Cbp Form 28 – Fill Out and Use This PDF

	DEPARTMENT OF HOMELAND SECURITY	OMB No. 1651-0023
		Exp. 03-31-2014

U.S. Customs and Border Protection

1. Date of Request

REQUEST FOR INFORMATION

19 CFR 151.11

2. Date of Entry and Importation

3. Manufacturer/Seller/Shipper

4. Carrier

5. Entry No.

5a. Invoice Description of Merchandise

5b. Invoice No.

6. HTSUS Item No.

7. Country of Origin/Exportation

8. CBP Broker and Reference or File No.

9. TO:

10. FROM:

Production of Documents and/or Information Required by Law: If you

11a. Port

11b. Date Information

have provided the information requested on this form to U.S. Customs and

Furnished

Border Protection at other ports, please indicate the port of entry to which it

was supplied, and furnish a copy of your reply to this office, if possible.

General Information and Instructions on Reverse

12. Please Answer Indicated Question(s)

13. Please Furnish Indicated Item(s)

A.

Are you related (see reverse) in any way to the seller of

A.

Copy of contract (or purchase order and seller's

this merchandise? If you are related, please describe the

confirmation thereof) covering this transaction, and any

revisions thereto.

relationship, and explain how this relationship affects the

price paid or payable for the merchandise.

B.

Descriptive or illustrative literature or information

explaining

what the merchandise is, where and how it is

used, and exactly how it operates.

C.

Breakdown of components, materials, or ingredients by

weight and the actual cost of the components at the time

of assembly into the finished article.

B.

Identify and give details of any additional costs/

D.

Submit samples:

Article number and description

expenses incurred in this transaction, such as:

(1) packing

from container

(2) commissions

mark(s)and number

(3) proceeds that accrue to the seller

Samples consumed in analysis, and other samples whose

(4) assists

return is not specifically requested, will not normally be

(5) royalties and/or license fees

returned.

E.

See item 14 below.

14. CBP Officer Message

15. Reply Message (Use additional sheets if more space is needed.)

16.

It is required that an appropriate corporate/company official execute this certificate and/or endorse all correspondence

CERTIFICATION

in response to the information requested. (NOTE: NOT REQUIRED IF FOREIGN FIRM COMPLETES THIS FORM.)

I hereby certify that the information

16a. Name and Title/Position of Signer (Owner,

l6b. Signature

Importer, or Corporate/Company Official)

furnished herewith or upon this form in

response to this inquiry is true and correct,

16c. Telephone No.

16d. Date

and that any samples provided were taken

from the shipment covered by this entry.

17. CBP Officer

18. Team Designation

19. Telephone No.

CBP Form 28 (03/11)

GENERAL INFORMATION AND INSTRUCTIONS

1.The requested information is necessary for proper classification and/or appraisement of your merchandise and/or for insuring import compliance of such merchandise. Your reply is required in accordance with section 509(a), Tariff Action of 1930, as amended (19 U.S.C. 1509).

2.All information, documents, and samples requested must relate to the shipment of merchandise described on the front of this form.

3.Please answer all indicated questions to the best of your knowledge.

4.All information submitted will be treated confidentially.

5.If a reply cannot be made within 30 days from the date of this request or if you wish to discuss any of the questions designated for your reply, please contact the CBP officer whose name appears on the front of this form.

6.Return a copy of this form with your reply.

DEFINITIONS OF KEY WORDS IN BLOCK 12

Question A: RELATED - The persons specified below shall be treated as persons who are related:

(A)Members of the same family, including brothers and sisters (whether by whole or half blood), spouse, ancestors, and lineal descendants.

(B)Any officer or director of an organization and such organization.

(C)An officer or director of an organization and an officer or director of another organization, if each such individual is also an officer or director in the other organization.

(D)Partners.

(E)Employer and employee.

(F)Any person directly or indirectly owning, controlling, or holding with power to vote, 5 percent or more of the outstanding voting stock or shares of any organization and such organization.

(G)Two or more persons directly or indirectly controlling, controlled by or under common control with, any person.

PRICE PAID OR PAYABLE - This term is defined as the total payment (whether direct or indirect and exclusive of any costs, charges, or expenses incurred for transportation, insurance, and other C.I.F. charges) made, or to be made, for imported merchandise by the buyer to, or for the benefit of, the seller.

Question B: ASSISTS - The term "assist" means any of the following if supplied directly or indirectly, and free of charge or at reduced cost, by the buyer of the imported merchandise for use in connection with the production or the sale for export to the United States of the merchandise:

(1)Materials, components, parts, and similar items incorporated in the imported merchandise.

(2)Tools, dies, molds, and similar items used in the production of the imported merchandise.

(3)Merchandise consumed in the production of the imported merchandise.

(4)Engineering, development, artwork, design work, and plans and sketches that are undertaken elsewhere than in the United States and are necessary for the production of the imported merchandise.

PROCEEDS THAT ACCRUE TO THE SELLER - This term is defined as the amount of any subsequent resale, disposal, or use of the imported merchandise that accrues, directly or indirectly, to the seller.

ROYALTIES AND/OR LICENSE FEES - This term relates to those amounts that the buyer is required to pay, directly or indirectly, as a condition of the sale of the imported merchandised for exportation to the United States.

PAPERWORK REDUCTION ACT STATEMENT - An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0023. The estimated average time to complete this application is 2 hours. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of Regulations and Rulings, 799 9th Street, NW., Washington DC 20229.

CBP Form 28 (03/11)(Back)