Form KC-334 Preliminary/Final Discharge/Delivery Survey Summary

Form Approved - OMB No. 0581-0317

See reverse side for Privacy Act, Public Burden and Nondiscrimination Statements.

KC-334

Exp. XX/XXXX

SURVEY COMPANY NAME

U.S. DEPARTMENT OF AGRICULTURE

PAGE

of

Farm Service Agency

Preliminary
Final (Check One)
DISCHARGE/DELIVERY SURVEY SUMMARY
(For CCC Contracted Surveys)

REPORT NUMBER

NAME OF SUBCONTRACTOR

PERSON(S) WHO PERFORMED SURVEY
VESSEL NAME/VOYAGE #

FEEDER VESSEL/VOYAGE #

OCEAN BILL OF LADING #

COMMODITY PO #

DESTINATION COUNTRY/CITY

DISCHARGE PORT

VESSEL ARRIVAL DATE

VESSEL DISCHARGE COMMENCED/COMPLETED

DELIVERY TO FINAL DESTINATION MMENCED/COMPLETED

DESTUFFING OF CONTAINERS COMMENCED/COMPLETED

COMMODITY/PACK SIZE

MANIFESTED UNITS

SHIPMENT INFORMATION

MANIFESTED WEIGHT (KGS)

SURVEY FINDINGS
DESCRIPTION

UNITS

ACCEPTED WEIGHT (Includes reconstituted/
sound KGS)

WEIGHT LOSS IN KGS (Includes unfit losses)

Quantity Discharged Sound
Torn/Slack/Leaking
Discharged Empty
Wet/Moldy/Other Unfit
Infested
TOTAL QUANTITY
DISCHARGED
Short Landed
Excess Landed
Sound/recovered
Sweepings

Additional Comments

PRINTED NAME OF PREPARER
PREPARER SIGNATURE

DATE

KC-334 (REVERSE)

Form Approved - OMB No. 0581-0317

Exp. XX/XXXX

PRIVACY ACT AND PUBLIC BURDEN STATEMENTS
The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a – as amended). The authority for
requesting the information identified on this form is 7 CFR Part 1400, the Commodity Credit Corporation Charter Act (15
U.S.C. 714 et seq.), and the Agricultural Act of 2014 (Pub. L. 113-79). The information will be used to evaluate the CCCcontracted surveyor’s ability to submit bids to purchase processed commodities and provide services. The information
collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and
nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in
applicable Routine Uses identified in the System of Records Notice for USDA/FSA-3,Consultants File. Providing the
requested information is voluntary. However, failure to furnish the requested information will result in a determination that
the CCC-contracted surveyor is unable to submit bids to purchase processed commodities and provide services.
Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it
displays a currently valid OMB control number. Public reporting burden for this collection of information is estimated to average
30 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. Send comments regarding this
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, on the
Internet at http://www.regulations.gov or to Department of Agriculture, Service Contracting Support Branch, AMS-PPSCD,
USDA, P.O. Box 419205, Kansas City, Missouri 64141-6205. (OMB No. 0581-0317).
NONDISCRIMINATION STATEMENT
IIn accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies,
the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are
prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender
expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance
program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded
by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print,
audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202)
720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program
information may be made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found
online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and
provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992.
Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary
for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email:
[email protected]. USDA is an equal opportunity provider, employer, and lender.