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Get USDA FV-237 2003

U.S. USDA Form usda-fv-237 UNITED STATES DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE FRUIT AND VEGETABLE PROGRAMS FRESH PRODUCTS BRANCH REQUEST FOR INSPECTION APPEAL INSPECTION This is the only acceptable form for fax or electronic submission to USDA for inspection requests 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. USDA is an equal opportunity provider and employer. NOTE Fill in all appropriate blocks blocks with must be completed. Inspection may be delayed because of incomplete information. Type of Inspection must be selected above. Applicant s Company Name Street Address City State Zip Contact Person Phone Number Enter when different from Applicant Date Time Type of Carrier Car Number or Type License Number E-Mail Address Shipper s Name City and State Receiver s Name Location of Product s Car Trailer Lot Inspection Applicant s P. O. Number Lots Separated by Optional PLI Numbers Grower Numbers Size Other Specify Digital Images Requested Yes No Inspection Requested For Must select at least one Quality and Condition including size when applicable Condition Only Net Weight Products To Be Inspected PRODUCTS BRANDS/MARKS Remarks/Special Instructions FV-237 10/03 Previous editions may be used QUANTITY Type Container Type/Variety. The valid OMB control number for this information collection is 0581-0125. The time required to complete this information collection is estimated to average 2 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* The U*S* Department of Agriculture USDA prohibits discrimination in all its programs and activities on the basis of race color national origin gender religion age disability political beliefs sexual orientation and marital or family status. Not all prohibited bases apply to all programs. Persons with disabilities who require alternative means for communication of program information Braille large print audiotape etc* should contact USDA s TARGET Center at 202-720-2600 voice and TDD. To file a complaint of discrimination write USDA Director Office of Civil Rights Room 326-W Whitten Building 1400 Independence Avenue SW Washington DC 20250-9410 or call 202-720-5964 voice and TDD. USDA is an equal opportunity provider and employer. NOTE Fill in all appropriate blocks blocks with must be completed* Inspection may be delayed because of incomplete information* Type of Inspection must be selected above. Applicant s Company Name Street Address City State Zip Contact Person Phone Number Enter when different from Applicant Date Time Type of Carrier Car Number or Type License Number E-Mail Address Shipper s Name City and State Receiver s Name Location of Product s Car Trailer Lot Inspection Applicant s P. O. Number Lots Separated by Optional PLI Numbers Grower Numbers Size Other Specify Digital Images Requested Yes No Inspection Requested For Must select at least one Quality and Condition including size when applicable Condition Only Net Weight Products To Be Inspected PRODUCTS BRANDS/MARKS Remarks/Special Instructions FV-237 10/03 Previous editions may be used QUANTITY Type Container Type/Variety. .

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