Form 9540-4 Shipper Notification - Importation of Undenatured Inedib

OMB Control Number 0583-0161
Expiration Date:
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 0583-0161. The time required to complete this information collection is estimated to average 15 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

Shipper Notification - Importation of Undenatured Inedible Product
TO BE COMPLETED BY SHIPPER
1. IMPORT PERMIT NO. (As assigned by FSIS)

2. SHIPMENT SERIAL NUMBER (Assigned by shipper) 3. AMENDED PERMIT

4. SEAL NUMBER (s) (Assigned by shipper)

6. FOREIGN COUNTRY (s)
SUPPLYING MATERIAL

7. U.S. CUSTOMS ENTRY NUMBER

5. DATE OF NOTIFICATION

9. U.S. PORT OF ENTRY

8. SHIPPING DATE

(Customs Entry Number)

(MM/DD/YYY)

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, telephone number and e-mail address)

DRAFT

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

13. STORAGE LOCATION IN U.S. (if applicable)

DESCRIPTION OF PRODUCT TO BE IMPORTED
14. NAME OF PRODUCT AS LABELED AND SPECIES

15. HTS Code

16. NET WEIGHT (lbs,)

CONTAINERIZATION: (Check the appropriate block and complete)
17.

CARTONS

(NUMBER OF)

18.

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 United States Department of
Agriculture (USDA), Food Safety and Inspection Service (FSIS), Recall Management and Technical Analysis Division (RMTAD) at
importinspection@usda.gov 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) 855-3300 and via email at APIE@USDA.GOV
. SIGNATURE OF PERMIT HOLDER OR AUTHORIZED REPRESENTATIVE
22. PRINTED NAME AND TITLE
21.
(Must be signed)

FSIS FORM 9540-4 (05/10/2022)

INSTRUCTIONS FOR PREPARATION OF FSIS FORM 9540-4
Note: The information on the form can be typed or written
Submit Form: The form may be printed and scanned or saved as a .doc or .pdf and emailed to:
ImportInspection@usda.gov
1. Import Permit No. (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 - the port where the shipment will enter the United States (City, State)
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)

DRAFT

11. U.S. Custom's Broker (Name, address, telephone 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

Description of Product to be Imported
14. Name of product as labeled and species derived from - detailed product name and the species (e.g., beef, goat, lamb, pork)
15. HTS Code - Harmonized Tariff System code - can be retrieved from broker
16. Net weight - weight of shipment, in avoirdupois (pounds)

Containerization: (Check the appropriate block and complete)
17. Cartons (Number of x) - include total number of cartons
18. Exposed Blocks (Number of x) - include total number of blocks
19. Bulk Tanker (Number of x) - include total number of tankers
20. Other Specify (Number of x) - 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 (must be signed)
22. Printed Name and Title - the name and title of the permit holder or authorized representative
FSIS FORM 9540-4 (05/10/2022)