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 1651-0064. The
estimated average time to complete this application is 15 minutes. 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.
BLOCK 9 - STATE
For a U.S. mailing address, insert a valid 2-position alphabetic U.S. state
postal code (see list below). For a Canadian mailing address, insert a 2-
character alphabetic code representing the province of the importer's mailing
address (see list below).
BLOCK 10 - ZIP CODE
For a U.S. mailing address, insert a 5 or 9 digit numeric ZIP code as
established by the U.S. Postal Service. For a Canadian mailing address,
insert a Canadian postal routing code. For a Mexican mailing address, leave
blank. For all other foreign mailing addresses, a postal routing code may be
inserted.
BLOCK 11 -COUNTRY ISO CODE
For a U.S. mailing address, leave blank. For any foreign mailing address,
including Canada and Mexico, insert a 2 character alphabetic International
Standards Organization (ISO) code representing the country. Please Note:
Valid ISO codes may be found in Annex B of the Harmonized Tariff Schedule
of the United States; Customs Directive 099 5610-002, ''Standard Guidelines
for the Input of Names and Addresses into ACS Files"; or CBP Form 7501
Instructions".
BLOCK 12 - SECOND IMPORTER ADDRESS
If the importer's place of business is the same as the mailing address, leave
blank. If different from the mailing address, insert the importer's business
address in this space. A second address representing the importer's place of
business is to be provided if the mailing address is a post office box or
drawer.
BLOCK 13 - CITY
Insert the city name for the importer's business address.
BLOCK 14 - STATE
For a U.S. address, insert a 2 character alphabetic U.S. state postal code
(see list below). For a Canadian address, insert a 2 character alphabetic code
representing the province of the importer's business address (see list below).
BLOCK 15 - ZIP CODE
For a U.S. business address, insert a 5 or 9 digit numeric ZIP code as
established by the U.S. Postal Service. For a Canadian address, insert a
Canadian postal routing code. For a Mexican address, leave blank. For all
other foreign addresses, postal routing code may be inserted.
BLOCK 16 - COUNTRY ISO CODE
For a U.S. address, leave blank. For any foreign address, including Canada
and Mexico, insert a 2 character alphabetic ISO code representing the country.
BLOCK 17 - PREVIOUSLY ASSIGNED CUSTOMS IMPORTER NUMBER
Indicate whether or not importer has previously been assigned a CBP
Importer Number under the same name or a different name. If "Yes" to either
question, list name(s) and/or number(s) in Block 17c.
PRIVACY ACT STATEMENT: Pursuant to the requirements of Public Law
93-579 (Privacy Act of 1974, notice is hereby given that 19 CFR 24.5
authorizes the disclosure of Social Security numbers (SSN) on the CBP Form
5106. The principal purpose for disclosure of the Social Security number is to
assure maintenance of records that have a high degree of usefulness in
regulatory investigations or proceedings. The information collected may be
provided to those officers and employees of the CBP and any constituent unit
of the Department of the Homeland Security who have a need for the records
in the performance of their duties. The records may be referred to any
department or agency of the federal government upon the request of the head
of such department or agency. The authority to collect the SSN is 31 CFR
103.25. The SSN will be used to identify the individuals conducting business
with the CBP.
BLOCK 1 - TYPE OF ACTION
Notification of Importer's Number - Check this box if you are a first time
importer, using an importer number for the first time, or if you have not
engaged in CBP business within the last year.
Change of Name - Check this box if this importer number is on file but there is
a change in the name on file.
Change of Address - Check this box if this importer number is on file but there
is a change in the address on file.
BLOCK 2 - IMPORTER
2A
2B -Social Security Number - Complete this block if no Internal Revenue
Service employer identification number has been assigned. The Social
Security number should belong to the principal or owner of the
company or the individual who represents the importer of record.
2C -Requesting a CBP Assigned Number - Complete this block if no Internal
Revenue Service employer identification number has been assigned, or
no Social Security number has been assigned. If this box is checked, all
corresponding boxes in 2C must also be marked. PLEASE NOTE. A
CBP Assigned Number is for CBP use only and does not replace a
Social Security number or Internal Revenue Service employer
identification number. In general, a CBP Assigned Number will only be
issued to foreign businesses or individuals, provided no IRS or Social
Security number exists for the applicant. If Block 2C is completed, this
form must be submitted in duplicate. CBP will issue an Assigned
Number and return a copy of the completed form with the Assigned
Number to the requester. This identification number will be used for all
future CBP transactions when an importer number is required. If an
Internal Revenue Service employer identification number and/or a Social
Security number are obtained after an importer number has been
assigned by CBP, the importer will continue to use the assigned number
unless otherwise instructed.
OFFICIAL UNITED STATES POSTAL SERVICE
TWO-LETTER STATE AND POSSESSION ABBREVIATIONS
AL
AK
AZ
AR
AS
CA
CO
CT
DE
DC
FM
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MH
MD
MA
MI
MN
MS
MO
Alabama
Alaska
Arizona
Arkansas
American Samoa
California
Colorado
Connecticut
Delaware
Distric of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinios
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
2D
BLOCK 3 - IMPORTER NAME
If the name is an individual, input the last name first, first name, and middle
initial. Business names should be input first name first.
BLOCK 4 - DIV/AKA/DBA
Complete this block if an importer is a division of another company (DIV), is
also known under another name (AKA), or conducts business under another
name (DBA).
BLOCK 5 - DIV/AKA/DBA NAME
Complete this block only if Block 4 is used.
BLOCK 6 - TYPE OF COMPANY
Check applicable box. Please Note: Place an *X* after U.S. Gov't only for a
U.S. federal government department, agency, bureau or office. All federal
agencies are assigned I.R.S. numbers which should be used for any CBP
transactions by that agency.
BLOCK 7 - IMPORTER MAILING ADDRESS
This block must always be completed. It may or may not be the importer's
business address. Insert a post office box number, or a street number
representing the first line of the importer's mailing address (up to 32
characters). For a U.S. or Canadian mailing address, additional mailing
address information may be inserted (up to 32 characters). If a P.O. box
number is given for the mailing address, a second address (physical location)
must be provided in Block 12.
BLOCK 8 - CITY
Insert the city name of the importees mailing address.
OFFICIAL TWO-LETTER CANADIAN PROVINCE CODES
-IRS Number - Complete this block if you are assigned an Internal
Revenue Service employer identification number.
-CBP Assigned Number - Complete this block if you are assigned a
CBP Assigned Number but there is an Action change (Block 1).
CBP Form 5106 (05/13)
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PW
PA
PR
RI
SC
SD
TN
TX
UT
VT
VA
VI
WA
WV
WI
WY
Montana
Nebraska
Nevada
New Hamsphire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Virgin Islands
Washington
West Virginia
Wisconsin
Wyoming
AB
BC
MB
NB
NL
NT
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland (Incl. Labrador)
Northwest Territories
NS
ON
PE
QC
SK
YT
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
