9010-1 Application for the Return of Exported Products to the U

OMB Control Number: 0583-0159
Expiration Date: 12/31/2025
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 0583-0159. The time required to complete this information collection is estimated to average 20 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.
U.S. DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

Applicant must submit the completed form to:USDA, FSIS.
See Page 2 for instructions.

1. Export Certificate Number.: (Attach Copy)

APPLICATION FOR THE RETURN OF EXPORTED PRODUCTS
TO THE UNITED STATES

(e.g. MPM-000000 or 0000000 (for PHIS Certificates))

2. Applicant: (Company name and address including zip code, contact name, phone number and email)

3. U.S. Port of Entry: (Name of Port/City)
4. Estimated Date of Entry: (mm/dd/yyyy)

5. U.S. Export Est. Number: 6. U.S. Export Est.: (Name and address)

9.
Marked Weight

8.
Product as Labeled

(in lbs.)

14. Ports Transited: (Include all ports)

7. Date of Request: (mm/dd/yyyy)

10.
Number of
Cartons

15. Country Returned From:

12.
Shipping Marks

11.
Production Code

(Applied at Time of Export)

13.
Est. Number on
Product

16. Reason for Return:

17. Reinspection Official FSIS Establishment or Destruction Establishment/Location*: (The Establishment number 18. Date at Est.: (mm/dd/yyyy)
and full address must be included.)

*Applicant should identify an official FSIS establishment for the reinspection, if required, and a date for the reinspection (block 19); or the official FSIS
establishment or location for destruction. Approval of the establishment and reinspection date, or destruction location, depends on concurrence from the
District Office of Field Operations.
19. Comments/Remarks:

TO BE COMPLETED BY FSIS PERSONNEL ONLY
20. Reinspection Required:
(Date and Initials)

21. Application Denied:
(Date and Initials)

22. Application Cancelled:
(Date and Initials)

23. For Destruction:
(Date and Initials)

25. Signature of Staff Officer:

FSIS 9010-1 (09/04/2025)

24. Released:

(Date and Initials)

26. Date: (mm/dd/yyyy)

PREVIOUS EDITIONS ARE OBSOLETE

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INSTRUCTIONS FOR PREPARING FSIS 9010-1
Note: This form is to be completed by the Applicant and may be typed or handwritten. Once completed, you may print or scan and
save as a .pdf to submit by email to: USReturnedExports@usda.gov. If it includes more than six products or lines, please complete
and submit additional FSIS 9010-1 forms as needed.
For assistance, contact: USReturnedExports@usda.gov.
1. Export Certificate Number: As identified on certificate and shipping cartons.
2. Applicant: Information regarding the applicant's company, including company's name, address, phone number, and email address. Include
the name of person filling out application (the applicant's representative).
3. U.S Port of Entry: City and State of U.S. Port of Entry either entering sea or ground/air. (Do not utilize the port number).
4. Estimated Date of Entry: Enter Estimated date when the product is to arrive in the U.S..
5. Originating Export Establishment: (mm/dd/yyyy) Enter establishment number where export originated.
6. U.S. Establishment: Enter Export Establishment name and address - Full address (street, city, state and zip code) where export originated.
7. Date of Request: (mm/dd/yyyy) Date application is completed and submitted. Use the drop down calendar feature.
8. Product as Labeled: Provide species and product as described on Label or Export documents. e.g. "Beef Boneless Round". If the product
is derived from cell-cultured technology, this must be indicated in the product description (e.g. Beef boneless rounds cell cultured beef).
9. Marked Weight: Total shipment weight in pounds.
10. No. of Cartons: The numeric count of product returning.
11. Production Code: Date produced or other production codes. Information in this field is not required if it is unavailable.
12. Shipping Marks: (Applied at Time of Export) - Provide Export stamp number or other identifying marks on the carton(s).
13. Establishment No. on Product: Producing establishment number of the returned product.
14. Ports Transited: All ports visited by the shipment (leaving and returning to the U.S.)
15. Country Returned from: Country product was exported to as listed on export certificate.
16. Reason for Return: Reason product is returning to the U.S. (e.g. Refused contamination, Returned because not up to specification, etc.)
17. Reinspection Official FSIS Establishment or Destruction Establishment/Location: The FSIS Establishment proposed for reinspection,
should it be required, pending concurrence from the appropriate District. Include the establishment number, name, and full address.
18. Date at Est: Estimated date the shipment will arrive for reinspection or destruction (at the establishment listed in block 17).
19. Comments/Remarks: (mm/dd/yyyy) Comments by the applicant and/or FSIS personnel.
Blocks 20 through 26 For FSIS Personnel Only
20. Reinspection Required: Date and initials of the FSIS staff officer if shipment must be reinspected at location specified in block 17.
21. Application Denied: Date and initials of the FSIS staff officer if shipment is denied entry in the U.S..
22. Application Cancelled: Date and initials of the FSIS staff officer if the shipment has been cancelled for any reason.
23. For Destruction: Date and initials of the FSIS staff officer if the shipment is returned to the U.S. for destruction.
24. Released: Date approved to move if reinspection is not required or acceptable results are reported by District Office after reinspection.
25. Signature of Staff Officer: Signature of FSIS staff officer completing the return.
26. Date: (mm/dd/yyyy) Enter date final action is taken by the FSIS staff officer.
FSIS 9010-1 (09/04/2025)

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