FORM APPROVED OMB NO. 0581-0309

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 0581-0309. The time 

re-quired to complete this information collection is estimated to average 5 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

AGRICULTURAL MARKETING SERVICE 

FEDERAL GRAIN INSPECTION SERVICE

REQUEST FOR WAIVER OF INSPECTION

TO:

FROM:

We hereby request a waiver of inspection for the lot identified below. 

(An English written copy of the contract is attached.) 

NAME OF VESSEL CONTRACT NO

LOCATION OF SERVICE DESTINATION

APPROXIMATE DATE OF LOADING KIND OF GRAIN QUANTITY OF GRAIN TO BE LOADED

CONTAINER MARKING

_____________________ __________________________________________ (DATE) (NAME AND SIGNATURE)

__________________________________________ (TITLE)

FOR USDA USE ONLY QUANTITY OF GRAIN LOADED

 WAIVER APPROVED

 WAIVER DENIED FOR THE FOLLOWING REASON(S): _____________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

 __________________ ___________________________________________ (DATE) (NAME AND SIGNATURE)

 FIELD OFFICE MANAGER

(TITLE)

Form FGIS-941 (01/24) Previous editions are obsolete. Expires 03-25
FORM APPROVED OMB NO. 0581-0309

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 0581-0309. The time 

re-quired to complete this information collection is estimated to average 5 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

AGRICULTURAL MARKETING SERVICE

FEDERAL GRAIN INSPECTION SERVICE

REQUEST FOR WAIVER OF INSPECTION

TO:

FROM:

We hereby request a waiver of inspection for the lot identified below. 

(An English written copy of the contract is attached.) 

NAME OF VESSEL CONTRACT NO

LOCATION OF SERVICE DESTINATION

APPROXIMATE DATE OF LOADING KIND OF GRAIN QUANTITY OF GRAIN TO BE LOADED

CONTAINER MARKING

_____________________ __________________________________________ (DATE) (NAME AND SIGNATURE)

__________________________________________ (TITLE)

FOR USDA USE ONLY QUANTITY OF GRAIN LOADED

 WAIVER APPROVED

 WAIVER DENIED FOR THE FOLLOWING REASON(S): _____________________________________________

_________________________________________________________________________________________________

_________________________________________________________________________________________________

 __________________ _____________________________________________ (DATE) (NAME AND SIGNATURE)

 FIELD OFFICE MANAGER

(TITLE)

Form FGIS-941 (01/24) Previous editions are obsolete. Expires 03-25

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Instructions for Completing FGIS-941

1. Show the name of person who the letter is addressed to.

2. Show the name of the person who is requesting the waiver.

3. Show the name of the vessel for which the waiver of inspection is requested.

4. Show the contract number for the lot of grain which the waiver is requested.

5. Show the location of the elevator where the grain is to be loaded.

6. Show the country of destination of the grain to be loaded.

7. Show the approximate date the grain will be loaded.

8. Show the type of grain to be loaded.

9. Show the approximate quantity of grain to be loaded.

10. Show any applicable markings of the containers.

11. Show the date of the applicant’s signature.

12. Show the name and signature of the applicant for the wavier of inspection.

13. Show the title of the person signing the wavier of inspection.

14. Show the actual quantity of grain that was loaded.

15. Check the appropriate box. If the wavier is denied please include the reason(s) for denial.

16. Show the date of the Field Office Manager’s signature.

17. Show the name and signature of the Field Office Manager.

CONTACT INFORMATION:

Contact the field office responsible for the geographic area in which the service will be provided.

The signed form should also be mailed to this location.

For further information on Request for Waiver of Inspection:

Charles Parr, Director

Field Management Division

Charles.T.Parr@usda.gov