1. This form must accompany all shipments of shrimp and
shrimp products into the United States.
2. The form accompanying each shipment must include
original signatures in all signature blocks. The form is to
be retained by the U.S. importer for a period of three years
from the date of import, and is to be produced upon a
request from U.S. government officials.
3. All forms must have all blocks complete with all
necessary information, signatures, addresses, etc.
Incomplete forms will not be accepted.
4. All information included on all forms must be easily
5. Forms may be reproduced locally, but it is the
responsibility of the exporter to ensure that any such
reproduced forms are clearly legible. The requirement for
original signature in 2, above, still applies.
6. Instructions for individual blocks:
Block 1:
The harvesting nation means either: (1) the nation in
which the shrimp is raised in an aquaculture facility; or (2)
the nation in whose waters the shrimp is harvested.
Block 2:
Insert the name and address of the aquaculture facility or
facilities at which the shrimp is raised and harvested, if
Block 3:
The "exporter" is the individual or company in the
harvesting nation who sells the goods for export to a
foreign buyer, e.g. a U.S. or third-country buyer.
Block 4:
Insert name and address of U.S. importer or ultimate
Block 5:
"Date of export" means the date on which the shipment
departed the last port of the harvesting nation for
Block 6:
Insert in the appropriate column the U.S. Harmonized
Tariff Schedule Number, number of boxes/cases or other
units in a particular shipment, and the net weight in
kilograms. HTS categories covered by this form include:
0306.16.00 (cold-water shrimps and prawns, frozen);
0306.17.00 (other shrimps and prawns, frozen);
0306.26.00 (cold-water shrimps and prawns, not frozen);
0306.27.00 (other shrimps and prawns, not frozen);
1605.21.10 (shrimps and prawns, not in airtight
containers); and 1605.29.10 (shrimps and prawns, other).
Instruction Page 1 of 1
Block 7:
If shipment consists of more than one type of product,
they may be listed on an additional page and attached.
Insert date of entry, port of entry, and entry number at the
top of attachment.
Check the appropriate box to indicate if the shrimp is (A)
harvested in a manner which does not adversely affect
sea turtles; or (B) harvested in the waters of a nation that
is certified pursuant to Section 609 of P.L. 101-162 as of
the date of export from the harvesting nation. In order to
qualify pursuant to (A), the shrimp must have been
harvested under one of the following conditions: (1)
shrimp harvested in an aquaculture facility in which the
shrimp spend at least 30 days in ponds prior to being
harvested; (2) shrimp harvested by commercial trawl
vessels using TEDs (Turtle Excluder Devices) comparable
in effectiveness to those required in the U.S.; (3) shrimp
harvested exclusively by means that do not involve the
retrieval of fishing nets by mechanical devices or by
vessels using only the following types of gear: barred
beam trawls and/or roller trawls, wing nets, skimmer
trawls, and pusher-head trawls; (4) Shrimp harvested in a
manner or under circumstances determined by the
Department of State not to pose a threat of the incidental
taking of sea turtles (the use of box 7A(4) is restricted to
only those countries for which such a determination has
been made pursuant to the State Department's revised
guidelines for the implementation of Sec. 609 of P. L.
10-102, contained in public notice no. 3086, published July
8, 1999 in the Federal Register, Vol. 64, No. 130). Nations
that are certified pursuant to Section 609 of P.L. 101-162
will be listed in the U.S. Federal Register. An agent or
representative of the exporter must complete, sign, and
date the line designated for this purpose. If box 7A is
checked, certification by an appropriate Government
official of the harvesting nation is required in block 8.
Block 8:
The U.S. importer or customs broker should insert the
date of entry, port of entry, entry number, and sign this
section upon receipt of this form and its corresponding
If box 7A is checked, this section must be completed and
signed by a responsible agent of the government of the
exporting country. This may be any official so designated
for this purpose provided that such designee is employed
on a full-time basis by the government of the exporting
nation. Governments may not delegate the authority to
certify the forms to a representative of the private sector or
to a part-time government employee.
Block 9:
8. Government Certification (Necessary only if box 7a above is checked; to be signed by a responsible Government official of the harvesting
I hereby declare that the statements signed above by the exporter of this shipment of shrimp are true and accurate to the best of my knowledge.
Date of Entry (mm-dd-yyyy)
7. Exporter's Declaration (To be completed by a responsible agent of the exporter of the product.)
Harvested in a manner not harmful to sea turtles. Check the condition of harvest which applies:
Harvested in the waters of a nation currently certified pursuant to Section 609 of P.L. 101-162.
U.S. HTS Tariff Schedule Number Number of Units Net Weight in Kilograms
5. Date of Export (mm-dd-yyyy)
6. Description of Product
Harvested using TEDs
Harvested by aquaculture.
Shrimp harvested in a manner or under circumstances
determined by the Department of State not to pose a threat
of the incidental taking of sea turtles.
3. Harvested using non-mechanical net retrieval
or by special gear (See the Instructions).
Exporter (Name and Title)
Signature Date (mm-dd-yyyy)
Port of Entry Entry Number
9. Import Information (To be completed by U.S. importer or customs broker.)
Name/Agency/Title Address/Telephone/Fax Date (mm-dd-yyyy)
Page 1 of 1
4. U.S. Importer/Ultimate Consignee (Name, Address, and Telephone/Fax)
3. Exporter (Name, Address, and Telephone/Fax)
2. Aquaculture Facility (If applicable) (Name and Address)
1. Harvesting Nation
U.S. Department of State
OMB APPROVAL NO. 1405-0095
(See Instructions on Reverse)
Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time required for searching existing data sources, gathering
the necessary documentation, providing the information and/or documents required, and reviewing the final collection. You do not have to supply this information unless this
collection displays a currently valid OMB control number. If you have comments on the accuracy of this burden estimate and/or recommendations for reducing it, please send
them to: Office of Marine Conservation, Attn: Section 609 Program Manager, U.S. Department of State, 2201 C Street, NW, Room 2758, Washington, DC 20520-7818.
(Formerly DSP-121)
I hereby declare that the shipment of shrimp accompanying this declaration (Check One):
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