U.S. DEPARTMENT OF AGRICULTURE 

FEDERAL GRAIN INSPECTION SERVICE APPLICATION 

 REQUEST FOR EXCEPTION TO USGSA GEOGRAPHIC BOUNDARIES 

INSTRUCTIONS: To request use of an official agency other than the official agency assigned to your geographic area for inspection and weighing services under the 

U.S. Grain Standards Act, fill in the requested information in Section A and the information requested in one of the parts in Section B, as appropriate. Submit this 

document and any support to the Federal Grain Inspection Service at FGISQACD@usda.gov.

SECTION A – APPLICANT INFORMATION

1. REPRESENTATIVE NAME (LAST NAME, FIRST NAME) 2. APPLICANT MYFGIS NUMBER 3. ASSIGNED OFFICIAL AGENCY 

4. REPRESENTATIVE EMAIL ADDRESS 5. REPRESENTATIVE PHONE NUMBER 6. FACILITY/ELEVATOR LEGAL NAME

7. FACILITY/ELEVATOR COMPLETE ADDRESS

SECTION B –EXCEPTION REQUEST DETAILS 

Complete only the applicable Timely Service or Nonuse of Service information

TIMELY SERVICE EXCEPTION

Applicants may request a timely service exception when the assigned official agency cannot provide the requested official services within 6 hours or cannot 

provide the results and certificate in accordance with 7 CFR 800.160(c). Select one type of timely service exception and provide the requested information. 

1. TYPE OF TIMELY SERVICE EXCEPTION REQUEST ONE TIME 90-DAY LONG-TERM 

2. REQUESTED OFFICIAL AGENCY 4. LAST UNTIMELY SERVICE DATE

(required for only for 90-day and long-term requests)

3. DATE OF REQUESTED SERVICE

5. REASON FOR REQUEST (Applicants may attached additional supporting documentation)

6. ADDITIONAL TIMELY SERVICE EXCEPTION REQUEST DETAILS

NONUSE OF SERVICE EXCEPTION

Applicants who have not obtained service from the assigned official agency within the last 90-days, – for reasons other than timely service exceptions – 

may request a Nonuse of Service Exception as outlined in 7 CFR 800.117(b)(2). 

7. REQUESTED OFFICIAL AGENCY

9. REASON FOR REQUEST 

8. DATE OFFICIAL SERVICES LAST RECEIVED

10. DESCRIBE THE REASON OFFICIAL SERVICES HAVE NOT BEEN REQUESTED OR USED WITHIN THE PAST 90 DAYS.

11. JUSTIFICATION FOR NONUSE OF SERVICE EXCEPTION REQUEST (Applicants may attached additional supporting documentation) 

12. SIGNATURE OF APPLICANT 13. DATE 

QACD-101 (03/2023)
Instructions for Completing QACD-101

Complete sections A1 to B13 with the following information 

SECTION A 

1. REPRESENTATIVE NAME. The first and last name of the person submitting the form.

2. APPLICANT MYFGIS NUMBER. The MyFGIS number of the customer. Customers who do not yet have a MyFGIS number

must request one through MyFGIS (https://fgisonline.ams.usda.gov/MyFGIS/HOME)

3. ASSIGNED OFFICIAL AGENCY. Insert the official agency currently assigned to the facility in which excepted services is being

requested.

4. REPRESENTATIVE EMAIL ADDRESS. The applicant’s email address.

5. REPRESENTATIVE PHONE NUMBER. The applicant’s phone number.

6. FACILITY/ELEVATOR LEGAL NAME. The official name of the facility in which excepted services are being requested.

7. FACILITY/ELEVATOR COMPLETE ADDRESS. The facility’s street address, city, state, and zip code where services are being

requested.

SECTION B – Applicants should only complete the applicable timely service or nonuse of service section. 

TIMELY SERVICE REQUESTS 

1. TYPE OF TIMELY SERVICE EXCEPTION. Select one of the three timely services exception request options. A one-time exception must

be requested and granted before a 90-day request may be submitted. A 90-day request must be approved before a long-term

request may be requested.

2. REQUESTED OFFICIAL AGENCY. Insert the potential gaining agency to provide official services.

3. DATE OF REQUESTED SERVICE. The start date services are needed, or the date the one-time service was performed.

4. DATE OF UNTIMELY SERVICE OCCURRENCE. The date the assigned official agency was unable to fulfill an official service request in a

timely manner.

5. REASON FOR REQUEST. Select one of the options from the drop-down box.

6. ADDITIONAL TIMELY SERVICE EXCEPTION REQUEST DETAILS. Additional information regarding the request including the types of

services being requested.

NONUSE OF SERVICE REQUESTS 

7. REQUESTED OFFICIAL AGENCY. Insert the potential gaining agency to provide official services.

8. DATE OFFICIAL SERVICES LAST RECEIVED. Date the assigned official agency last provided services to the facility.

9. REASON FOR REQUEST. Select one of the options from the drop-down box.

10. STATE THE REASON OFFICIAL SERVICES HAVE NOT BEEN REQUESTED OR RECEIVED IN THE PAST 90 DAYS. Please provide details on 

which official services have not been received or requested as well as the reasons they have not been received or requested.

11. JUSTIFICATION for NONUSE OF SERVICE REQUEST. Customers may include other information to accompany their request. This may

include but is not limited to the location of the specified service need(s), the types of services requested by the applicant and offered by

the assigned official agency, the ability of the assigned official agency to provide the requested service, and the impact on the applicant

in the event it continues with the assigned official agency. A facility that has never used the official system before may not qualify for a

nonuse of service exception

12. SIGNATURE OF APPLICANT. The applicant’s signature either electronically or on a printed and scanned version.

13. DATE. The date the applicant signs the form.
CONTACT INFORMATION: 

Submit exception requests by the following method: 

E-mail: Send via electronic mail to FGISQACD@usda.gov

For further information contact: 

Federal Grain Inspection Service

Quality Assurance & Compliance Division 

1400 Independence Avenue, SW, Room 

2043-S Washington, DC 20250 

Email: FGISQACD@usda.gov

AMS website: https://www.ams.usda.gov/