OMB No. 0581-0125 

Exp. 10/31/2026

SPECIALTY CROPS INSPECTION DIVISION 

REQUEST FOR INSPECTION 

REQUEST FOR: ☐ INSPECTION ☐ REINSPECTION ☐ APPEAL INSPECTION

(This is the only acceptable form for fax or electronic submission to USDA for requesting inspection services) 

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:

*E-Mail Address:

Enter 

when 

different 

from 

Applicant: 

*Shipper’s Name:

City and State: 

Receiver’s Name: 

City and State: 

*Location of Product(s):

*Date:

*Time:

Type of Carrier: 

Type: 

Car Number or 

License Number: 

☐ Car: 

☐ Trailer:

☐ Lot Inspection

Applicant’s P.O. Number: 

Lots Separated by (Optional): *Inspection Requested For (Must select at leastone):

☐ PLI Numbers ☐ Quality and Condition (including size when applicable)

☐ Grower Numbers ☐ Condition Only

☐ Size ☐ Size

☐ Other, Specify: ☐ Net Weight

☐ Other, Specify:

Digital Images Requested: 

☐ Yes ☐ No 

☐ Section 8e Import Requirements:

Customs Entry Number: _____________________________ 

Shipping Container Number: _________________________

Products To Be Inspected 

*Products Brands/Marks *Quantity Type Container *Size Type/Variety 

Remarks/Special Instructions: 

Non-Discrimination Policy: In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and 

institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, 

disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or 

funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. 

Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or 

USDA’s TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other 

than English. 

To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or 

write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA 

by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: 

program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender. 

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 is 0581-0125. The time required to complete this information collection is estimated to average 2 minutes per response, including the time for reviewing the 

instruction, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. 

SC-237 (01/2024) Destroy previous editions. USDA is an equal opportunity provider, employer, and lender.