FSIS 9080-3 Establishment Application for Export

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UNITED STATES DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

2. DATE OF REQUEST

ESTABLISHMENT APPLICATION
FOR EXPORT OF
MEAT

TO: USDA/FSIS/OPPD/IEPDS
1400 Independence Ave., SW
Room 2137S
Washington, DC 20250

4. DISTRICT OFFICE (Name and Number)

OTHER

EGG PRODUCTS

POULTRY

3. COUNTRY (To which product will be exported)

Email: ImportExport@fsis.usda.gov

5. USDA ESTABLISHMENT NO. (Specify Est. No., M, P, ID, I, etc)

PHONE: (202) 720-0082
FAX:
(202) 720-7990

(Check if Voluntary Inspection)

6. FROM: (Establishment name and address as shown on current Grant of

9. TYPE OF
OPERATION(s)
(Check)

Inspection, FSIS Form 5200-1, and include DBA's if applicable)

10. CLASS OF PRODUCT(s) TO BE EXPORTED
(Check)
03B Raw Product-Ground

Slaughter

03C Raw Product-Not Ground

Boning/Cut-up

03D Thermal Processed/Com. Sterile
03E Not Heat Treated-Shelf Stable (S.S.)

Grinding

03F Heat Treated-Shelf Stable

Processing

03G Fully Cooked/Not Shelf Stable

Cold Storage

03H Heat Treated/Not Fully Cooked-Not S.S.

Other
7. PHONE NO.

03I Product With Secondary Inhibitors-Not S.S

8. FAX NO.

11. SPECIES (Check all that apply)*:

WILD GAME LIST

Beef

Bison

Buffalo

Chicken

Lamb

Duck

Emu

Horse

Turkey

Mutton

Ostrich

Pork

Veal

Siluriformes Fish

OTHER SPECIES LIST

Antelope

Deer

Elk

Catalo

Rabbit

Rhea

Pheasant

Quail

Reindeer

Guinea

Goose

Egg Products

Water Buffalo

Goat

Squab

12. The undersigned requests that the firm identified in Item 6 be included on the list of establishments certified by USDA as meeting the requirements of the
country specified with respect to the importation of meat/poultry or meat/poultry products.

.
..
.
.

We make this request with the understanding that, in addition to compliance with normal U.S. inspection requirements, the above-named firm voluntary agrees to
the following:

To comply with all provisions of appropriate inspection laws and regulations of the importing country when preparing
product for export to that country. These requirements have been reviewed by officials of this firm and are fully
understood.
To reimburse USDA for any inspections over and above U.S. requirements, (Reference FSIS Directive 5110.1).
To segregate and maintain identity of product eligible for export from noneligible product.
To operate in the mode to meet the importing country's requirements anytime an export audit is made by a U.S. review
team or by a foreign official.
To notify appropriate FSIS officials promptly when firm wishes to be removed from the list of plants that are eligible to
export to the country named herein (Item 3).

13. SIGNATURE OF AUTHORIZED FIRM REPRESENTATIVE
(Type or Print Name Above Signature)

14. TITLE (Type or Print)

15. DATE SIGNED

16. NAME OF CONTACT PERSON IF DIFFERENT FROM ABOVE

17. TITLE (Type or Print)

18. PHONE:

FSIS SECTION (Type or Print Name Above All Signatures)
20. I surveyed the above-named establishment on the date indicated below and in my opinion, it meets the requirements for export to

(Name of Country)

, subject to comments if any on the attached correspondence.
22. DATE SURVEYED

21. SIGNATURE OF INSPECTOR-IN-CHARGE

23. SIGNATURE OF CIRCUIT SUPERVISOR/DATE
FSIS FORM 9080-3 (06/22/2017)

24. SIGNATURE OF DISTRICT MANAGER/DATE
(PREVIOUS EDITIONS OBSOLETE)

19. FAX:

INSTRUCTIONS FOR FSIS FORM 9080-3

Purpose:
For most countries, all FSIS authorized meat, poultry and egg product establishments are eligible to
export meat, poultry and egg products, provided all requirements indicated in the FSIS Export Library
are met. Several countries however, require additional certification provided by the plant and
approved by FSIS. The country requirements listed in the FSIS Export Library will reflect the necessity
of this additional certification process if required. Plants wishing to export to such countries must
submit FSIS Form 9080-3 to the Office of Policy and Program Development in order to become
eligible.
Instructions:
Complete FSIS Form 9080-3 in its entirety. All fields must be filled in order to process the request.
The completed form should be faxed, mailed or emailed to the Office of Policy and Program
Development at the contact information that appears on the form.
Approval:
Once submitted, the Office of Policy and Program Development will process the request with the
appropriate foreign authorities. Upon receiving approval, the Office of Policy and Program
Development will post the plant information in the FSIS Export Library under the list of approved
plants for the appropriate country. Users should check the FSIS Export Library to see when their
plant has been approved. Users may contact the Office of Policy and Program Development for an
update of the status of the application.