4. DISTRICT OFFICE (Name and Number)

3. COUNTRY (To which product will be exported)

2. DATE OF REQUEST

10. CLASS OF PRODUCT(s) TO BE EXPORTED

 (Check)

03I 

03G 

03H 

03F 

Raw Product-Ground

03C 

03D 

03E 

11. SPECIES (Check all that apply)*:

7. PHONE NO. 8. FAX NO.

14. TITLE (Type or Print) 15. DATE SIGNED

FSIS SECTION (Type or Print Name Above All Signatures)

, subject to comments if any on the attached correspondence. (Name of Country)

21. SIGNATURE OF INSPECTOR-IN-CHARGE 22. DATE SURVEYED

13. SIGNATURE OF AUTHORIZED FIRM REPRESENTATIVE

 17. TITLE (Type or Print) 18. PHONE:

20. I surveyed the above-named establishment on the date indicated below and in my opinion, it meets the requirements for export to

23. SIGNATURE OF CIRCUIT SUPERVISOR/DATE

Slaughter

Boning/Cut-up

Grinding

Processing

Cold Storage

Other

19. FAX:

9. TYPE OF 

 OPERATION(s)

(Check)

16. NAME OF CONTACT PERSON IF DIFFERENT FROM ABOVE

(Type or Print Name Above Signature)

5. USDA ESTABLISHMENT NO. (Specify Est. No., M, P, ID, I, etc)

Duck Rhea

Mutton

Bison

Horse

Beef

Pork

Buffalo Chicken

Turkey

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 0583-0153. The time required 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.

UNITED STATES DEPARTMENT OF AGRICULTURE

FOOD SAFETY AND INSPECTION SERVICE

ESTABLISHMENT APPLICATION 

FOR EXPORT OF

POULTRY

MEAT

OTHER

6. FROM: (Establishment name and address as shown on current Grant of 

 Inspection, FSIS Form 5200-1, and include DBA's if applicable)

12. The undersigned requests that the firm identified in Item 6 be included on the list of establishments certified by USDA as meeting the requirements of the 

country specified with respect to the importation of meat/poultry or meat/poultry products. 

 

We make this request with the understanding that, in addition to compliance with normal U.S. inspection requirements, the above-named firm voluntary agrees to 

the following:

To operate in the mode to meet the importing country's requirements anytime an export audit is made by a U.S. review

To notify appropriate FSIS officials promptly when firm wishes to be removed from the list of plants that are eligible to 

export to the country named herein (Item 3).

To comply with all provisions of appropriate inspection laws and regulations of the importing country when preparing 

product for export to that country. These requirements have been reviewed by officials of this firm and are fully

understood.

To reimburse USDA for any inspections over and above U.S. requirements, (Reference FSIS Directive 5110.1).

To segregate and maintain identity of product eligible for export from noneligible product.

team or by a foreign official.

.

.

.

.

.

FSIS FORM 9080-3 (08/27/2018) (PREVIOUS EDITIONS OBSOLETE)

03B

Raw Product-Not Ground

Thermal Processed/Com. Sterile

Not Heat Treated-Shelf Stable (S.S.)

Heat Treated-Shelf Stable

Fully Cooked/Not Shelf Stable

Heat Treated/Not Fully Cooked-Not S.S.

Product With Secondary Inhibitors-Not S.S

Ostrich

Emu

Veal

Pheasant

Lamb Antelope Deer

Quail

Elk

Reindeer

WILD GAME LIST OTHER SPECIES LIST

Catalo

Guinea

Goat

Rabbit

Goose

Water Buffalo Squab

EGG PRODUCTS

Egg Products

Siluriformes 

 Fish

(Check if Voluntary Inspection)

24. SIGNATURE OF DISTRICT MANAGER/DATE
INSTRUCTIONS FOR FSIS FORM 9080-3

Purpose:

Instructions:

Approval:

For most countries, all FSIS authorized meat, poultry and egg product establishments are eligible to 

export meat, poultry and egg products, provided all requirements indicated in the FSIS Export Library

are met. Several countries however, require additional certification provided by the plant and 

approved by FSIS. The country requirements listed in the FSIS Export Library will reflect the 

necessity of this additional certification process if required. Plants wishing to export to such countries 

must submit FSIS Form 9080-3 to the Office of Policy and Program Development in order to become 

eligible.

FSIS Form 9080-3 is to be completed and submitted by establishment personnel using PHIS (Public 

Health Information System). Effective June 29, 2018, FSIS no longer accepts the paper version of 

FSIS Form 9080-3 submitted to FSIS IPP for review and approval. For establishments that do not 

have access to or use PHIS, they are to send a fully completed paper copy of FSIS Form 9080-3 to 

the FSIS Proxy, using one of the three options listed below. The FSIS Proxy will enter the 

application information into PHIS on the applicant's behalf. 

 

 1. Email: FSCExport.Recon@fsis.usda.gov; 

 

 2. Mail: U.S. Department of Agriculture, Food Safety and Inspection Service, FMD, Financial 

 Services Center, P.O. Box 9205, Des Moines, IA 50306-9948; or 

 

 3. Fax: 1-844-378-1048 

 

Once FSIS Form 9080-3 is approved by Office of Field Operations personnel, the Office of Policy 

and Program Development will process the request with the appropriate foreign authorities. Upon 

receipt of approval notification from foreign authorities, the Office of Policy and Program 

Development will post the plant information in the FSIS Export Library under the list of approved 

plants for the appropriate country. Users should monitor the FSIS Export Library to see when their 

plant has been approved. Users may contact the Office of Policy and Program Development for an 

update of the status of the application by email at ImportExport@fsis.usda.gov or phone at (202) 

720-0082.