upon movement from the approved warehouse to an approved establishment, by submission of a
completed VS Form 16-78, within 5 business days of movement.

c)

The approved warehouse must notify the appropriate USDA office if they have received completed VS Form 16-78 from Customs
and Border Protection (CBP) but the shipment has not arrived within 30 days. The approved warehouse must also
notify the appropriate USDA office immediately upon receipt of a restricted shipment that is not accompanied by a VS Form 16-78 .

VS Form 16-28
FEB 2020

d)

Officials of the approved warehouse shall maintain the identity of the restricted imports and keep records to show that the
disposition of each shipment is in accordance with USDA requirements. These records include, but are not limited to,
copies of VS Form 16-78, arrival documents (packing slip, shipping documents, etc.), and records showing traceability to
final dispensation of the consignment. These records must be kept for a minimum of 3 years after disposition of the
shipment. Representatives of USDA shall be given access to the approved warehouse records in connection with the
restricted import in order to determine that disposition of the restricted imports is in accordance with this agreement.

e)

Restricted imports shall not be moved to an approved establishment other than that listed on the VS Form 16-78 without
prior approval by USDA.

f)

Damaged or abandoned shipments shall not be moved without authorization by USDA.

g)

Any personnel handling restricted imports shall receive annual training on biosecurity. Training must be documented.

h)

The approved warehouse must have a written protocol for cleaning and disinfection any areas contaminated by restricted
products, e.g. vehicles or storage areas, when required.

i)

Packing must remain unopened and intact. However, if containers are found to be leaking or broken on arrival at the
approved warehouse, the transport vehicle shall be disinfected using authorized disinfectants, and the container shall be
repackaged or repeated to prevent leakage prior to further movement or storage.

j)

Approved warehouses shall be maintained in a sanitary condition. Practical precautions should be taken to exclude
insects, rodents, or other animals from approved warehouses.

k)
l)

Restricted products must be kept in a secure storage area.
The approved warehouse shall retain responsibility for ensuring they are inspected at least once every 365 days and
maintain all required approvals. If the establishment official signing this agreement changes, USDA must be notified prior to
the change and a new agreement must be completed.

14. Acknowledgement by Approved Warehouse:

I, the undersigned, hereby declare that I am authorized to represent the company listed in blocks 4 and 5. The above is true and accurate to
the best of my knowledge. I understand that if any changes are made to the above, I must notify USDA prior to doing so. Such changes to
my approval may require an additional inspection and thus incur additional user fee charges. I have read and understand the conditions
listed in block 13. With my signature, I agree to comply with all conditions on this agreement. I understand that failure to comply with all
conditions, or failure to maintain adequate documentation, may result in the revocation of the warehouse’s approval. I understand that I am
responsible for payment of all associated user fees (current user fees may be found in 9 CFR 130.11). I understand that the warehouse may
be subjected to unannounced inspections by USDA, and additional user fees may apply for those inspections.

15. Authorized Warehouse Official
Printed Name:

Signature:

_________________________________________________________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB__BBBBBBBBBBBBBB

Title:

Date:

16. VS Inspector:
Printed Name:

Signature:

_________________________________________________________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB__BBBBBBBBBBBBBB

Title:

Date:

17. Service Center Veterinarian in Charge or Designee
Printed Name:

Signature:

_________________________________________________________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB__BBBBBBBBBBBBBB

Title:

Date:

18. Approving Import Products Staff Veterinarian:
Printed Name:

Signature:

_________________________________________________________BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB__BBBBBBBBBBBBBB

Title::
VS Form 16-28
FEB 2020

Date: