Form FGIS-992 "Service Performed Report"

What Is Form FGIS-992?

This is a legal form that was released by the U.S. Department of Agriculture - Agricultural Marketing Service on January 1, 2018 and used country-wide. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2018;
  • The latest available edition released by the U.S. Department of Agriculture - Agricultural Marketing Service;
  • Easy to use and ready to print;
  • Yours to fill out and keep for your records;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FGIS-992 by clicking the link below or browse more documents and templates provided by the U.S. Department of Agriculture - Agricultural Marketing Service.

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*
Calculated Field
Form Approved: OMB 0580-0013
1. Field Office
UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FEDERAL GRAIN INSPECTION SERVICE
SERVICE PERFORMED REPORT
Instructions: Send original to the field office, one copy to the testing laboratory and retain one copy.
2. Sample Type (Check one)
FSA
DSCP
VA
Submitted
Supervision
Other(Specify)
3. Contract No.
4. Sample or Lot No.
5. Date Sampled
6. Commodity Code
7. Location Code
8. Applicant No.
9. Name and Address of Applicant
10. Commodity
Domestic
Export
11. Location of Commodity
12. Identification of Carrier
13. Seal Numbers
14. Inspection Point
15. Destination
17. Gross Weight
16. Number of Containers
Kind of Containers
Laboratory Instructions
31.Time
32.Time
33. Hours
Start (mil)
Stop (mil)
29. Sampler
30. Date
Worked
34. Activity
XX:XX
XX:XX
*
Tare Weight
19. Empty
21. Empty
Outer
Inner
Containers
Containers
Weighed
Weighed
# of
# of
containers =
containers =
35. Total Hours
*
Boxes 19. and 21. are the
total number of empty
36. Comments of Sampler
containers randomly
selected (minimum 10).
Boxes 20. (outer) and 22.
(inner) are the total weights
of the containers indicated
in boxes 19. or 21.
18. Total Gross Wt
*
20. Total
22. Total
Weight Per Container
37. Name(s)
23. Gross
*
24. Tare
*
25. Net
*
Estimated Weight of Lot
26. Gross
*
27. Tare
*
28. Net
*
38. Sample Mailed
39. Results Received
40. Vendor Called
41. Cert. Mailed
Warning: Sec 203(h) of the Agricultural Marketing Act of 1946 (7 U.S.C. 1622 (h)) provides that anyone causing a false certificate to be issued shall be subject to a $1,000 fine or imprisonment for not more
than 1 year, or both. 18 U.S.C. provides for a fine of not more than $10,000 or imprisonment for not more than 5 years, or both for false or fraudulent statements made to an agency of the United States.
Form Approved OMB NO. 0580-0013: 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 0580-0013. The time required to complete this information collection is estimated to average 20
minutes per response and 3.3 hours yearly per recordkeeper, this includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information
FORM FGIS-992 (01/18) Previous editions are obsolete. Expires January 2021
CLEAR FORM
PRINT FORM
This is a fillable form.
*
Calculated Field
Form Approved: OMB 0580-0013
1. Field Office
UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FEDERAL GRAIN INSPECTION SERVICE
SERVICE PERFORMED REPORT
Instructions: Send original to the field office, one copy to the testing laboratory and retain one copy.
2. Sample Type (Check one)
FSA
DSCP
VA
Submitted
Supervision
Other(Specify)
3. Contract No.
4. Sample or Lot No.
5. Date Sampled
6. Commodity Code
7. Location Code
8. Applicant No.
9. Name and Address of Applicant
10. Commodity
Domestic
Export
11. Location of Commodity
12. Identification of Carrier
13. Seal Numbers
14. Inspection Point
15. Destination
17. Gross Weight
16. Number of Containers
Kind of Containers
Laboratory Instructions
31.Time
32.Time
33. Hours
Start (mil)
Stop (mil)
29. Sampler
30. Date
Worked
34. Activity
XX:XX
XX:XX
*
Tare Weight
19. Empty
21. Empty
Outer
Inner
Containers
Containers
Weighed
Weighed
# of
# of
containers =
containers =
35. Total Hours
*
Boxes 19. and 21. are the
total number of empty
36. Comments of Sampler
containers randomly
selected (minimum 10).
Boxes 20. (outer) and 22.
(inner) are the total weights
of the containers indicated
in boxes 19. or 21.
18. Total Gross Wt
*
20. Total
22. Total
Weight Per Container
37. Name(s)
23. Gross
*
24. Tare
*
25. Net
*
Estimated Weight of Lot
26. Gross
*
27. Tare
*
28. Net
*
38. Sample Mailed
39. Results Received
40. Vendor Called
41. Cert. Mailed
Warning: Sec 203(h) of the Agricultural Marketing Act of 1946 (7 U.S.C. 1622 (h)) provides that anyone causing a false certificate to be issued shall be subject to a $1,000 fine or imprisonment for not more
than 1 year, or both. 18 U.S.C. provides for a fine of not more than $10,000 or imprisonment for not more than 5 years, or both for false or fraudulent statements made to an agency of the United States.
Form Approved OMB NO. 0580-0013: 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 0580-0013. The time required to complete this information collection is estimated to average 20
minutes per response and 3.3 hours yearly per recordkeeper, this includes the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information
FORM FGIS-992 (01/18) Previous editions are obsolete. Expires January 2021
CLEAR FORM
PRINT FORM
FSA Commodity Codes
WBUE20 Bulgur, Soy Fortified- Exp
WFLE20 Flour, Bread-Exp
SSHD10 Shortening-I-Dom
WBUD10 Bulgur-Dom
WFLD45 Flour, Cake-Dom
SSHD20 Shortening-II-Dom
WBUE10 Bulgur-Exp
CFLE10 Flour, Corn Soya Masa Instant-Exp
SSHD30 Shortening-III-Dom, Liquid
RCED10 Cereal, Rice, Instant-Dom
CFLD10 Flour, Corn Masa Instant-Dom
SOLE40 Soybean Oil, Crude Degummed-Exp
WCED10 Cereal, Whole Wheatmeal-Dom
WFLD50 Flour, Durum-Dom
WPAD30 Spaghetti-Dom
WPAD10 Lasagna-Dom
WFLD55 Flour, Pastry-Dom
CYSD10 Syrup, Corn Blend-Dom
CBLE10 Corn Soy Blend-Dom
SFLE10 Flour, Soy, Defatted-Exp
OLD10 Vegetable Oil-A-Dom
CMKE20 Corn Soy Milk, Instant-Exp
WFLD60 Flour, Whole Wheat-Dom
SOLE10 Vegetable Oil-A-Exp
CMKE10 Corn Soy Milk-Exp
CCED20 Fortified Corn Cereal-Dom
SOLD20 Vegetable Oil-B-Dom
CCME20 Cornmeal, Soy Fortified-Exp
RCED20 Fortified Rice Cereal-Dom
SOLE20 Vegetable Oil-B-Exp
CCMD10 Cornmeal-Dom
WCED20 Fortified Wheat Cereal-Dom
SOLD30 Vegetable Oil-C-Dom
CCME10 Cornmeal-Exp
CGRD10 Grits, Corn, Coarse-Dom
SOLE30 Vegetable Oil-C-Exp
CCMD20 Cornmeal Regular-Dom
CGRD20 Grits, Corn, fine-Dom
WPAD40 Vermicelli-Dom
WFAD20 Farina-Dom
GGRE10 Grits-sorghum, Soy fortified-Exp
WBLE10 Wheat Protein Concentrate Blend-Exp
WFLD10 Flour, All Purpose-Dom
WPAD10 Lasagna-Dom
WBLE20 Wheat Soy Blend-Exp
WFLE10 Flour, All Purpose-Exp
WPAE10 Macaroni, Wheat Soy-Exp
WMKE10 Wheat Soy Milk-Exp
WFLD20 Flour, Bakers, Hd Wht Hearth Style-Dom
WPAD20 Macaroni-Dom
WRGD10 Wheat Rolled-Dom
WFLD25 Flour, Bakers Soft Wht Bl-Dom
WPAD24 Macaroni, Enr, Rotelle, Reg. Cook
SOLE30 Vegetable Oil-C-Exp
WFLD30 Flour, Bakers Soft Wht Unbl-Dom
WPAD25 Macaroni, Rotini, Reg. cook
WPAD40 Vermicelli-Dom
WFLD15 Flour, Bred Bakers Hd Wht-dom
TRGE30 Oats, Rolled, Soy Fortified-Exp
WBLE10 Wheat Protein Concentrate Blend-Exp
WFLD40 Flour, Bread, Hearth Style-Dom
TRGD20 Oats, Rolled, Instant-Dom
WBLE20 Wheat Soy Blend-Exp
WFLE30 Flour, Bread, Wheat, Soyfort 12%-Exp
TRGE20 Oats, Rolled, Instant-Exp
WMKE10 Wheat Soy Milk-Exp
WFLD35 Flour, Bread-Dom
TRGD30 Oats, Rolled, Quick-Dom
WRGD10 Wheat Rolled-Dom
VA Commodity Codes
CCMD90 Cornmeal, Degummed, Enriched
CRGD90 Hominy Grits, Enriched, Quick-Cook
SSHD95 Shortening Type III
WEGD90 Egg Noodles, Ribbon Shaped
WPAD95 Macaroni, Enriched, Elbow, Regular
WPAD90 Spaghetti, Enriched, Long Form, Regular
WEGD95 Egg Noodles, Ribbon, Shaped, Yolk
NCMD90 Noodles Chow Mein
CSYD90 Syrup, Type III, Blended and Ref.
WFAD90 Farina Enriched Malt Low Sodium
TRGD90 Rolled Oats, Quick Cooking
MSYD90 Syrup, Type VIII, Class 2, Thick
WFAD95 Farina wheat Enriched, Quick-Dom
SOLD90 Salad Oil, Type A
WCED90 Whole Wheat Cereal, Malt Quick-Cook
WFLD90 General Purpose Wheat Flour
SSHD90 Shortening Type I
DSCP Commodity Codes
MMXU63 Mix, Cheesecake (Unbaked)
UDUP30 Dessert, Pwdr, Inst, Starch, Class 3-Btsc
NCMU10 Noodles, Chow Mein
MSHU95 Bakery Mix Shortening, Emulsified
WFAU10 Farina, Type I
WEGU10 Noodles, Egg, Type I
MBRU20 Bread, White, Enriched, Canned
WFLU20 Flour, Bread, Type I, Hd Wht
WEGU20 Noodles, Egg, Type I, Egg yolk
MBRU25 Bread, Shelf Stable, I
WFLU30 Flour, Pastry, Type IV
MCBU30 Oatmeal Cookie Bar, Type I
MBRU10 Brownies, Type I
WFLU40 Flour, Type II, Cake
MCBU90 Oatmeal Cookie and Granola Bar
MCCU10 Cake, Canned, Apple Coffee, Type II
WFLU10 Flour, Type III, General Purpose
TRGU40 Oats, Instan, Flavored
MCCU40 Cake, Canned, Blueberry, Type II
MCBU35 Granola Bar Type II
TRGU50 Oats, Instant, Flavored, Tray - Pack
MCCU50 Cake, Canned, Cherrynut, Type II
CGRU20 Grits, Hominy
TRGU30 Oats, Rolled, Instant, Type I I I
MCCU35 Cake, Canned, Chocolate, Type II
UICU10 Icing Mix Powder, Flavor 1 (Vanilla)
TRGU20 Oats, Rolled, Quick, Type I I
MCCU25 Cake, Canned, Fruit, Type I
UICU30 Icing Mix Powder, Flavor 3 (Other)
TRGU10 Oats, Rolled, Regular, Type I
MCCU15 Cake, Canned, Marble, Type II
UICU20 Icing Mix Powder, flavor 2 (Chocolate)
CGNU20 Popcorn, Type I, Fancy
MCCU45 Cake, Canned, Orange Nut, Type I
WPAU10 Lasagna, Group IV
CGNU30 Popcorn, Type I, No. 1
MCCU20 Cake, Canned, Pound, Type II
WPAU20 Macaroni, Group I
CGNU40 Popcorn, Type I I, Fancy
MCCU30 Cake, Canned, Spice, Type II
UMAU10 Margarine, Canned
CGNU50 Popcorn, Type I I, No. 1
MCBU10 Cereal Bars I, Cornflake
UMAU20 Margarine, Type I
MSOU10 Salad Oil, Type A
MCBU15 Cereal Bars II, Rice-Cornflake
UMAU30 Margarine, Type II
MSOU20 Salad Oil, Type B
MCBU20 Cereal Bars III, Fruit-Flv Cornflake
MMXU45 Mix, Angel Food, Class 1, Style F
MSOU30 Salad Oil, Type C
MCBU25 Cereal Bars IV, Granola
MMXU48 Mix, Devil’s Food, Class I, Style C
MSHU10 Shortening-I
TCOU10 Cookies, Oatmeal, Type II
MMXU21 Mix, Doughnut, Class 3
MSHU20 Shortening- I I
CSTU10 Corn Starch, Type I
MMXU51 Mix, Gingerbread, Class 1, Style D
MSHU45 Shortening-I I I
CSTU20 Corn Starch, Type II
MMXU30 Mix, Pancake & Waffle, Class 2, Style G
WPAU30 Spaghetti, Group I I
CSTU30 Corn Starch, Type III
MMXU39 Mix, Pancake & Waffle, Class 2
USYU10 Syrup, Type I
CCMU10 Cornmeal, Type I, Coarse
MMXU09 Mix, Pancake & Waffle, Buckwheat, Class 2, Style F
USYU20 Syrup, Type I I
CCMU15 Cornmeal, Type I, Fine
MMUX54 Mix, Pound Cake, Class 1, Style E
USYU30 Syrup, Type I I I
CCMU20 Cornmeal, Type II, Coarse
MMUX06 Mix, Roll, Class 4, Style A
USYU40 Syrup, Type V
CCMU25 Cornmeal, Type II, Fine
MMUX36 Mix, Sweetdough, Class 4, Style B
USYU50 Syrup, Type V I
WCRU30 Crackers, Class II
MMUX57 Mix, White Cake, Class 1, Style A
USYU80 Syrup, Type V I I
WCRU10 Crackers, Soda, Plain, Type I, Class A
MMUX60 Mix, Yellow cake, Class 1, Style B
USYU60 Syrup, Type V I I I , Class 1, Thin
WCRU20 Crackers, Soda, Salted, Type I, Class B
MMUX42 Mix, Yellow Cornbread, Class 2, Style A
USYU70 Syrup, Type V I I I, Class 2, Thick
UDUP10 Dessert, Pwdr, Inst, Starch, Class 1-Choc
MMUX12 Mix, Brownie, Butterscotch, Class 5, Style B
WPAU40 Vermicelli, Group I I I
UDUP20 Dessert, Pwdr, Inst, Starch Class 2-Van
MMUX15 Mix, Brownie, Chocolate, Class 5, Style A
MMXU03 Mix, Biscuit, Class 2, Style B
Instructions for Completing FGIS-992
Actions by person performing inspection. Complete items 1 through 37.
1.
Field office performing the service.
2.
Type of sample, check one; or specify if you check “other”.
3.
Contract number assigned by the contracting party when applicable. Include prefix
characters as part of the contract number.
4.
Sample or lot number assigned. Field offices shall specify one range of lot numbers for
each commodity location (mill point). This range shall be large enough to accommodate the
maximum number of lots inspected at that commodity location under any one contract. Each
range must begin with a number which ends with the digit 1 (e.g., 501-1000; 2501-3000; 1-350).
Lot numbers must be numeric and cannot exceed 4 digits in length. Each lot will have its own
number (e.g., 501; 502; 503; etc.). To identify new original inspections, either reserve the first digit
of the four digit lot code number for this purpose or use the next available lot number for each
contract. Julian date codes may be used for DSCP.
5.
Date sampled (MM/DD/YY).
6.
Commodity code (sees reverse side of form for codes, or contact the testing laboratory for
codes not listed).
7.
Location code from the list of numbers provided to the field office.
8.
Applicant number derived by using the last six numbers of the NFC applicant number.
9.
Name and address of applicant.
10.
Type of commodity and whether domestic or export.
11.
Location of commodity if other than the applicant’s address. If the location is the same as
block 9, show “Same”.
12.
Car number, license number, or other identification of the carrier.
13.
Record the seal numbers applied and/or broken. If space is not adequate, show “See
Below” and place in blocks 16 or 36.
14.
Inspection point code. Field offices view the Grain and Weighing Information System(GIWIS)
under “Reports -- Active Specified Service Points” for identifying codes, agencies and contractors
must contact area field office for codes.
15.
Destination if known. When submitting ethylene dibromide residue testing and aflatoxinsurvey
samples, use the destination codes provided in Grain Inspection Handbook, Book IV, Chapter 4,
Data Collection Forms, Report of Grain Inspected and Weighed for export, Form FGIS-938.
16.
Number of containers and complete description of kind of containers (the descriptiveterms should
be those used in the announcements and specifications). Record checkloading information, such
as tally or description, of how the count was made. When submitting supervision samples, include
the type of test performed and the original results obtained. Also, include any necessary laboratory
instructions.
17.
The gross weight of each container weighed. Refer to the checkweighing instructions in the
Weighing Handbook, Chapter 4, Section 4.5, to determine the number of containers to weigh.
When not recording in pounds. Indicate the unit of weight used. Weights should be entered as
exactly displayed on the scale used. E.G., if the scale’s smallest division size is 0.1, then 110.1,
not 110.10.
18.
Record the total gross weight of the containers weighed by totaling the results in the
columns following block 17.
19.
The weight of the empty outer containers weighed. Refer to the checkweighing instructions in the
Weighing Handbook, Chapter 4, Section 4.5, for the number of containers to weigh. Place a “1”
here if the tare is not known and using a tare value from Table 4 of Chapter 4 of the Weighing
Handbook in block 20.
20.
The total weight of the empty outer containers weighed by totaling the results in block 19 above
(The tare containers are weighed together in one weighing). Outer containers weighed individually
must be handwritten by on the back of the form and the total of all entered in block 20.
21.
The weight of empty inner containers weighed, if present. Refer to the checkweighing instructions
in the Weighing Handbook, Chapter 4, Section 4.5, for the number of containers to weigh. When
not recording in pounds, indicate the unit of weight used (The tare containers are weighed
together in one weighing). Inner containers weighed individually must be handwritten by on the
back of the form and the total of all entered in block 22.
22.
The total weight of the empty inner containers selected, if present from block 21.
23.
Record the average gross weight of the filled containers, by dividing the results in block 18 by
the number of containers weighed. This field is automatically calculated if completed electronically
24. Record the average tare weight of the empty containers. This field is automatically calculated if
completed electronically. If the empty containers are not available for determining tare weight and
the lot was previously checkweighed (e.g., at origin), use the previously determined tare weight. If
it is not known whether the tare was previously determined use Weighing Handbook, Chapter 4,
Section 4.5, Table 4.
25.
Record the average net weight of containers by subtracting the result in block 24 from that
in block 23. This field is automatically calculated if completed electronically.
26.
Record the estimated gross weight of the lot by multiplying the number of containers in the
lot block 16 by the result in block 23. This field is automatically calculated if completed
electronically.
27.
Record the estimated tare weight of the lot by multiplying the number of containers in the lot block
16 by the result in block 24. This field is automatically calculated if completed electronically.
28.
Record the estimated net weight of the lot by subtracting the result in block 27 from that in block
26. Some commodity instructions say to certify using the labeled or intended amount for
certification if the lot complies, but for the purposes of this worksheet use the sampled calculations
for block 28. This field is automatically calculated if completed electronically.
29.
The name of the sampler(s).
30.
Date service was performed.
31.
Starting time to the nearest ¼ hour. For the automatic calculating feature to work column 33
the time must be entered in military time and with a “:” (colon) separating the hours from minutes.
Shifts exceeding a calendar day 24-hour period (00:15-24:00) must be split between two entries.
32.
Stopping time to the nearest ¼ hour. For the automatic calculating feature to work column 33
the time must be entered in military time and with a “:” (colon) separating the hours from minutes.
Shifts exceeding a calendar day 24-hour period (00:15-24:00) must be split between two entries.
33.
The total hours for each period of time recorded. If more than one lot is worked simultaneously,
prepare an FGIS-992, for each. Record the time worked on each form; however, do not attempt
to prorate and divide the time between different lots. This field is automatically calculated if
completed electronically.
Place asterisks by the hours worked and under the “comments of sampler,” identify the other lots
worked simultaneously. When billing, field office personnel shall divide the time equally between
the lots worked simultaneously or use the following method to prorate the time worked on each lot.
a.
Total the hours worked on each lot individually during a 1-day (24 hour) period.
b.
Total the hours worked on all lots during the 1-day (24 hour) period.
c.
Divide the hours worked on each individual lot by the total hours worked on all lots.
d.
Multiply this amount by the actual clock hours worked for the day (24 hours) and
round to the nearest ¼ hour.
34.
The type of service performed (abbreviations are acceptable; i.e., S-sampling, C-condition,
CW-checkweighing, CC-checkcount, SB-stand by, etc).
35.
The total hours worked. This field is automatically calculated if completed electronically.
36.
Special services, unusual conditions, events, or observations concerning the lot. When necessary,
give an explanation of the time recorded when other lots are worked simultaneously or condition
of the carrier when found to be unfit to maintain the quality of the product.
37.
Name(s) of person(s) performing services.