FGIS-922 Inspection and Weighing Report

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FEDERAL GRAIN INSPECTION SERVICE

INSPECTION AND WEIGHING REPORT
(TYPE AND NUMBER OF INSPECTIONS AND WEIGHINGS PERFORMED
UNDER THE UNITED STATES GRAINSTANDARDS ACT)

FIELD OFFICE NAME

INSPECTION REPORT

FORM APPROVED OMB NO 0580-0013

According to the Paperwork Reduction Act of 1995, no persons are 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 0580-0013. The time required to complete this information collection is estimated to average 40
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.

MO & YR

SSP CODE

SACKED (lbs)

SUBMITTED

SACKED (lbs)

SUBMITTED

WARNING: - “This report is required by the U.S. Grain Standards Act (7 U.S.C. 71 et seq.). Any person who
knowingly makes false statements may be subject to criminal (fine or imprisonment or both under 18 U.S.C.
1001) and administrative penalties.“

OFFICIAL AGENCY NAME

SERVICE POINT NAME
NUMBER OF INSPECTIONS

TRUCK

RAIL

BARGE

LOCAL (lbs)

FULL GRADE
FACTOR ONLY
OFFICIAL CRITERIA ONLY
OFFICIAL COMMERCIAL INSPECTION SERVICE
WAREHOUSEMAN SAMPLE
REINSPECTION
SAMPLE ONLY
STOWAGE EXAMINATION ONLY
OFFICIAL CRITERIA REPORT

NUMBER OF OFFICIAL CRITERIA TESTS
TRUCK

RAIL

BARGE

LOCAL (lbs)

AFLATOXIN
BARLEY PROTEIN
CORN OIL
CORN PROTEIN
CORN STARCH
CORN PROTEIN/OIL/STARCH
CORN PRESENCE OF WAXY
CORN STRESS CRACKED
DEOXYNIVALENOL
FUMONISIN
OATS SIZING
SOYBEAN OIL
SOYBEAN PROTEIN/OIL
SOYBEAN PROTEIN
SOYBEAN CRACKED SEEDCOATS
FORM FGIS-922 (01/18) Previous editions are obsolete. Expires January 2021

NAME

DATE

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FEDERAL GRAIN INSPECTION SERVICE

INSPECTION AND WEIGHING REPORT
(TYPE AND NUMBER OF INSPECTIONS AND WEIGHINGS PERFORMED
UNDER THE UNITED STATES GRAINSTANDARDS ACT)

WARNING: - “This report is required by the U.S. Grain Standards Act (7 U.S.C. 71 et seq.). Any person who
knowingly makes false statements may be subject to criminal (fine or imprisonment or both under 18 U.S.C. 1001)
and administrative penalties.“

FIELD OFFICE NAME

OFFICIAL AGENCY NAME

INSPECTION REPORT

FORM APPROVED OMB NO 0580-0013

According to the Paperwork Reduction Act of 1995, no persons are 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 0580-0013. The time required to complete this information collection is estimated to average 40
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.

MO & YR

SSP CODE

SACKED (lbs)

SUBMITTED

SACKED (lbs)

SUBMITTED

SERVICE POINT NAME
NUMBER OF OFFICIAL CRITERIA TESTS

TRUCK

RAIL

BARGE

LOCAL (lbs)

SOYBEAN HILUM PURITY
SOYBEAN SEED COUNT
SOYBEAN SEED SIZING
SOYBEAN SHRIVELED/WRINKLED
OCHRATOXIN
SUNFLOWER OIL
WET GLUTEN
WHEAT HARDNESS
WHEAT PROTEIN
ZEARALENONE
WEIGHING REPORT

NUMBER OF WEIGHINGS WITH INSPECTIONS
TRUCK

RAIL

BARGE

LOCAL (lbs)

INBOUND
CLASS X

OUTBOUND
EXPORT
OTHER
INBOUND

CLASS Y

OUTBOUND
OTHER

WEIGHING ONLY REPORT
INBOUND
CLASS X

OUTBOUND
EXPORT
OTHER
INBOUND

CLASS Y
FORM FGIS-922 (01/18) Reverse

OUTBOUND
OTHER

NUMBER OF WEIGHINGS ONLY