Form NSHS Version 4.2 NSHS Version 4.2 Accreditation Application Form

Export Certification, Accreditation of Non-Government Facilities

NSHS New Accreditation Application Version 4.2 exp XXXX

Export Certification, Accreditation of Non-Government Facilities (Business)

OMB: 0579-0130

Document [pdf]
Download: pdf | pdf
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 OMB control number for
this information collection is 0579-0130. The time required to complete this information collection is estimated to
average 3.9 hours 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.

OMB Approved
0579-0130
Exp XX/XXXX

VERSION 4.1
March 23, 2022

ACCREDITATION APPLICATION FORM

TABLE OF CONTENTS
APPLICANT DETAILS . . . . . . . . . . 2
ACCREDITATION OPTIONS . . . . . 3
TESTING SITE LOCATIONS . . . . . . 3-4
OPTION 1 . . . . . . . . . . . . . . . . . . . 5
OPTION 2 . . . . . . . . . . . . . . . . . . . 6-7
OPTION 3 . . . . . . . . . . . . . . . . . . . 8
OPTION 4 . . . . . . . . . . . . . . . . . . . 9
APPLICATION SUBMISSION . . . . . 10
EXTRA WORKSHEETS . . . . . . . . . . 11-15

APPLICANT DETAILS
COMPANY / ORGANIZATION TO BE ACCREDITED
Legal Name
Street Address
City

State

Zip Code

Telephone Number
Email Address
Website URL

MAIN CONTACT PERSON
Full Name

Position

Street Address
City

State

Telephone Number

Zip Code
Mobile Number

Email Address

TYPE OF COMPANY / ORGANIZATION
Seed Company
Private Seed Laboratory
Private Agricultural Consultants
Certification Agency
State / County Agency
University Laboratory
Other
Page 2 of 15

ACCREDITATION OPTIONS
OPTION 1: Seed Health Testing
• Laboratory-based program to test for plant pathogens in seeds.
• Costs: $1500 per lab site, with an additional $200 per method.

OPTION 2: Phytosanitary Inspection
• Disease Inspection of plants grown to produce seed in the field, nursery, or
greenhouse.
• Costs: $2000 per site (state), with an additional $150 per crop, with a maximum
charge of 5 states and associated crops.

OPTION 3: Seed Sampling for Seed Health Testing
• Sampling seeds that require laboratory seed health tests.
• Costs: $1000 per site (state), with a maximum charge of 5 states.

OPTION 4: Visual Inspection of Seed for Phytosanitary Certification
• Visual inspection of seed shipments at exporter’s facility prior to issuance of
phytosanitary certificates.
• Costs: $1000 per site (state), with a maximum charge of 5 states.

TEST SITE LOCATIONS TO BE ACCREDITED
SITE LOCATION #1
Site Location Name (State)
Street Address
City

State

Zip Code

Contact Person

Position

Telephone Number

Mobile

Email Address
Accreditation

OPTION 1

OPTION 2

OPTION 3

OPTION 4
Page 3 of 15

TEST SITE LOCATIONS TO BE ACCREDITED (CONTINUED)
( PLEASE COPY AND ATTACH MORE PAGES AS NECESSARY )

SITE LOCATION #
Site Location Name (State)
Street Address
City

State

Zip Code

Contact Person

Position

Telephone Number

Mobile

Email Address
Accreditation

OPTION 1

OPTION 2

OPTION 3

OPTION 4

SITE LOCATION #
Site Location Name (State)
Street Address
City

State

Zip Code

Contact Person

Position

Telephone Number

Mobile

Email Address
Accreditation

OPTION 1

OPTION 2

OPTION 3

OPTION 4

SITE LOCATION #
Site Location Name (State)
Street Address
City

State

Zip Code

Contact Person

Position

Telephone Number

Mobile

Email Address
Accreditation

OPTION 1

OPTION 2

OPTION 3

OPTION 4
Page 4 of 15

OPTION 1: Seed Health Testing
• Laboratory-based program to test for plant pathogens in seeds.
• Costs: $1500 per lab site, with an additional $200 per method.

Accreditation Fee Worksheet

Site #

FIND NSHS METHODS CODES: SEEDHEALTH.ORG

Cost $ 0.00

($1500 per Site)

Pathogen and Test Code

Cost ($200 per method)

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

TOTAL COST 0
Page 5 of 15

OPTION 2: Phytosanitary Inspection
• Disease Inspection of plants grown to produce seed in the field, nursery, or greenhouse.
• Costs: $2000 per site (state), with an additional $150 per crop, with a maximum charge of 5
states and associated crops.

Accreditation Fee Worksheet
Site #

State

List of Crops

Cost
$ 0.00
($2000 per state)
Cost ($150 per crop)

$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Site #

State

List of Crops

Cost
($2000 per state) $ 0.00
Cost ($150 per crop)

$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Site #
List of Crops

State

Cost
$ 0.00
($2000 per state)
Cost ($150 per crop)

$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Continued on next page

Page 6 of 15

OPTION 2: Phytosanitary Inspection
•
•

Disease Inspection of plants grown to produce seed in the field, nursery, or greenhouse.
Costs: $2000 per site (state), with an additional $150 per crop, with a maximum charge of 5 states and associated
crops.

Accreditation Fee Worksheet Continued
Site #

State

List of Crops

Cost
$ 0.00
($2000 per state)
Cost ($150 per crop)

$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
Site #

State

List of Crops

Cost
$ 0.00
($2000 per state)
Cost ($150 per crop)

$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
$ 0.00
TOTAL COST

$ 0.00

Provide the laboratory name where field samples will be diagnosed.
LABORATORY PROVIDING DIAGNOSTIC SERVICES
Laboratory Name
Street Address
City
State
Contact Person
Telephone Number
Email Address

Zip Code
Position
Mobile

Page 7 of 15

OPTION 3: Seed Sampling for Seed Health Testing
• Sampling seeds that require laboratory seed health tests.
• Costs: $1000 per site (state), with a maximum charge of 5 states.
Accreditation Fee Worksheet
State
Site Number
Crops
Sampled
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

State
Site Number
Crops
Sampled
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

State
Site Number
Crops
Sampled
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

State
Site Number
Crops
Sampled
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

State
Site Number
Crops
Sampled
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

TOTAL COST: $ 0.00
Page 8 of 15

OPTION 4: Visual Inspection of Seed for Phytosanitary Certification
• Visual inspection of seed shipments at exporter’s facility prior to issuance of phytosanitary
certificates.
• Costs: $1000 per site (state), with a maximum charge of 5 states.
Accreditation Fee Worksheet
State:
Site #s located in state
Crops
Tested
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

State:
Site #s located in state
Crops
Tested
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

State:
Site #s located in state
Crops
Tested
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

State:
Site #s located in state
Crops
Tested
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

State:
Site #s located in state
Crops
Tested
at Site(s)

Cost ($1000 per state) $ 0.00
Number of Inspectors

TOTAL COST:

$ 0.00

LABORATORY PROVIDING DIAGNOSTIC SERVICES
Laboratory Name
Street Address
City

State

Zip Code

Contact Person

Position

Telephone Number

Mobile

Email Address

Page 9 of 15

APPLICATION SUBMISSION CHECKLIST
STEP 1
Submit a non-refundable $400 deposit check payable to USDA
• Online at pay.gov - accepts payment from bank accounts, credit card, and PayPal. Instructions available
at seedhealth.org/pay-gov
OR
• Mail check payable to USDA to address below.
Sign and Submit all completed Accrediation Application forms to:

Sarika Negi

Accreditation and Certification Policy Manager
Plant Health Programs – Export Services
4700 River Road, Unit 131	
Riverdale, MD 20737-1236	

Tele: 301.851.2349
E-mail: [email protected]

STEP 2
Submit a non-refundable $600 deposit check payable to Iowa State University
• By phone for credit card payment - 515.294.6493
OR
• Mail check payable to Iowa State University to address below.
Submit a copy of your Quality Manual
Submit a copy of all completed Accreditation Application forms to:

Kelly Iverson

NSHS Administrative Unit
160 Seed Science Center
Iowa State University
2115 Osborn Drive
Ames, IA 50011

Tele: 515.294.7560
E-mail: [email protected]
Website URL: seedhealth.org

STEP 3
Upon approval of your application by USDA-APHIS, you will be contacted by the NSHS Accreditation Unit
with further instructions on the accreditation process and billing for the total accreditation fee and auditor
fees.

OPTION 1
OPTION 2
OPTION 3
OPTION 4

Total fees from Accreditation OPTION 1: Page 5
Total fees from Accreditation OPTION 2: Page 6-7
Total fees from Accreditation OPTION 3: Page 8
Total fees from Accreditation OPTION 4: Page 9
TOTAL FEES

STEP 4
Company or Organization Authorized Signature

SIGNATURE:
Legal Name:

Title:

Date:
Page 10 of 15

TEST SITE LOCATIONS TO BE ACCREDITED (CONTINUED)
( PLEASE COPY AND ATTACH MORE PAGES AS NECESSARY )

SITE LOCATION #
Site Location Name (State)
Street Address
City

State

Zip Code

Contact Person

Position

Telephone Number

Mobile

Email Address
Accreditation

OPTION 1

OPTION 2

OPTION 3

OPTION 4

SITE LOCATION #
Site Location Name (State)
Street Address
City

State

Zip Code

Contact Person

Position

Telephone Number

Mobile

Email Address
Accreditation

OPTION 1

OPTION 2

OPTION 3

OPTION 4

SITE LOCATION #
Site Location Name (State)
Street Address
City

State

Zip Code

Contact Person

Position

Telephone Number

Mobile

Email Address
Accreditation

OPTION 1

OPTION 2

OPTION 3

OPTION 4
Page 11 of 15

OPTION 1: Seed Health Testing
• Laboratory-based program to test for plant pathogens in seeds.
• Costs: $1500 per lab site, with an additional $200 per method.
Accreditation Fee Worksheet (Please Copy and Attach Pages as Necessary)
FIND NSHS METHODS CODES: SEEDHEALTH.ORG

Site #

Cost $ 0.00

($1500 per Site)

Pathogen and Test Code

Cost ($200 per method)

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

Drop down to select

$ 0.00

TOTAL COST
Page 12 of 15

OPTION 2: Phytosanitary Inspection
•
•

Disease Inspection of plants grown to produce seed in the field, nursery, or greenhouse.
Costs: $2000 per site (state), with an additional $150 per crop, with a maximum charge of 5 states and associated
crops.

Accreditation Fee Worksheet (Please Copy and Attach Pages as Necessary)
Site #
State
List of Crops

Site #
State
List of Crops

Site #
State
List of Crops

Site #
State
List of Crops

Page 13 of 15

OPTION 3: Seed Sampling for Seed Health Testing
• Sampling seeds that require laboratory seed health tests.
• Costs: $1000 per site (state), with a maximum charge of 5 states.
Accreditation Fee Worksheet (Please Copy and Attach Pages as Necessary)
State:
Site #s located in state
Crops
Sampled
at Site(s)
State:

Number of Inspectors

Site #s located in state

Number of Inspectors

Crops
Sampled
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Sampled
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Sampled
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Sampled
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Sampled
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Sampled
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Sampled
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Sampled
at Site(s)

Page 14 of 15

OPTION 4: Visual Inspection of Seed for Phytosanitary Certification
• Visual inspection of seed shipments at exporter’s facility prior to issuance of phytosanitary
certificates.
• Costs: $1000 per site (state), with a maximum charge of 5 states.
Accreditation Fee Worksheet (Please Copy and Attach Pages as Necessary)
State:
Site #s located in state

Number of Inspectors

Crops
Tested
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Tested
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Tested
at Site(s)
State:
Site #s located in state
Crops
Tested
at Site(s)

Number of Inspectors

State:
Site #s located in state

Number of Inspectors

Crops
Tested
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Tested
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Tested
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Tested
at Site(s)
State:
Site #s located in state

Number of Inspectors

Crops
Tested
at Site(s)

Page 15 of 15


File Typeapplication/pdf
AuthorRobertson, Cynthia S [SSCXP]
File Modified2023-06-15
File Created2022-03-23

© 2024 OMB.report | Privacy Policy