Fillable Printable Cbp Form 6478
Fillable Printable Cbp Form 6478
Cbp Form 6478
CBP Form 6478 (0716)
DEPARTMENT OF HOMELAND SECURITY
U.S. Customs and Border Protection
APPLICATION FOR CBP APPROVED
GAUGERS AND ACCREDITED LABORATORIES
19 CFR 151.12; 151.13
INSTRUCTIONS: Submit application, including all additional continuation sheets (if required) and attachments in duplicate
to the Executive Director, Laboratories and Scientific Services Directorate.
SECTION I - APPLICANT
1. Applicant's Name and Principal Office Address and indicate fictitious name (if applicable)
2. Type of License Applied For
Laboratory Gauger Laboratory/Gauger
3. CBP Port and Port Code
4. Have you ever applied for a CBP accreditation/approval?
No
Yes (Explain in Block 16)
5. Has the applicant (or any officer, member, or principal thereof)
ever had an accreditation/approval suspended, refused,
revoked, or cancelled?
Yes (Explain in Block 16)
No
6. Is the applicant (or any officer, member or principal thereof)
an officer or employee of the United States?
No
Yes (Explain in Block 16)
7. Date of Birth 8. Birthplace (City & State) 9. SSN 10. Telephone Numbers:
Home -
Business - Ext.
11. U.S. Citizenship
Natural Born Naturalized - Give Date and Place >
12. Have you ever been arrested, charged, convicted of or
forfeited collateral for, any felony, misdemeanor, or other
violation? > > > > > > > > >
Yes (Explain in Block 16)No
You may omit: 1. traffic violations for which you paid a fine of $250
or less; 2. any incident which happened before your 16th birthday.
All other incidents must be included, even though the case records
were expunged or suppressed under a rehabilitation program, or
you were sentenced under a State statute which provides that you
need not report the incident when apply for employment, a license,
etc.
13. Address of principal place of business (if different from Block 1: is same, write "Same")
14. In the last 5 years, have you, or a company ever which you exercised some control, filed for bankruptcy, been declared bankrupt,
been subject to a tax lien, or had legal judgement rendered against you for a debt?
Yes (Explain in Block 16)
No
15. List names of all Officers and Directors
16. Remarks/Additional Information (In responding to questions above, include Block number. If more space is needed
use blank sheet.
Email (Business) -
A statement of financial condition (i.e., statement from a
Certified Public Accountant or notarized statement)
CBP Form 6478 (07/16)
SECTION II - CORPORATION
17. Date Corporation was organized 18. State Where Organized
19. List each person who will be authorized to sign/approve analysis report and/or gauging reports:
Name Title Qualifications
20. Attachments
If a corporation, a copy of articles of incorporation or
association
Detailed statement of ownership and any partnerships,
parent-subsidiary relationships, or affiliations with any other
domestic or foreign organization, including, but not limited to,
import, other commercial laboratories, producers refiner, CBP
brokers, or carriers
A complete description of the applicant's facilities, instruments,
and equipment
An expressed agreement that if notified by CBP of pending
accreditation/approval to execute a bond in accordance with 19
CFR, part 113, CBP Regulations, and submit it to the CBP port
nearest to the applicant's main office. The limits of liability on the
bond will be established by the CBP port in consultation with the
Executive Director. In order to retain CBP accreditation/
approval, the laboratory/gau
ger must maintain an adequate
bond, as determined by the Port Director.
A listing of each commodity group for which laboratory
accreditation is being sought and, if methods are being
submitted for approval with are not specifically provided for in a
Commodity Group Brochure and the CBP Laboratory Methods
Manual, a listing of such methods.
A listing by commodity group of each method according to
its CBP Laboratory Method Number for which the Laboratory is
seeking accreditation; (section 151.12(d) or CBP website
An expressed agreement to be bound by required obligation
(see commercial gauger and laboratory agreement)
A non-refundable prepayment equal to 50 percent of the fixed
accreditation/approval fee, as published in the Federal Register and
CBP Bulletin, to cover preliminary processing costs. Further, the
applicant agrees to pay CBP with in thirty (30) days of notification of
preliminary accreditation/approval the associated charges assessed
for accreditation/approval (i.e., those charges for actual travel and
b
ackground investigation costs, and the balance of the fixed
accreditation/approval fee.)
SECTION III - CERTIFICATION (All Applicants)
WARNING: Any misstatement of pertinent facts in this application constitutes sufficient grounds for denial of the application.
21. NAME OF PERSON SIGNING APPLICATION
I , Certify that the statements contained in the foregoing application and supporting
attachments thereto are true and correct to the best of my knowledge and belief. Written notice of any change in my mailing address,
and business connection, or the name and style under which I conduct my business will be given to the Commissioner of U.S.
Customs and Border Protection.
Signature Date
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 1651-0053. The estimated average time to complete this application is 75 Minutes. The obligation to respond to this
information collection is mandatory. If you have any comments regarding the burden estimate you can write to CBP PRA Officer, U.S.
Customs and Border Protection, Office of Regulations and Rulings, 10th floor, 90K Street NE., Washington, DC 20229-1177.
http://www.cbp.gov/about/labs-scientific-svcs
