Form 9540-4 Shipper Notification - Importation of Undenatured Inedib

OMB Control Number: 0583-0161
Expiration Date: 06/30/2025
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 valid OMB control number for this information collection is 0583-0161. 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.
U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

Shipper Notification - Importation of Undenatured Inedible Product
SECTION I - TO BE COMPLETED BY SHIPPER
1. Import Permit Number: (As assigned by FSIS)

6. Foreign Country(s) Supplying
Material:

2. Shipment Serial Number: (Assigned by shipper)

3. Amended Permit:

4. Seal Number (s): (Assigned by shipper)

5. Date of Notification: (mm/dd/yyyy)

9. U.S. Port of Entry:

8. Shipping Date: (mm/dd/yyyy)

7. U.S. Custom Entry Number:

10. Shipper: (Permit Holder's name, address, e-mail address including country and city code, if applicable)

11. U.S. Custom's Broker: (Name, address, phone number and e-mail address)

12. Consignee: (Name and address of U.S. manufacturer where product will be shipped)

13. Storage Location in U.S.: (If applicable)

SECTION II - DESCRIPTION OF PRODUCT TO BE IMPORTED
15. Harmonized Tariff System (HTS) Code:

14. Name of Product as Labeled and Species:

16. Net Weight: (lbs.)

SECTION III - CONTAINERIZATION (Check the appropriate block and complete)
17.

Cartons:

18.

(Number of)

Exposed Blocks:

(Number of)

19.

Bulk Tanker:

(Number of)

20.

Other

(Specify):
(Number of)

RESTRICTIONS AND CONDITIONS FOR TRANSPORTING UNDENATURED INEDIBLE PRODUCT
The Import Permit Number, shipment serial number, and the individual seal number(s) must be included on all notifications. Prior to or no later than making
entry with the Department of Homeland Security, Customs and Border Protection, you must file this notification with the U.S. Department of Agriculture
(USDA), Food Safety and Inspection Service (FSIS), Recall Management and Technical Analysis Staff (RMTAS) at [email protected]. The above
referenced inedible product may be shipped, without denaturing, to the listed U.S. consignee in accordance with the requirements specified in CFR 325.11; 9
CFR 325.19; 9 CFR 327.20; 9 CFR 590.45.
This permit is not required for undenatured lungs provided; they come from an approved country that conforms to 9 CFR 325.8; 9 CFR 327.2 and meets the
USDA-Animal Plant Health and Inspection Service (APHIS) and the Department of Health and Human Services (DHHS), Food and Drug Administration's
(FDA) requirements.
The permit number issued by FSIS is active for three years. It is the responsibility of the permit holder to renew his/her application for a permit number before
it expires. Permits which are not renewed are considered expired and are no longer valid. USDA-APHIS is responsible for the control of animal diseases in
the U.S.. APHIS regulations may restrict the importation of certain products into the U.S.. For more information, they may be contacted at (301) 851-3300 and
via e-mail at [email protected].
21. Signature of Permit Holder or Authorized Representative: (Must be signed)
FSIS 9540-4 (01/28/2025)

22. Printed Name and Title:
Page 1 of 2

INSTRUCTIONS FOR PREPARATION OF FSIS 9540-4
Note: The form can be typed or written. When submitting, you may print or scan and save as a doc. or .pdf and
e-mail to: [email protected].
Section I - To Be Completed by the Shipper
1. Import Permit Number: (As assigned by FSIS) - The number assigned by FSIS after shipper (Permit Holder) requests and receives
an imported undenatured inedible permit by FSIS.
2. Shipment Serial Number: (Assigned by Shipper) - The number assigned by the shipper for this shipment.
3. Amended Permit: For use by Shipper reason for amendment, i.e: original serial number, etc..
4. Seal Number(s): (Assigned by Shipper) - Seal number for shipment assigned by shipper.
5. Date of Notification: Date this form was completed and submitted to FSIS.
6. Foreign Country(s) Supplying Material: The eligible foreign country from which the product was exported.
7. U.S. Customs Entry Number "Customs Entry Number": The number issued by U.S. Customs and Border Protection,
(11 alphanumeric characters/- e.g., 000-0000000-0 or abc-0000000-0).

8. Shipping Date: (mm/dd/yyyy) - Date product is shipped.
9. U.S. Port of Entry: (City and State) - The port where the shipment will enter the United States.
10. Shipper: (Permit Holder's Name, Address, E-mail address, including Country and City code, if applicable): Permit holder's
company name, full address (including state and zip code) and e-mail address, (including country and city code, if applicable).
11. U.S. Custom's Broker: (Name, Address, Phone number and E-mail address): U.S. Customs Broker name, full address
(including state and zip code) with phone number and e-mail address.
12. Consignee (Name, Address of the U.S. manufacturer where product will be shipped): The name of the consignee (manufacturer)
who will receive and manufacture the product in the United States for articles other than for human food and the product is for use
solely by the consignee for manufacturing articles not for human food with full address (including state and zip code).
13. Storage Location in U.S. (If applicable): The name of the storage facility, full address (including state and zip) where the product
may be temporarily stored prior to arriving at the consignee.

Section II - Description of Product to be Imported
14. Name of product as labeled and species detailed from: Detailed product name and the species (e.g., beef, goat, lamb, pork).
If the meat is derived from animal cell culture technology, this must be indicated in the product description (e.g., Raw ground non
intact cell-cultured beef).

15. HTS Code: Harmonized Tariff System code (Can be retrieved from broker).
16. Net Weight : Weight of shipment, in avoirdupois (Pounds).

Section III - Containerization: (Check the appropriate block and complete)
17. Cartons: Include total number of cartons.
18. Exposed Blocks: Include total number of blocks.
19. Bulk Tanker: Include total number of tankers.
20. Other Specify: Provide type of "container" and total number of that type.
21. Signature of Permit Holder or Authorized Representative: (Must be signed) - The signature of the permit holder or authorized
representative.
22. Printed Name and Title: The name and title of the permit holder or authorized representative.
FSIS 9540-4 (01/28/2025)

Page 2 of 2