FGIS 998 Questionnaire for Proposed Dioverter Type Mechanical Sam

This is a fillable form.
* Calculated Field

Form Approved: OMB 0581-0309
1. Field Office

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FEDERAL GRAIN INSPECTION SERVICE

SERVICE PERFORMED REPORT
Instructions: Send original to the field office, one copy to the testing laboratory and retain one copy.
2. Sample Type (Check one)
FSA
DSCP
3. Contract No.

VA

4. Sample or Lot No.

Submitted
5. Date Sampled

9. Name and Address of Applicant

Supervision

Other(Specify)

6. Commodity Code

7. Location Code

8. Applicant No.

10. Commodity
Domestic

Export

11. Location of Commodity
12. Identification of Carrier
17. Gross Weight

13. Seal Numbers

14. Inspection Point

16. Number of Containers

15. Destination

Kind of Containers

Laboratory Instructions

29. Sampler

30. Date

31.Time
Start (mil)
XX:XX

32.Time
Stop (mil)
XX:XX

33. Hours
Worked
*

34. Activity
Times must have colons (:)!

Tare Weight
19. Empty
Outer
Containers
Weighed

21. Empty
Inner
Containers
Weighed

# of
containers =

# of
containers =

Boxes 19. and 21. are the
total number of empty
containers randomly
selected (minimum 10).

35. Total Hours *
36. Comments of Sampler

Boxes 20. (outer) and 22.
(inner) are the total weights
of the containers indicated
in boxes 19. or 21.
18. Total Gross Wt *

20. Total

22. Total

Weight Per Container
23. Gross *

24. Tare *

37. Name(s)
25. Net *

Estimated Weight of Lot
26. Gross *

27. Tare *

28. Net *

38. Sample Mailed

39. Results Received

40. Vendor Called

41. Cert. Mailed

Warning: Sec 203(h) of the Agricultural Marketing Act of 1946 (7 U.S.C. 1622 (h)) provides that anyone causing a false certificate to be issued shall be subject to a $1,000 fine or imprisonment for not more
than 1 year, or both. 18 U.S.C. provides for a fine of not more than $10,000 or imprisonment for not more than 5 years, or both for false or fraudulent statements made to an agency of the United States.
Form Approved OMB NO. 0581-0309: 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 0581-0309. The time required to complete this information collection is estimated to average 20
minutes per response and 3.3 hours yearly per recordkeeper, this includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing
and reviewing the collection of information

FORM FGIS-992 (01/21) Previous editions are obsolete. Expires XX-XX
CLEAR FORM

PRINT FORM

FSA Commodity Codes
WBUE20 Bulgur, Soy Fortified- Exp
WBUD10 Bulgur-Dom
WBUE10 Bulgur-Exp
RCED10 Cereal, Rice, Instant-Dom
WCED10 Cereal, Whole Wheatmeal-Dom
WPAD10 Lasagna-Dom
CBLE10 Corn Soy Blend-Dom
CMKE20 Corn Soy Milk, Instant-Exp
CMKE10 Corn Soy Milk-Exp
CCME20 Cornmeal, Soy Fortified-Exp
CCMD10 Cornmeal-Dom
CCME10 Cornmeal-Exp
CCMD20 Cornmeal Regular-Dom
WFAD20 Farina-Dom
WFLD10 Flour, All Purpose-Dom
WFLE10 Flour, All Purpose-Exp
WFLD20 Flour, Bakers, Hd Wht Hearth Style-Dom
WFLD25 Flour, Bakers Soft Wht Bl-Dom
WFLD30 Flour, Bakers Soft Wht Unbl-Dom
WFLD15 Flour, Bred Bakers Hd Wht-dom
WFLD40 Flour, Bread, Hearth Style-Dom
WFLE30 Flour, Bread, Wheat, Soyfort 12%-Exp
WFLD35 Flour, Bread-Dom

WFLE20 Flour, Bread-Exp
WFLD45 Flour, Cake-Dom
CFLE10 Flour, Corn Soya Masa Instant-Exp
CFLD10 Flour, Corn Masa Instant-Dom
WFLD50 Flour, Durum-Dom
WFLD55 Flour, Pastry-Dom
SFLE10 Flour, Soy, Defatted-Exp
WFLD60 Flour, Whole Wheat-Dom
CCED20 Fortified Corn Cereal-Dom
RCED20 Fortified Rice Cereal-Dom
WCED20 Fortified Wheat Cereal-Dom
CGRD10 Grits, Corn, Coarse-Dom
CGRD20 Grits, Corn, fine-Dom
GGRE10 Grits-sorghum, Soy fortified-Exp
WPAD10 Lasagna-Dom
WPAE10 Macaroni, Wheat Soy-Exp
WPAD20 Macaroni-Dom
WPAD24 Macaroni, Enr, Rotelle, Reg. Cook
WPAD25 Macaroni, Rotini, Reg. cook
TRGE30 Oats, Rolled, Soy Fortified-Exp
TRGD20 Oats, Rolled, Instant-Dom
TRGE20 Oats, Rolled, Instant-Exp
TRGD30 Oats, Rolled, Quick-Dom

SSHD10 Shortening-I-Dom
SSHD20 Shortening-II-Dom
SSHD30 Shortening-III-Dom, Liquid
SOLE40 Soybean Oil, Crude Degummed-Exp
WPAD30 Spaghetti-Dom
CYSD10 Syrup, Corn Blend-Dom
OLD10 Vegetable Oil-A-Dom
SOLE10 Vegetable Oil-A-Exp
SOLD20 Vegetable Oil-B-Dom
SOLE20 Vegetable Oil-B-Exp
SOLD30 Vegetable Oil-C-Dom
SOLE30 Vegetable Oil-C-Exp
WPAD40 Vermicelli-Dom
WBLE10 Wheat Protein Concentrate Blend-Exp
WBLE20 Wheat Soy Blend-Exp
WMKE10 Wheat Soy Milk-Exp
WRGD10 Wheat Rolled-Dom
SOLE30 Vegetable Oil-C-Exp
WPAD40 Vermicelli-Dom
WBLE10 Wheat Protein Concentrate Blend-Exp
WBLE20 Wheat Soy Blend-Exp
WMKE10 Wheat Soy Milk-Exp
WRGD10 Wheat Rolled-Dom

VA Commodity Codes
CCMD90 Cornmeal, Degummed, Enriched
WEGD90 Egg Noodles, Ribbon Shaped
WEGD95 Egg Noodles, Ribbon, Shaped, Yolk
WFAD90 Farina Enriched Malt Low Sodium
WFAD95 Farina wheat Enriched, Quick-Dom
WFLD90 General Purpose Wheat Flour

CRGD90 Hominy Grits, Enriched, Quick-Cook
WPAD95 Macaroni, Enriched, Elbow, Regular
NCMD90 Noodles Chow Mein
TRGD90 Rolled Oats, Quick Cooking
SOLD90 Salad Oil, Type A
SSHD90 Shortening Type I

SSHD95 Shortening Type III
WPAD90 Spaghetti, Enriched, Long Form, Regular
CSYD90 Syrup, Type III, Blended and Ref.
MSYD90 Syrup, Type VIII, Class 2, Thick
WCED90 Whole Wheat Cereal, Malt Quick-Cook

DSCP Commodity Codes
MMXU63 Mix, Cheesecake (Unbaked)
MSHU95 Bakery Mix Shortening, Emulsified
MBRU20 Bread, White, Enriched, Canned
MBRU25 Bread, Shelf Stable, I
MBRU10 Brownies, Type I
MCCU10 Cake, Canned, Apple Coffee, Type II
MCCU40 Cake, Canned, Blueberry, Type II
MCCU50 Cake, Canned, Cherrynut, Type II
MCCU35 Cake, Canned, Chocolate, Type II
MCCU25 Cake, Canned, Fruit, Type I
MCCU15 Cake, Canned, Marble, Type II
MCCU45 Cake, Canned, Orange Nut, Type I
MCCU20 Cake, Canned, Pound, Type II
MCCU30 Cake, Canned, Spice, Type II
MCBU10 Cereal Bars I, Cornflake
MCBU15 Cereal Bars II, Rice-Cornflake
MCBU20 Cereal Bars III, Fruit-Flv Cornflake
MCBU25 Cereal Bars IV, Granola
TCOU10 Cookies, Oatmeal, Type II
CSTU10 Corn Starch, Type I
CSTU20 Corn Starch, Type II
CSTU30 Corn Starch, Type III
CCMU10 Cornmeal, Type I, Coarse
CCMU15 Cornmeal, Type I, Fine
CCMU20 Cornmeal, Type II, Coarse
CCMU25 Cornmeal, Type II, Fine
WCRU30 Crackers, Class II
WCRU10 Crackers, Soda, Plain, Type I, Class A
WCRU20 Crackers, Soda, Salted, Type I, Class B
UDUP10 Dessert, Pwdr, Inst, Starch, Class 1-Choc
UDUP20 Dessert, Pwdr, Inst, Starch Class 2-Van

UDUP30 Dessert, Pwdr, Inst, Starch, Class 3-Btsc
WFAU10 Farina, Type I
WFLU20 Flour, Bread, Type I, Hd Wht
WFLU30 Flour, Pastry, Type IV
WFLU40 Flour, Type II, Cake
WFLU10 Flour, Type III, General Purpose
MCBU35 Granola Bar Type II
CGRU20 Grits, Hominy
UICU10 Icing Mix Powder, Flavor 1 (Vanilla)
UICU30 Icing Mix Powder, Flavor 3 (Other)
UICU20 Icing Mix Powder, flavor 2 (Chocolate)
WPAU10 Lasagna, Group IV
WPAU20 Macaroni, Group I
UMAU10 Margarine, Canned
UMAU20 Margarine, Type I
UMAU30 Margarine, Type II
MMXU45 Mix, Angel Food, Class 1, Style F
MMXU48 Mix, Devil’s Food, Class I, Style C
MMXU21 Mix, Doughnut, Class 3
MMXU51 Mix, Gingerbread, Class 1, Style D
MMXU30 Mix, Pancake & Waffle, Class 2, Style G
MMXU39 Mix, Pancake & Waffle, Class 2
MMXU09 Mix, Pancake & Waffle, Buckwheat, Class 2, Style F
MMUX54 Mix, Pound Cake, Class 1, Style E
MMUX06 Mix, Roll, Class 4, Style A
MMUX36 Mix, Sweetdough, Class 4, Style B
MMUX57 Mix, White Cake, Class 1, Style A
MMUX60 Mix, Yellow cake, Class 1, Style B
MMUX42 Mix, Yellow Cornbread, Class 2, Style A
MMUX12 Mix, Brownie, Butterscotch, Class 5, Style B
MMUX15 Mix, Brownie, Chocolate, Class 5, Style A

NCMU10 Noodles, Chow Mein
WEGU10 Noodles, Egg, Type I
WEGU20 Noodles, Egg, Type I, Egg yolk
MCBU30 Oatmeal Cookie Bar, Type I
MCBU90 Oatmeal Cookie and Granola Bar
TRGU40 Oats, Instan, Flavored
TRGU50 Oats, Instant, Flavored, Tray - Pack
TRGU30 Oats, Rolled, Instant, Type I I I
TRGU20 Oats, Rolled, Quick, Type I I
TRGU10 Oats, Rolled, Regular, Type I
CGNU20 Popcorn, Type I, Fancy
CGNU30 Popcorn, Type I, No. 1
CGNU40 Popcorn, Type I I, Fancy
CGNU50 Popcorn, Type I I, No. 1
MSOU10 Salad Oil, Type A
MSOU20 Salad Oil, Type B
MSOU30 Salad Oil, Type C
MSHU10 Shortening-I
MSHU20 Shortening- I I
MSHU45 Shortening-I I I
WPAU30 Spaghetti, Group I I
USYU10 Syrup, Type I
USYU20 Syrup, Type I I
USYU30 Syrup, Type I I I
USYU40 Syrup, Type V
USYU50 Syrup, Type V I
USYU80 Syrup, Type V I I
USYU60 Syrup, Type V I I I , Class 1, Thin
USYU70 Syrup, Type V I I I, Class 2, Thick
WPAU40 Vermicelli, Group I I I
MMXU03 Mix, Biscuit, Class 2, Style B

Instructions for Completing FGIS-992
Actions by person performing inspection. Complete items 1 through 37.
1.

Field office performing the service.

2.

Type of sample, check one; or specify if you check “other”.

3.

Contract number assigned by the contracting party when applicable. Include prefix
characters as part of the contract number.

4.

Sample or lot number assigned. Field offices shall specify one range of lot numbers for
each commodity location (mill point). This range shall be large enough to accommodate the
maximum number of lots inspected at that commodity location under any one contract. Each
range must begin with a number which ends with the digit 1 (e.g., 501-1000; 2501-3000; 1-350).
Lot numbers must be numeric and cannot exceed 4 digits in length. Each lot will have its own
number (e.g., 501; 502; 503; etc.). To identify new original inspections, either reserve the first digit
of the four digit lot code number for this purpose or use the next available lot number for each
contract. Julian date codes may be used for DSCP.

5.

Date sampled (MM/DD/YY).

6.

Commodity code (sees reverse side of form for codes, or contact the testing laboratory for
codes not listed).

7.

Location code from the list of numbers provided to the field office.

8.

Applicant number derived by using the last six numbers of the NFC applicant number.

9.

Name and address of applicant.

10.

Type of commodity and whether domestic or export.

11.

Location of commodity if other than the applicant’s address. If the location is the same as
block 9, show “Same”.

12.

Car number, license number, or other identification of the carrier.

13.

Record the seal numbers applied and/or broken. If space is not adequate, show “See
Below” and place in blocks 16 or 36.

14.

Inspection point code. Field offices view the Grain and Weighing Information System(GIWIS)
under “Reports -- Active Specified Service Points” for identifying codes, agencies and contractors
must contact area field office for codes.

15.

Destination if known. When submitting ethylene dibromide residue testing and aflatoxinsurvey
samples, use the destination codes provided in Grain Inspection Handbook, Book IV, Chapter 4,
Data Collection Forms, Report of Grain Inspected and Weighed for export, Form FGIS-938.

16.

Number of containers and complete description of kind of containers (the descriptiveterms should
be those used in the announcements and specifications). Record checkloading information, such
as tally or description, of how the count was made. When submitting supervision samples, include
the type of test performed and the original results obtained. Also, include any necessary laboratory
instructions.

17.

The gross weight of each container weighed. Refer to the checkweighing instructions in the
Weighing Handbook, Chapter 4, Section 4.5, to determine the number of containers to weigh.
When not recording in pounds. Indicate the unit of weight used. Weights should be entered as
exactly displayed on the scale used. E.G., if the scale’s smallest division size is 0.1, then 110.1,
not 110.10.

18.

Record the total gross weight of the containers weighed by totaling the results in the
columns following block 17.

19.

The weight of the empty outer containers weighed. Refer to the checkweighing instructions in the
Weighing Handbook, Chapter 4, Section 4.5, for the number of containers to weigh. Place a “1”
here if the tare is not known and using a tare value from Table 4 of Chapter 4 of the Weighing
Handbook in block 20.

20.

The total weight of the empty outer containers weighed by totaling the results in block 19 above
(The tare containers are weighed together in one weighing). Outer containers weighed individually
must be handwritten by on the back of the form and the total of all entered in block 20.

21.

The weight of empty inner containers weighed, if present. Refer to the checkweighing instructions
in the Weighing Handbook, Chapter 4, Section 4.5, for the number of containers to weigh. When
not recording in pounds, indicate the unit of weight used (The tare containers are weighed
together in one weighing). Inner containers weighed individually must be handwritten by on the
back of the form and the total of all entered in block 22.

22.

The total weight of the empty inner containers selected, if present from block 21.

23.

Record the average gross weight of the filled containers, by dividing the results in block 18 by
the number of containers weighed. This field is automatically calculated if completed electronically
24. Record the average tare weight of the empty containers. This field is automatically calculated if
completed electronically. If the empty containers are not available for determining tare weight and
the lot was previously checkweighed (e.g., at origin), use the previously determined tare weight. If
it is not known whether the tare was previously determined use Weighing Handbook, Chapter 4,
Section 4.5, Table 4.

25.

Record the average net weight of containers by subtracting the result in block 24 from that
in block 23. This field is automatically calculated if completed electronically.

26.

Record the estimated gross weight of the lot by multiplying the number of containers in the
lot block 16 by the result in block 23. This field is automatically calculated if completed
electronically.

27.

Record the estimated tare weight of the lot by multiplying the number of containers in the lot block
16 by the result in block 24. This field is automatically calculated if completed electronically.

28.

Record the estimated net weight of the lot by subtracting the result in block 27 from that in block
26. Some commodity instructions say to certify using the labeled or intended amount for
certification if the lot complies, but for the purposes of this worksheet use the sampled calculations
for block 28. This field is automatically calculated if completed electronically.

29.

The name of the sampler(s).

30.

Date service was performed.

31.

Starting time to the nearest ¼ hour. For the automatic calculating feature to work column 33
the time must be entered in military time and with a “:” (colon) separating the hours from minutes.
Shifts exceeding a calendar day 24-hour period (00:15-24:00) must be split between two entries.

32.

Stopping time to the nearest ¼ hour. For the automatic calculating feature to work column 33
the time must be entered in military time and with a “:” (colon) separating the hours from minutes.
Shifts exceeding a calendar day 24-hour period (00:15-24:00) must be split between two entries.

33.

The total hours for each period of time recorded. If more than one lot is worked simultaneously,
prepare an FGIS-992, for each. Record the time worked on each form; however, do not attempt
to prorate and divide the time between different lots. This field is automatically calculated if
completed electronically.
Place asterisks by the hours worked and under the “comments of sampler,” identify the other lots
worked simultaneously. When billing, field office personnel shall divide the time equally between
the lots worked simultaneously or use the following method to prorate the time worked on each lot.
a.

Total the hours worked on each lot individually during a 1-day (24 hour) period.

b.

Total the hours worked on all lots during the 1-day (24 hour) period.

c.

Divide the hours worked on each individual lot by the total hours worked on all lots.

d.

Multiply this amount by the actual clock hours worked for the day (24 hours) and
round to the nearest ¼ hour.

34.

The type of service performed (abbreviations are acceptable; i.e., S-sampling, C-condition,
CW-checkweighing, CC-checkcount, SB-stand by, etc).

35.

The total hours worked. This field is automatically calculated if completed electronically.

36.

Special services, unusual conditions, events, or observations concerning the lot. When necessary,
give an explanation of the time recorded when other lots are worked simultaneously or condition
of the carrier when found to be unfit to maintain the quality of the product.

37.

Name(s) of person(s) performing services.

Actions by person(s) in the field office confirming information. Complete items 38 through 41.
38.

Date sample was mailed.

39.

Date the field office received the results from the testing laboratory.

40.

Date the results were called to the vendor.

41.

The date the certificate was mailed.

CONTACT INFORMATION:
Contact the field office responsible for the geographic area in which the service will be provided.
Details for these locations can be found on the FGIS website. The completed form should also be mailed
to this location.
For further information on the Form FGIS-992 “Service Performed Report” contact:
Patrick McCluskey, Chief
Field Management Division
Policies, Procedures, and Market Analysis Branch
[email protected]