Clear Form

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control OMB APPROVED
number. The valid OMB control number for this information collection is 0579-0040. The time required to complete this information collection is estimated to
average .5 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, 0579-0040
and completing and reviewing the collection of information. EXP.: 01/2021
UNITED STATES DEPARTMENT OF AGRICULTURE ON-HOLD SHIPMENT NOTIFICATION
ANIMAL AND PLANT HEALTH INSPECTION SERVICES
VETERINARY SERVICES APPLICATION
This form is to be completed by customers that have been subject to an animal products or organism and vectors shipment being
held or in quarantine by the USDA and/or the Department of Homeland Security, Customs and Border Protection (CBP). The on-hold
processing fee associated with this application is non-refundable and does not expedite or guarantee release of shipment. For additional
information contact the Veterinary Services (VS) office at 301-851-3300.
Instructions: Submit the completed packet (application form and supporting documents) to:
For Animal Products: Fax to 301-724-8226 or (preferably) by email to animalproducts.application@aphis.usda.gov
For Organism and Vectors: Fax to 301-851-2239 or (preferably) by email to OV@aphis.usda.gov
The supporting documents listed below MUST accompany this application:
1. Valid Veterinary Services Import Permit or Application for New Permit (if applicable)
2. Airway Bill/Bill of Lading/Courier Tracking Receipt
3. Invoice/Manifest
4. Foreign Government Certification and/or Manufacturers Statement
5. Detailed documents describing the processing the materials have undergone prior to export to the U.S.
6. Copies of correspondence with the port regarding the shipment including the reason the shipment was placed On-Hold
Emergency Action Notification (EAN) issued:
Yes or No - If yes, EAN document must be provided. Contact the VS
office BEFORE submitting this form, as the shipment may not be eligible for release.
1. CBP Agriculture Specialist (CBPAS) or USDA Inspector 2. U.S. Importer/Consignee

Name: Name: Michael Martin

Port City: Company Name:
UnitedAnH
Port State: Address:
214 S. Main Street, Sheridan, IN 46069
Port Phone Number: Phone Number:
317.758.2670
Port Fax Number: Fax Number:
317.758.2670
Email Address: Email Address:
<Michael.Martin@unitedanh.com>
3. Description of Material Presently Detained at the Port of Entry
Name of Product: Vessel Name:
Shrimp Finished Meal / Enspira Blend xxxx
Country of Origin: Tracking Number:
Guatemala 8163 7304 4140
Country of Export: Container Number:
Guatemala xxx
Date of Arrival: Flight Information:
12/07/2021
Customs Entry Number: Airway Bill (if applicable):
xxx
Courier Name: Bill of Lading (if applicable):
FEDEX xxx
Identify the animal origin ingredients/components including animal species (cow, sheep, horse, bird) and country of origin:
Shrimp Finished Meal: Fish meal comming from Peru.
Enspira Blend: No animal origin ingredients.

4. Payment Method
User Fee Account Number: Credit Card Number:

Expiration Date (mm/yyyy):

Signature: Date:

VS Form 16-79
APR 2017