SC-266-4 920-Kiwifruit Restyle Verification Form

OMB No. 0581-0189

KIWIFRUIT RESTYLE VERIFICATION FORM

INSTRUCTIONS:

Previously inspected kiwifruit that has been restyled may be shipped under a Restyle Verification Option, providing that the marked size and grade are unchanged from the original inspection. Contact your local Federal-State Inspection Program (FSIP) to receive authorization to ship kiwifruit under this option. You must provide FSIP with the number and type of restyled containers to be shipped. FSIP will assign a Restyle Verification Number that must be placed on each container. This number is only authorized for use on the requested number and type of containers.

Date of Request:	Authorization must be obtained from FSIP prior to shipping restyled fruits.
Restyle Facility:	FSIP Assigned Restyle Verification Number: R-
Shipper Name:	Authorized by:

Shippers must supply the following information for all kiwifruit shipped under the “R” number. Additional forms may be attached if more space is needed. The Kiwifruit Administrative Committee will use this information to audit compliance with Marketing Order requirements. Completed forms must be faxed or mailed to your FSIP office within 3 days of receipt.

Original Inspection Information							Restyled Containers
PLI Numbers	Inspection Certificate Number(s)(when available)	Responsible Shipper	Fruit Size and Grade	No. of Containers	Container Type	Brand (when applicable)	No. of Containers	Container Type	Brand (when applicable)
I certify that all kiwifruit was restyled from previously inspected kiwifruit and that this fruit meets all requirements of the Kiwifruit Marketing Order. The marked size and grade of the restyled product are the same as the original inspection. Additionally, the undersigned hereby certifies to the U.S. Department of Agriculture and the Committee that the information supplied herein is complete and correct and that the above agreement as to usage and reporting is accepted. The making of any false statement or representation on this form, knowing it to be false, is a violation of Title 18, section 1001, United States Code, which provides for the penalty of a fine or imprisonment, or both.
Date:			Signature:				Title:

Restyle Verification Options

Restyle Verification – A handler may ship previously inspected kiwifruit that has been restyled without obtaining an additional inspection if all shipments made under the restyle verification option comply with all regulations in effect and all of the following conditions are met:

a. All kiwifruit was restyled from kiwifruit which previously have been inspected and certified as meeting Committee requirements.

b. The marked size on the restyled product is the same as the marked size on the original product.

c. The grade on the restyled product is the same as the grade on the original product.

d. The handler notifies the Federal-State Inspection Program at least 4 hours in advance of when the product will be shipped.

e. The handler provides the Federal-State Inspection Program with the number and type of restyled containers.

f. The Federal-State Inspection Program furnishes the handler with a restyle verification number which links the restyled product to the original PLI stamp, and to an official USDA inspection certificate and supporting note sheets.

g. The handler shall plainly and conspicuously mark one end of each container with the letter “R” and the restyle verification number assigned by the Federal-State Inspection Program. The letter “R” and the number shall not be less than one-half inch in height.

h. The Federal-State Inspection Program shall notify the KAC upon issuing a restyle verification number.

i. Handlers will be subject to random spot-checks to verify compliance.

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 OMB 0581-0189. 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.

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident.

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.

SC-266-4 (Exp. X/XXXX) Destroy previous editions.