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Pay.gov - Continued Dumping and Subsidy Offset Act of 2000 Certification

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Continued Dumping and Subsidy Offset Act of 2000 Certification
Before You Begin

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1 Complete Agency Form

This form is used to apply for CDSOA distribution
Preview Form

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CDSOA Online Certification
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This is a secure service provided by United States Department of the Treasury. The information you will enter will
remain private. Please review our privacy policy for more information.

Contact: CDSOA/Byrd Help
Desk
Email: Click to email
Phone: (317) 614-4462

WARNING WARNING WARNING
You have accessed a United States Government computer. Unauthorized use of this computer is a violation of federal law and may subject you to civil and criminal penalties. This computer
and the automated systems which run on it are monitored. Individuals are not guaranteed privacy while using government computers and should, therefore, not expect it. Communications
made using this system may be disclosed as allowed by federal law.
Note: This system may contain Sensitive But Unclassified (SBU) data that requires specific data privacy handling.

Contact Us | Notices & Agreements | Accessibility Policy | Privacy & Security Policy | For Agencies |

https://www.pay.gov/public/form/start/8776895/

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12/27/2016

Pay.gov - Continued Dumping and Subsidy Offset Act of 2000 Certification

Page 1 of 1

Log in | Register

Search

Find Forms, Agencies...

MAKE A PAYMENT

FIND AN AGENCY

ONLINE HELP

x
Alert Message:
Agencies and their customers are notified that Pay.gov will conduct system maintenance on Tuesday, December 27, 2016, between 10:00 p.m. and 10:30 p.m.
Eastern Time.

Continued Dumping and Subsidy Offset Act of 2000 Certification
Before You Begin

Need Help?

1 Complete Agency Form

Expand

Click for Instructions

Department of Homeland Security
U.S. Customs and Border Protection
Continued Dumping and Subsidy Offset Act of 2000 Form

OMB No. 1651-0086
Exp. 12-31-2016

Please avoid using your browser's Back Button and keyboard's Enter Button - this may
lead to incomplete data being transmitted and pages being loaded incorrectly.
Claimant's Information
1. Claimant's Name:
(As it appears on USITC List or Association Membership List, if applicable)
(If person's name, list Last Name, First Name)
2. Mailing Address:
3. Address 2:
4. City:



5. State:
6. ZIP/Postal Code:

Check here if Mailing Address is a PO Box.

(Street Address is required when Mailing Address is a PO Box)
7. Street Address:
8. Address 2:
9. City:



10. State:
11. ZIP/Postal Code:
12. Business Type (select one):
Sole Proprietorship
Partnership
Corporation

13. Number Type (select one and enter number below):
Social Security Number
Employee Identification Number
Federal Tax Identification Number
Enter Number Here

Contact Information (Primary Contact For All Certification Related Inquiries)
14. Contact Person:

15. Contact Email:

16. Contact Phone:

17. Contact Fax:

(If Different From Claimant's Mailing Address)
18. Address:
19. Address 2:
20. City:
21. State:



22. ZIP/Postal Code:
Page 1

CBP Form 7401 (12/16)

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WARNING WARNING WARNING
You have accessed a United States Government computer. Unauthorized use of this computer is a violation of federal law and may subject you to civil and criminal penalties. This computer
and the automated systems which run on it are monitored. Individuals are not guaranteed privacy while using government computers and should, therefore, not expect it. Communications
made using this system may be disclosed as allowed by federal law.
Note: This system may contain Sensitive But Unclassified (SBU) data that requires specific data privacy handling.

Contact Us | Notices & Agreements | Accessibility Policy | Privacy & Security Policy | For Agencies |

https://www.pay.gov/public/form/entry/101/

*

12/27/2016