Form CBP Form 28 CBP Form 28 Request for Information

DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection

OMB APPROVAL NO. 1651-0023
EXPIRATION DATE: 09-30-2019
ESTIMATED BURDEN:

REQUEST FOR INFORMATION
19 CFR 151.11

1. Date of Request (mm-dd-yyyy)

2. Date of Entry and Importation (mm-dd-yyyy)

3. Manufacturer/Seller/Shipper

4. Carrier

5. Entry No.
6. HTSUS Item No.

5a. Invoice Description of Merchandise

5b. Invoice No.

7. Country of Origin/Exportation

8. CBP Broker and Reference or File No.

9. TO:

10. FROM:

11b. Date Information
Furnished (mm-dd-yyyy)

11a. Port

Production of Documents and/or Information Required by Law: If you have
provided the information requested on this form to U.S. Customs and Border
Protection at other ports, please indicate the port of entry to which it was
supplied, and furnish a copy of your reply to this office, if possible.

General Information and Instructions
12. Please Answer Indicated Question(s)
A.

B.

13. Please Furnish Indicated Item(s)

Are you related (see reverse) in any way to the seller of this
merchandise? If you are related, please describe the
relationship, and explain how this relationship affects the price
paid or payable for the merchandise.

A.

Copy of contract (or purchase order and seller's confirmation
thereof) covering this transaction, and any revisions thereto.

B.

Descriptive or illustrative literature or information explaining what
the merchandise is, where and how it is used, and exactly how it
operates.

C.

Breakdown of components, materials, or ingredients by weight
and the actual cost of the components at the time of assembly
into the finished article.

D.

Submit samples:
Article number:

Identify and give details of any additional costs/expenses
incurred in this transaction, such as:

Article description

(1) packing
Number from container:
Mark(s)and number:

(2) commissions
(3) proceeds that accrue to the seller

Samples consumed in analysis, and other samples whose return
is not specifically requested, will not normally be returned.

(4) assists
E.

(5) royalties and/or license fees
14. CBP Officer Message

See item 14 below.

15. Reply Message (Use additional sheets if more space is needed.)

16.
It is required that an appropriate corporate/company official execute this certificate and/or endorse all correspondence in response to
the information requested. (NOTE: NOT REQUIRED IF FOREIGN FIRM COMPLETES THIS FORM.)
CERTIFICATION
I hereby certify that the information
l6b. Signature
16a. Name and Title/Position of Signer (Owner,
furnished herewith or upon this form in
Importer, or Corporate/Company Official)
response to this inquiry is true and
16c. Telephone No.
16d. Date (mm-dd-yyyy)
correct, and that any samples provided
were taken from the shipment covered
by this entry.
17. CBP Official
18. Team Designation
19. Telephone No.
20. Fax No.
CBP Form 28 (07/18)

21. Email

GENERAL INFORMATION AND INSTRUCTIONS
1.

The requested information is necessary for proper classification and/or appraisement of your merchandise and/or for insuring import compliance of such
merchandise. Your reply is required in accordance with section 509(a), Tariff Action of 1930, as amended
(19 U.S.C.1509).

2.

All information, documents, and samples requested must relate to the shipment of merchandise described on the front of this form.

3.

Please answer all indicated questions to the best of your knowledge.

4.

All information submitted will be treated confidentially.

5.

If a reply cannot be made within 30 days from the date of this request or if you wish to discuss any of the questions designated for your reply, please
contact the CBP officer whose name appears on the front of this form.

6.

Return a copy of this form with your reply.

DEFINITIONS OF KEY WORDS IN BLOCK 12
Question A: RELATED - The persons specified below shall be treated as persons who are related:
(A) Members of the same family, including brothers and sisters (whether by whole or half blood), spouse, ancestors, and lineal descendants.
(B) Any officer or director of an organization and such organization.
(C) An officer or director of an organization and an officer or director of another organization, if each such individual is also an officer or
director in the other organization.
(D) Partners.
(E) Employer and employee.
(F) Any person directly or indirectly owning, controlling, or holding with power to vote, 5 percent or more of the outstanding voting stock or
shares of any organization and such organization.
(G) Two or more persons directly or indirectly controlling, controlled by or under common control with, any person.
PRICE PAID OR PAYABLE - This term is defined as the total payment (whether direct or indirect and exclusive of any costs,
charges, or expenses incurred for transportation, insurance, and other C.I.F. charges) made, or to be made, for imported
merchandise by the buyer to, or for the benefit of, the seller.
Question B:

ASSISTS - The term "assist" means any of the following if supplied directly or indirectly, and free of charge or at reduced cost, by the buyer
of the imported merchandise for use in connection with the production or the sale for export to the United States of the merchandise:
(1) Materials, components, parts, and similar items incorporated in the imported merchandise.
(2) Tools, dies, molds, and similar items used in the production of the imported merchandise.
(3) Merchandise consumed in the production of the imported merchandise.
(4) Engineering, development, artwork, design work, and plans and sketches that are undertaken elsewhere than in the United States and
are necessary for the production of the imported merchandise.

PROCEEDS THAT ACCRUE TO THE SELLER - This term is defined as the amount of any subsequent resale, disposal, or use of the imported merchandise
that accrues, directly or indirectly, to the seller.
ROYALTIES AND/OR LICENSE FEES - This term relates to those amounts that the buyer is required to pay, directly or indirectly, as a condition of the sale
of the imported merchandised for exportation to the United States.
PAPERWORK REDUCTION ACT STATEMENT - An agency may not conduct or sponsor an information collection and a person is not required to respond to
this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0023. The
estimated average time to complete this application is 2 hours. The obligation to respond to this information collection is mandatory. If you have any
comments regarding the burden estimate you can write to CBP PRA Officer, U.S. Customs and Border Protection, Office of Regulations and Rulings, 10th
Floor, 90K Street NE., Washington, DC 20229-1177.

CBP Form 28 (07/18)