Form FSIS 9540-4 FSIS 9540-4 Permit Holder Notification - Importation of Undenatured

This response to this information request is voluntary. This information is needed to document the intended importation of undenatured inedible meat products into
the United States. (9 CFR 325.11). OMB DISCLOSURE STATEMENT: 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-xxxx. The time required to complete this information collection is estimated to average 10 minutes per response, including the time for reviewing
instruction, 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

PERMIT HOLDER NOTIFICATION - IMPORTATION OF
UNDENATURED INEDIBLE PRODUCT
IMPORT PERMIT NO. (As assigned by FSIS)

TO BE COMPLETED BY SHIPPER
SHIPMENT SERIAL NUMBER (Assigned by shipper)

DATE OF NOTIFICATION

SEAL NUMBER(s) (Assigned by shipper)

FOREIGN COUNTRY(s)
SUPPLYING MATERIAL

CUSTOMS ENTRY NUMBER

AMENDED PERMIT

SHIPPING DATE (MM/DD/YYYY)

PORT OF ENTRY

SHIPPER (Permit Holder's Name, Address, e-mail address, and Facsimile number including country and city code, if applicable)

U.S. CUSTOM'S BROKER (Name, address, telephone number, e-mail address and Facsimile number )

CONSIGNEE (Name, Address of U.S. manufacturer where product will be shipped)

STORAGE LOCATION IN U.S. (if applicable)

DESCRIPTION OF PRODUCT TO BE IMPORTED
NAME OF PRODUCT AS LABELED

HTS Code

NET WEIGHT (lbs,)

CONTAINERIZATION: (Check the appropriate block and complete)
CARTONS

( NUMBER OF)

EXPOSED BLOCKS

(NUMBER OF)

BULK TANKER

(NUMBER OF)

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
United States Department of Agriculture (USDA), Food Safety and Inspection Service (FSIS), Office of International Affairs (OIA). The
above referenced inedible product may be shipped, without denaturing, to the listed U.S. consignee in accordance with the requirements
specified in 9 CFR 325.11; 9 CFR 590.45; 9 CFR 325.19.
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) 734-3277.
SIGNATURE OF PERMIT HOLDER OR AUTHORIZED REPRESENTATIVE

FSIS FORM 9540-4 (11/1/2011)

PRINTED NAME AND TITLE

REPLACES FSIS FORM 9540-5 (11/98), W HICH IS OBSOLETE