20. COMMENTS/REMARKS

9.

 PRODUCT AS LABELED

FSIS FORM 9010-1 (01/12/2023) 

U.S. DEPARTMENT OF AGRICULTURE

FOOD SAFETY AND INSPECTION SERVICE

2. EXPORT CERTIFICATE NO. (Attach Copy) 

3. APPLICANT (Company name and address including zip code, contact name, phone number and email) 4. U.S. PORT OF ENTRY

6. U.S. EXPORT. EST. NO. 7. U.S. EXPORT EST. NAME AND ADDRESS

10.

MARKED

WEIGHT 

 (in lbs.) 

11.

NO. OF 

CARTONS 

13.

 SHIPPING MARKS

14.

EST. NO. 

ON PRODUCT

 18. REINSPECTION OFFICIAL FSIS ESTABLISHMENT or DESTRUCTION ESTABLISHMENT/LOCATION* 19. DATE AT EST. (mm/dd/yyyy)

26. SIGNATURE OF STAFF OFFICER 27. DATE (mm/dd/yyyy)

5. ESTIMATED DATE OF ENTRY (mm/dd/yyyy)

(Applied at Time of Export)

12.

 PRODUCTION CODE

8. DATE OF REQUEST (mm/dd/yyyy)

15. PORTS TRANSITED (include all ports) 16. COUNTRY RETURNED FROM 17. REASON FOR RETURN

1. DISTRIBUTION: Applicant must submit the completed form to USDA, FSIS. 

See Page 2 for address and instructions. 

APPLICATION FOR THE RETURN OF EXPORTED PRODUCTS TO THE UNITED STATES 

Submit via E-mail

 22. APPLICATION DENIED 

 (date and initials)

21. REINSPECTION REQUIRED 

 (date and initials)

 23. APPLICATION CANCELLED 

 (date and initials)

TO BE COMPLETED BY FSIS PERSONNEL ONLY

25. RELEASED 

 (date and initials)

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 0583-0159. The time required to complete this information collection is estimated to average 20 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.

OMB Control Number: 0583-0159 

Expiration Date: 12/31/2025.

PREVIOUS EDITIONS ARE OBSOLETE

*Applicant should identify an official FSIS establishment for the reinspection, if required, and a date for the reinspection (block 19); or the official FSIS 

establishment or location for destruction. Approval of the establishment and reinspection date, or destruction location, depends on concurrence from the 

District Office of Field Operations. 

24. FOR DESTRUCTION 

 (date and initials)

(e.g. MPM-000000 or 0000000 (for PHIS Certificates)) 
INSTRUCTIONS FOR PREPARATION OF FSIS FORM 9010-1

Export Certificate Number - As identified on certificate and shipping cartons

U.S. Port of Entry - City and State of U.S. Port of Entry either entering sea or ground/air

Estimated Date of Entry - Estimated Date when the product is to arrive in the US (Month, Day, and Year); use the dropdown for calendar feature

Originating Export Establishment - Establishment number where export originated from

U.S. Establishment - Export Establishment Name and Address - Full address (street, city, state and zip code ) where export originated

from

Date of request - Date application is completed and submitted; use the dropdown for the calendar feature 

Product as labeled - Species and Product as described on Label or Export documents, e.g. "Beef Boneless Rounds"

Marked Weight - Total Shipment Weight in pounds

No. of Cartons - The numeric count of product returning 

Production Code -

Shipping Marks (Applied at Time of Export) - Export Stamp number

Establishment No. on Product - Producing establishment number of the returned product

Ports Transited - All ports visited by the shipment - leaving and returning to the U.S.

Country Returned from - Country product was exported to as listed on export certificate

Reason for Return - Reason product is returning the US (e.g. Refused for contamination, Returned because not up to

specifications, etc.)

Reinspection: Official FSIS Establishment or Destruction Establishment/Location - The FSIS Establishment proposed for reinspection, 

should it be required, pending concurrence from the appropriate District.

Date - Estimated date the shipment will arrive for reinspection or destruction

Comments/Remarks -

Note: The form is to be completed by the Applicant and can be typed or written

1.

2.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

19.

17.

18.

20.

BLOCKS 21 through 27 FOR FSIS PERSONNEL USE ONLY

3. Applicant - Information regarding applicant's company, including the company's name, address, phone number, and email address. Include 

 the name of person filling out application (the applicant's representative)

25. Released - Date approved to move if reinspection is not required or acceptable results are reported by DO after reinspection

26. Signature of Staff Officer - signature of FSIS staff officer completing the return

27. Date - date final action is taken by the FSIS staff officer

Comments by the applicant and/or FSIS personnel

 (at the establishment listed in block 18);

23. Application Cancelled - Date and initials of the FSIS staff officer if the shipment has been cancelled for any reason

21. Reinspection Required - Date and initials of the FSIS staff officer if shipment must be reinspected at location specified in 

 block 18

22. Application Denied - Date and initials of the FSIS staff officer if the shipment is denied entry in the U.S.

Date produced or other production codes. Information in this field is not required if that information is unavailable 

USReturnedExports@usda.gov

Submit or Complete Form: Click the "Submit via E-mail" button at the bottom of the form or the form may be printed and scanned or saved as 

a pdf. and emailed to: 

Complete and submit multiple Forms 9010-1 if there are more than six products/line items on the export certificate. 

 For assistance, send an email to: 

 If the product is derived from cell-cultured technology, this must be indicated in the product description (e.g. Beef boneless rounds cell cultured 

 beef) 

calendar feature

use the dropdown for the

24. For Destruction - Date and initials of the FSIS staff officer if the shipment is to return to the U.S. for destruction

or other identifying marks on the cartons

Include the establishment number, name, and full address

USReturnedExports@usda.gov