SC-16 Notice for Hold for Re-Examination

Print

REPRODUCE LOCALLY Include form number and edition data on all reproductions.

Save

Reset

OMB No. 0581-0125
Exp. 3/31/2023

SPECIALTY CROPS INSPECTION DIVISION
NOTICE FOR HOLD FOR RE-EXAMINATION
APPLICANT

HOLD NUMBER

ADDRESS (Include number, street, city, state, and zip code)

PRODUCT

QUANTITY

CODE MARK(S)

LABEL

WAREHOUSE LOCATION

REASON FOR HOLD

We require that the above lot not be shipped pending further examination. The code mark(s) have been marked "hold" on inspection records pending further
action. Control of this product must be maintained. If the product with the above code mark(s) is shipped prior to re-examination or prior to corrective action
taken under USDA observation, it will be necessary to notify the Food and Drug Administration.
DATE

USDA INSPECTOR (Signature)

Mark an "X" in the block that indicates the course of action that will be taken. Sign, date, and return a copy to the inspection or to the USDA office
address by _________________________________.
☐ Re-examination of code mark(s)
☐ Re-examination after segregation
☐ Re-examination after reworking
DATE

☐ Dispose for nonfood use
☐ Other action (specify) _________________________________
PLANT OFFICIAL (Title and Signature)

USDA REPORT OF RE-EXAMINATION
We have completed the re-examination of the above merchandise. Re-examination results indicate the product is _________________________________
DATE

USDA INSPECTOR (Signature)

Control must be maintained on Grade Not Certified (GNC) products in order to preclude reporting to the Food and Drug Administration.
On GNC product, please indicate the appropriate steps that will be taken. Sign, date, and return a copy to the inspector or to the USDA office
address by _________________________________
APPLICANT - Complete by marking an "X" in appropriate block(s) and return: ☐ SEGREGATION
☐ DISPOSAL of (product) by _________________________________
DATE

☐ RECONDITIONING

☐ OTHER ACTION (Specify) __________________________________

PLANT OFFICIAL (Title and Signature)

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 is 0581-0125. The time required to complete this information collection is estimated to average 0.0833
minutes per response, including the time for reviewing the instruction, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the
collection of information.
Non-Discrimination Policy: 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-16 (9-2020) Destroy previous editions.