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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 Type | application/pdf |
| Author | Robertson, Cynthia S [SSCXP] |
| File Modified | 2023-06-15 |
| File Created | 2022-03-23 |