FGIS-930 AMA Output Report

U.S. DEPARTMENT OF AGRICULTURE
FEDERAL GRAIN INSPECTION SERVICE

AMA OUTPUT REPORT

FIELD OFFICE:

FISCAL YEAR:

COOPERATOR:

MONTH:
POUNDS (LBS)

TYPE OF PRODUCTS

FGIS

COOPERATOR

PULSES
DRY EDIBLE BEANS
DRY WHOLE PEAS
SPLIT PEAS
LENTILS

RICE
BROWN RICE
ROUGH RICE
MILLED RICE

PROCESSED COMMODITIES
PROCESSED COMMODITIES

TYPE OF SERVICE

OTHER SERVICES

NUMBER OF INSPECTIONS/SERVICE REQUESTS

AFLATOXIN
VOMITOXIN (DON)
BULK WEIGHING
CONDITION ONLY
FALLING NUMBER
PHYTOSANITARY INSPECTION
SANITATION
STOWAGE EXAMINATION-ONLY
OFFICIAL SAMPLING-ONLY
SUBMITTED SAMPLES
REMARKS:

TOTAL GROSS REVENUE:

$

This area for FGIS use:

Point of Contact

Phone Number

Date Completed

Form Approved OMB NO. 0581-0309: 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 0581-0309 The time required to complete this information collection is
estimated to average 15 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.

FORM FGIS-930 (01/21) Previous editions are obsolete. Expires XX-XX
CLEAR FORM

PRINT

U.S. DEPARTMENT OF AGRICULTURE
FEDERAL GRAIN INSPECTION SERVICE

AMA OUTPUT REPORT

FIELD OFFICE:
COOPERATOR:

TYPE OF PRODUCTS

FISCAL YEAR:

1

MONTH:

2
FGIS

PULSES

3

5

4

POUNDS (LBS)
COOPERATOR

6

DRY EDIBLE BEANS
DRY WHOLE PEAS
SPLIT PEAS
LENTILS

RICE
BROWN RICE
ROUGH RICE
MILLED RICE

PROCESSED COMMODITIES
PROCESSED COMMODITIES

TYPE OF SERVICE
AFLATOXIN

OTHER SERVICES
NUMBER OF INSPECTIONS/SERVICE REQUESTS
7

8

VOMITOXIN (DON)
BULK WEIGHING
CONDITION ONLY
FALLING NUMBER
PHYTOSANITARY INSPECTION
SANITATION
STOWAGE EXAMINATION-ONLY
OFFICIAL SAMPLING-ONLY
SUBMITTED SAMPLES
REMARKS:

9
TOTAL GROSS REVENUE:

$

This area for FGIS use:

Point of Contact

11

Phone Number

10

Date Completed

Form Approved OMB NO. 0581-0309 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 0581-0309. The time required to complete this information collection is
estimated to average 15 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.

FORM FGIS-930 (01/21) Previous editions are obsolete. Expires XX-XX

Instructions for Completing FGIS-930
1.

Name of the FGIS Field Office.

2.

Name of Cooperator.

3.

Current fiscal year.

4.

Month reported.

5.

Number of pounds for services (all pounds) obtained by FGIS Offices.

6.

Number of pounds for services (all pounds) obtained by Cooperators.

7.

Enter the number of Inspection/Service Requests performed per category when FGIS performs
the service.

8.

Enter the number of Inspection/Service Requests performed per category when Cooperator
performs the service.

9.

Any remarks necessary, please place here.

10.

Enter Total Gross AMA Revenue billed to customers per Cooperative Agreement for FGIS to bill
appropriate percentage for fees.

11.

Enter name of person completing the form, phone number, and date form completed.

Contact Information
Field Management Division
Policies, Procedures, and Market Analysis Branch
[email protected]