ATF E-Form 5400.4
Revised May 2003
1. THIS FORM IS TO BE UTILIZED ON AND AFTER MAY 24, 2003. ATF FORM
5400.4, TITLE EXPLOSIVES TRANSACTION RECORD, DATED 12-2002 IS
OBSOLETE AS OF MAY 24, 2003 AND CANNOT BE USED
2. All signatures on this form must be in ink and all other entries must be in ink or
3. This form must be prepared for each transaction involving distribution of explosive
materials to persons who have been issued a Federal explosives limited permit.
Distributee - (Purchaser)
4. Prior to receipt of explosive materials, the limited permittee must complete Section A
of ATF Form 5400.4 and affix one of his six original Intrastate Purchase of
Explosives Coupon(s) (IPEC), ATF F 5400.30, onto copies 1 and 2 of ATF Form
5400.4. The coupon must bear the name, address, permit number, and the coupon
5. A licensed importer, licensed manufacturer or a licensed dealer may distribute
explosive materials to a holder of a limited permit if such permittee is a resident of
the same State in which the licensee's premises are located.
6. Delivery by common or contract carrier hired by the distributee: Where a common or
contract carrier will transport explosive materials from the distributor to a holder of a
limited permit, the limited permittee will, prior to delivery of the explosive materials,
complete Section A on ATF Form 5400.4, affix to the form one of the six IPECs he
has been issued, and provide the form to the distributor in person or by mail. Before
the delivery of explosive materials from the distributor's premises to the common or
contract carrier, the distributor must obtain an executed ATF Form 5400.8,
Explosives Delivery Record, from the common or contract carrier before releasing
the explosive materials. ATF Form 5400.8 must contain all of the information
required by that form and by this part. ATF Form 5400.8 must be attached to the
distributor's copy of the ATF Form 5400.4 and retained in his permanent records in
accordance with 27 CFR 555.121.
7. If the distribution of the explosive materials takes place on a different day from the
date on which the limited permittee, or employee, signed in Section A, then the
person receiving the explosive materials must complete Section C.
8. When any Intrastate Purchase of Explosives Coupon (IPEC), ATF Form 5400.30, is
stolen, lost, or destroyed, the person losing possession will, upon discovery of the
theft, loss or destruction, immediately, but in all cases before 24 hours have elapsed
since the discovery, report the matter to the Director by telephoning 1-888-ATF-
Distributor - (Seller)
9. The distributor (seller) of explosive materials, will in every instance, require the
limited permittee to complete all items in Section A prior to receipt of explosive
materials by the purchaser.
10. The seller will complete Section B and retain one copy of the form as record of
disposition for the required record retention period in accordance with 27 CFR
11. The seller will submit the original copy of ATF Form 5400.4 to ATF Firearms and
Explosives Licensing Center, 244 Needy Road Martinsburg, WV 25405.
12. Where possession of explosive materials is transferred directly to the distributee at
the seller's premises, the seller must obtain an executed ATF form 5400.4 and verify
the identity of the person accepting possession of the explosive materials. In
instances where an employee truck driver of the distributor delivers the explosive
materials to the premises of the purchaser, the distributor's employee truck driver
will check item 2A, Section B.
13. Delivery by common or contract carrier hired by the distributor: Where a common
or contract carrier will transport explosive materials from the distributor to a holder
of a limited permit, the limited permittee will, prior to delivery of the explosive
materials complete Section A on ATF Form 5400.4, affix to the form one of the six
IPECs previously issued, and provide the form to the distributor in person or by
mail. Before the delivery of explosive materials from the distributor's premises to
the common or contract carrier who will transport explosive materials to the limited
permittee, the distributor must obtain an executed ATF Form 5400.8. Explosives
Delivery Record, from the common or contract carrier before releasing the
explosive materials. ATF Form 5400.8 must contain all of the information required
on the form by this part. At the time of delivery the common or contract carrier, as
agent for the distributor, must verify the identity of the person accepting delivery on
behalf of the distributee, note the type and number of the identification document
and provide this information to the distributor. The distributor will enter this
information on Section B of ATF Form 5400.4. ATF Form 5400.8 must be
attached to the distributor's copy of the ATF Form 5400.4 and retained in his
permanent records in accordance with 27 CFR 555.121.
14. Identification of a person accepting possession of explosive materials may be
verified by presenting a valid driver's license or State-issued identification
card. The identification document should establish a person's name, date of
birth, signature, photograph and State of residence.
15. If the distribution of the explosive materials takes place on a different day
from the date on which the limited permittee, or employee, signed in Section
A, the licensee must again check the photo identification of the person
receiving the explosive materials, and the person receiving the explosive
materials must complete the certification in Section C at the time of
distribution of the explosive materials.
16. The seller should contact the local ATF field office to report suspicious
coupons or suspicious attempts to purchase explosives.
1. 6 Separate Occasions - Six receipts of explosive materials and each receipt must
(1) relate to a single purchase transaction made on one ATF Form 5400.4; (2)
be referenced on one commercial invoice or purchase order; and (3) be
delivered to the holder of the limited permit in one shipment delivered at the
2. Limited Permit - A limited permit authorizes the holder to receive for his use
explosive materials from a licensee or permittee in his State of residence on no
more than 6 occasions during the 12-month period in which the permit is valid.
A limited permit does not authorize the receipt or transportation of explosive
materials in Interstate or foreign commerce.
Privacy Act Information
The following information is provided pursuant to Section 3 of the Privacy Act of
1974 [5 U.S.C. Section 552a(3)]:
1. Authority. Solicitation of this information is made pursuant to 18 U.S.C.
Sections 842 and 843. Disclosure of this information is mandatory.
2. Purpose. To identify the permittee, distributor, and the explosive materials.
3. Routine Uses. The information will be used by ATF to make determinations
set forth in paragraph 2. In addition, the information may be disclosed to other
Federal, State, foreign and local law enforcement and regulatory agency
personnel to verify information on the form and to aid in the performance of
their duties with respect to the regulations of explosives, unless such disclosure
is prohibited by law. Finally, the information may be disclosed to members of
the public in order to verify the information on the form where such disclosure
is not prohibited by law.
Paperwork Reduction Act Notice
This request is in accordance with the Paperwork Reduction Act of 1995. The
purpose of this information collection is to verify that all persons who are
purchasing explosive materials have the proper Federal permit and to ensure that
such person have appropriate facilities for storage of the explosive materials. The
information is subject to inspection by ATF officials. This information request is
mandatory by statute. (18 U.S.C. Sections 842 and 843.)
The estimated average burden associated with this collection is 20 minutes per
respondent or recordkeeper, depending on individual circumstances. Comments
concerning the accuracy of this burden estimate and suggestions for reducing this
burden should be addressed to Reports Management Officer, Document Services
Branch, Bureau of Alcohol, Tobacco, Firearms and Explosives, Washington, DC
An agency may not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a currently valid OMB control