Form FSA-750 End-Use Certificate for Wheat

Form Approved - OMB No. 0560-0151
FOR INTERNAL USE ONLY

U.S. DEPARTMENT OF AGRICULTURE
Farm Service Agency

FSA-750
(07-01-03)

Date (MM-DD-YYYY):
Initials:

END-USE CERTIFICATE FOR WHEAT

Serial Number:

NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended.
The authority for requesting the following information is 7 CFR Part 782. The information will be used to verify compliance by the importer of Canadian
wheat, subsequent buyer or an end user of imported Canadian wheat with the provisions of 7 CFR Part 782. Furnishing the requested information is
mandatory. Failure to comply with the regulations governing the End-Use Certificate Program may result in the assessment of penalties in accordance
with 7 CFR Part 782 against the non-complying party. This information may be provided to other agencies, IRS, Department of Justice, or other State
and Federal law enforcement agencies, and in response to a court magistrate or administrative tribunal. The provisions of criminal and civil fraud
statutes, including 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 31 USC 3729, may be applicable to the information provided.
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 0560-0151. The time
required to complete this information collection is estimated to average 11 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. RETURN
THIS COMPLETED FORM TO THE KANSAS CITY COMMODITY OFFICE, CONTRACT RECONCILIATION DIVISION, P.O. BOX 419205, KANSAS
CITY, MO 64141-6205 WITHIN 10 WORKDAYS FROM THE DATE OF ENTRY (ITEM 4).
1. Importer's Name and Address (Include Street, City, State and ZIP Code)

2. Importer's Telephone Number (Include Area Code)

3. Custom's Entry Number

4. Date of Entry (month, day, year)

5. Importer Number

7. U.S. Grade of Wheat

8. Protein Content

9. Moisture Content
%

6. Class of Wheat

10. Dockage

%

11. Sales Contract Date
%

12. Quantity Imported (in net metric tons, per entry)

13. Storage Location / Destination

14. Transportation Company

15. Mode of Transportation (mark one box)
RAIL

TRUCK

BARGE

VESSEL

16. CERTIFICATION

1 declare that I have personal knowledge concerning the wheat described above. I agree to preserve the identify of the wheat
and will not commingle or blend the imported wheat with U.S. produced wheat until such time as the imported wheat is
loaded onto a conveyance for direct delivery to the end user or foreign country. I further agree to provide copies of this form
to all parties when I sell this wheat and to provide the U.S. Department of Agriculture, Kansas City Commodity Office, P.O.
Box 419205, Kansas City, MO 64141-6205, with copies of all required documentation in accordance with 7 CFR Part 782.
A. Importer's Authorized Representative (Please Print)

B. Title

C. Signature

D. Date

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political
beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of
program information (Braille, large print, audiotape, etc.) should contact USDA's TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write
USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TDD). USDA
is an equal opportunity provider and employer.

FSA-750 (07-01-03) (Page 2)

GENERAL INFORMATION
A The United States Department of Agriculture (USDA) provides end-use certificates for persons requiring such
certificates for the importation of Canadian-produced wheat into the United States.
B Regulations regarding the End-Use Certificate Program can be found at 7 CFR Part 782. Copies of these
regulations can be obtained from the Kansas City Commodity Office (KCCO) at the address shown below.
C Form FSA-750, End-Use Certificate for Wheat, is required for each entry of Canadian-produced wheat and must
be submitted by the importer to KCCO at the address shown below within 10 workdays following the date of
entry.
D Copies of forms FSA-750, End-Use Certificate for Wheat, and FSA-751, Canadian Wheat Consumption and
Resale Report, can be obtained from KCCO at the address shown below.
E Wheat covered by an end-use certificate must be stored identity preserved and may not be commingled or
blended with U.S.-produced wheat until such time as the Canadian-produced wheat is loaded onto a conveyance
for direct delivery to an end user or foreign country.
F When wheat covered by this end-use certificate is sold to subsequent buyers or end users, the importer and
all subsequent buyers must also:
(1) provide purchasers with copies of the front and Page 2 sides of this form FSA-750.
(2) submit form FSA-751, Canadian Wheat Consumption and Resale Report, within 15 workdays of the date of
each individual sale to a subsequent buyer or end user to KCCO at the address shown below.
G When wheat covered by this end-use certificate is sold to an end user, the end user must submit form FSA-751,
Canadian Wheat Consumption and Resale Report, to KCCO at the address shown below to report consumption
of the Canadian-produced wheat. Reports from the end user must be submitted within 15 workdays following
March 31, June 30, September 30, and December 31.
H If wheat covered by this end-use certificate will be exported to a foreign country, the exporter must store the
Canadian-produced wheat identity preserved until the wheat is loaded onto a conveyance for delivery to the
foreign country. Exporters must submit form FSA-751, Canadian Wheat Consumption and Resale Report, to
KCCO at the address shown below, to report the exportation of Canadian-produced wheat. Reports from
exporters must be submitted within 15 workdays following March 31, June 30, September 30, and December 31.
I The reports and records of all parties that, at any point in time, had control of wheat covered by an end-use
certificate are subject to inspection by a representative of USDA.
Address for KCCO:
Kansas City Commodity Office
Contract Reconciliation Division
P.O. Box 419205, STOP 8758
Kansas City, MO 64141-6205