Form Approved – OMB No. 0581-0305 

Thisformisavailable electronically. See Page 2 for Privacy Act and Paperwork Reduction Act Statements. 

WA-53 U.S. DEPARTMENT OF AGRICULTURE 

(07-31-18) Agricultural Marketing Service 

APPLICATION FOR A LICENSE TO INSPECT, CLASSIFY, SAMPLE, 

AND/OR WEIGH AGRICULTURAL PRODUCTS 

UNDER THE UNITED STATES WAREHOUSE ACT 

A. Print Applicant Name Clearly and Distinctly for

Issuance of License

B. USWA Warehouse License Number (REQUIRED)

NOTE TO APPLICANT: This application must be filled out and signed by the applicant. This application must be 

accompanied by a check or money order for the required fee and made payable to: “AGRICULTURAL MARKETING 

SERVICE, USDA.”

C. Fee

$

I am applying for a license, under the United States Warehouse Act, to perform the services indicated in Item 2. 

1. TYPE OF WAREHOUSE:

Grain Cotton Cottonseed 

Dry Beans Nut Other: 

2. TYPE OF SERVICE LICENSE REQUESTED:

Inspect Weigh Sample 

Classify (Condition,Grade,Class) 

3. TYPE OF CERTIFICATION:

Grade Class 

Condition Weight 

4. Facsimile Signature

YES NO 

5. DATE EMPLOYED

(MM-DD-YYYY) 

6. PRESENT DUTIES OR TITLE

7. Name and Location (City, State, Zip Code) of Warehouse where

Services will be Performed

8. Name and Location (City and State) of Current Employer

9. State your experience in the actual inspection, grading, sampling, classing, and/or weighing of the agricultural products covered by this application,

specifying the number of years with dates and names of employers. (REQUIRED)

10. Are you presently, or have you ever held a license for a similar service? YES NO 

(If “YES”, please indicate warehouse license number(s), service license number(s), location(s) and for whom the services

were performed.)

11. Indicate any special training you have had pertinent to this application (i.e., grain grading schools, seminars, USDA related schools, etc.).
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

WA-53 (07-31-18) Page 2 of 2 

12. APPLICANT’S CERTIFICATION

“Knowing that false statements made to the Government are subject to penalty, I certify that I have not been convicted of a felony, that I am at 

least 18 years of age and physically capable to perform the duties required by the service(s) for which this application is made; that I have the 

skills and equipment needed to perform these service(s) in accordance with applicable standards; and if this application is to include weighing, I 

will not knowingly weigh on scales that I believe to be incorrect; and that the statements made in this application are true to the best of my 

knowledge. Further, as a condition to granting this license, I agree to comply with the terms of the United States Warehouse Act and its 

regulations.”

A. Applicant’s Signature B. Date (MM-DD-YYYY) 

13. WAREHOUSE OPERATOR’S CERTIFICATION

I certify that “The applicant is acceptable to perform the service(s) for which applied for at the warehouse operated by the undersigned and 

specified on this form.”

A. Name of Warehouse Operator (Legal Entity Name) B. Phone Number 

C. Authorized Signature D. Title E. Date (MM-DD-YYYY) 

No license will be issued until approved by the Warehouse and Commodity Management Division. 

NOTE: The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a- as amended). The authority for requesting the 

information identified on this form is 7 CFR Part 735, and the United States Warehouse Act (Pub. L. 106-472). The information will be used to 

apply for individual licensing under the United States Warehouse Act to inspect, weigh, classify as to condition, grade, and class, and or 

sample agricultural products within the authority. The information collected on this form may be disclosed to other Federal, State, Local 

government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or 

regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File 

(Automated) andUSDA/FSA-3,Consultants File. Providing the requested information is voluntary. However, failure to furnish the requested 

information will result in adetermination of ineligibility to obtain new licensing or retain existing licensing under the United States Warehouse 

Act. 

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 avalidOMB control number. The valid OMB control number for this information collection is 

0581-0305. The time required to complete this information collection is estimated to average 15 minutes per response, including the time for 

reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the 

collectionofinformation. 

The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided. RETURN 

THIS COMPLETED FORM TO THE WAREHOUSE AND COMMODITY MANAGEMENT DIVISION, STOP 9148,P.O.BOX419205, 

KANSASCITY, MO64141-6205. 

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 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. 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Instructions for WA-53 

APPLICATION FOR A LICENSE TO INSPECT, CLASSIFY, SAMPLE, AND/OR WEIGH 

AGRICULTURAL PRODUCTS UNDER THE U.S. WAREHOUSE ACT 

Applicants for personal licensing under the United States Warehouse Act to 

inspect, weigh, classify as to condition, grade, and class, and/or sample 

agricultural products within the authority of an existing United States Warehouse 

Act license use this form. 

Submit the original of the completed form in hard copy or facsimile to the 

Warehouse and Commodity Management Division, STOP 9148, P.O. Box 419205, 

Kansas City, MO 64141-6205; or FAX 844-930-0174. Customers who have 

established electronic access credentials with WCMD may electronically transmit 

this form to WCMD. Features for transmitting the form electronically are available 

to those customers with access credentials only. If you would like to establish 

online access credentials with WCMD, follow the instructions provided at the 

USDA eForms web site. 

Applicants must complete Items 1 through 14. The warehouse operator completes 

the certification in Item 15. AMS completes the certifications in items 16 and 17. 

Items 16 and 17 are for AMS use only. 

Fld Name/ 

Item No. 

Instruction 

A 

Name of 

Applicant 

Enter the name of applicant. 

B 

USWA License 

No. 

Enter USWA license number. 

C 

Fee 

Enter fee. 
 

 

 

 

Items 1 through 14 

Fld Name/ 

Item No. 

Instruction 

1 

Type of Service 

License 

Requested 

Check the box indicating the services the applicant intends to 

provide. 

With a License to: Applicant will be Certifying: 

Inspect and Weigh Condition and Weight 

Inspect, Classify, and Weigh Condition, Class, Grade, 

and/or Weight 

Weigh Weight 

Classify Condition, Class, and/or Grade 

Sample No Certification) 

Sample, Classify and Weigh Condition, Class, and/or 

Weight Sample and Weigh Weight 

According to 7 CFR 735.200 

2 

Type of 

Warehouse 

Check the box indicating the type of warehouse(s) at which the 

applicant will be providing the service requested in Item 1. 

3 

Type of 

Certification 

Check the box indicating the certification the applicant intends to 

give. 

See the table in Item 1. 

4 

Facsimile or 

E-Signature 

Check the box indicating whether the applicant needs facsimile or 

E-signature authority. 

5 Enter the name of the warehouse and the city and state location in 

Name and which the service will be performed. 

address of 

Warehouse in 

which the 

applicant will 

performs the 

service 

6 

Location of 

Warehouse 

Enter the complete mailing address of the warehouse in which the 

service will be performed. (So that we may mail the license to the 

applicant.) 
 

 

 

 

 

 

 

 

Fld Name/ 

Item No. 

Instruction 

7 Enter the name and address (city, state) of the licensed warehouse 

Name and operator for whom the applicant will be performing the activities 

Address of requested for licensing. 

Present Employer 

8 

Date Employed 

Enter the date (MM-DD-YYYY) employed by this warehouse 

operator. 

9 

Present Duties or 

Title 

Enter present duties or the applicant’s job title with the current 

employer. 

10 

State the 

applicant’s 

experience 

(etc.) 

Enter a summary of the applicant’s past experience with 

inspecting, grading, sampling, classing and/or weighing of 

agricultural products covered by this application including the 

number of years at a specific employer’s warehouse.

11 Check the box indicating whether the applicant has ever held a 

Is the applicant USWA license. Enter any license number, dates of license, and 

presently the name of the employer for whom the applicant may have held a 

licensed (or has USWA license for a similar service. 

the applicant ever 

been licensed)? 

12 

Please indicate 

any special 

training (etc.) 

Enter training course work completed including grain grading 

schools, seminars and the like along with dates of attendance. 

13 A - D 

Give names and 

addresses (etc.) 

13 A. Enter the names of four persons who know the applicant’s 

recent qualifications for the service(s) under application. 

The applicant’s most recent previous employer should be 

on this list. All others should not be the applicant’s 

immediate family or warehouses the applicant will 

service. 

13 B. Enter the address of four persons who know the 

applicant’s qualifications for the service(s) under 

application. 

13 C. Enter the telephone number of four persons who know the 

applicant’s qualifications for the service(s) under 

application. 

13 D. Enter the occupation of four persons who know the 

applicant’s qualifications for the service(s) under

application. 
 

 

 

Fld Name/ 

Item No. 

Instruction 

14 A-C 

Applicant’s

Certification 

14 A. Enter the applicant’s signature as the applicant wishes

the license to be issued. 

14B. Enter the date of the signature. 

14C. Enter the applicant’s LEGIBLY printed name as the

Applicant wishes it to appear on the license. 

15 A-D 

Warehouse 

Operator’s 

Certification 

15 A. Warehouse operator enters name of warehouse operator: 

Enter the warehouse operator’s full legal name and type of 

organization: 

For a proprietor, enter, for example “Susan Doe” .

For a corporation, enter, for example, “Does, Inc.”, a BLANK 

corporation, where BLANK is the name of the state of 

incorporation. 

For a general partnership, enter, for example “Letitia Doe, Frank 

Doe, Selma Doe, and James Doe, copartners, trading as Doe 

Farms” then “under the laws of BLANK” where BLANK is the 

state under whose laws the partnership is organized. 

For a limited partnership, enter, for example “Doe Farms 

Limited Partnership under the laws of BLANK, Selma Doe, 

General Partner” where BLANK is the state of organization and 

under whose laws the applicant operate. 

For a limited liability company, enter, for example “Doe Farms, 

L. L. C., a BLANK limited liability company” where BLANK is 

the name of the state under which organized). 

15 B. Enter the authorized signature. 

15 C. Enter the signer’s title.

15 D. Enter the date (MM-DD-YYYY) signed.