Customs Form 5106 (031595) Importer Id Input Record (Page 2 of 2) in pdf

Paperwork Reduction Act Notice: We need this information to establish the importer's name,

BLOCK 9 - STATE

address, and importer number. We will use this information as basis for establishing bond

coverage, release and entry of merchandise, liquidation, issuance of bills and refunds, and

For a U.S. mailing address, insert a valid 2-position alphabetic U.S. state postal

processing of drawback and FP&F actions. Your response is mandatory.

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

Statement Required by 5 CFR 1320.21: The estimated average burden associated with this

list below).

collection of information is 6 minutes per respondent or recordkeeper depending on individual

circumstances. Comments concerning the accuracy of this burden estimate and suggestions

BLOCK 10 - ZIP CODE

for reducing this burden should be directed to U.S. Customs Service, Paperwork Management

For a U.S. mailing address, insert a 5 or 9 digit numeric ZIP code as established

Branch, Washington DC 20229. DO NOT send completed form(s) to this office.

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

PRIVACY ACT STATEMENT: Pursuant to the requirements of Public Law 93-579 (Privacy Act

foreign mailing addresses, a postal routing code may be inserted.

of 1974, notice is hereby given that 19 CFR 24.5 authorizes the disclosure of Social Security

numbers (SSN) on the Customs Form 5106. The principal purpose for disclosure of the Social

BLOCK 11 - COUNTRY ISO CODE

Security number is to assure maintenance of records that have a high degree of usefulness in

For a U.S. mailing address, leave blank.

For any foreign mailing address,

regulatory investigations or proceedings. The information collected may be provided to those

including Canada and Mexico, insert a 2 character alphabetic International

officers and employees of the Customs Service and any constituent unit of the Department of the

Treasury who have a need for the records in the performance of their duties. The records may

Standards Organization (ISO) code representing the country.

Please Note:

be referred to any department or agency of the federal government upon the request of the head

Valid ISO codes may be found in Annex A of the Harmonized Tariff Schedule of

of such department or agency. The authority to collect the SSN is 31 CFR 103.25. The SSN will

the United States; Customs Directive 099 5610-002, "Standard Guidelines for

be used to identify the individuals conducting business with the Customs Service.

the Input of Names and Addresses into ACS Files"; or Customs Directive 099-

3550-061 "Instructions for Preparation of CF 7501".

BLOCK 1 - TYPE OF ACTION

Notification of Importer's Number - Check this box if you are a first time

BLOCK 12 - SECOND IMPORTER ADDRESS

importer, using an importer number for the first time, or if you have not

If the importer's place of business is the same as the mailing address, leave

engaged in Customs business within the last year.

blank.

If different from the mailing address, insert the importer's business

Change of Name - Check this box if this importer number is on file but there is a

address in this space. A second address representing the importer's place of

change in the name on file.

business is to be provided if the mailing address is a post office box or drawer.

Change of Address - Check this box if this importer number is on file but there is

BLOCK 13 - CITY

a change in the address on file.

Insert the city name for the importer's business address.

BLOCK 2 - IMPORTER NUMBER

BLOCK 14 - STATE

2A -IRS Number - Complete this block if you are assigned an Internal Revenue

For a U.S. address, insert a 2 character alphabetic U.S. state postal code (see

Service employer identification number.

list below).

For a Canadian address, insert a 2 character alphabetic code

2B -Social Security Number - Complete this block if no Internal Revenue

representing the province of the importer's business address (see list below).

Service employer identification number has been assigned. The Social

Security number should belong to the principal or owner of the company or

BLOCK 15 - ZIP CODE

the individual who represents the importer of record.

For a U.S. business address, insert a 5 or 9 digit numeric ZIP code as

2C -Requesting a Customs-Assigned Number - Complete this block if no

established by the U.S. Postal Service.

For a Canadian address, insert a

Internal Revenue Service employer identification number has been

Canadian postal routing code. For a Mexican address, leave blank. For all

assigned, or no Social Security number has been assigned. If this box is

other foreign addresses, postal routing code may be inserted.

checked, all corresponding boxes in 2C must also be marked.

BLOCK 16 - COUNTRY ISO CODE

PLEASE NOTE: A Customs-Assigned Number is for Customs use only

For a U.S. address, leave blank. For any foreign address, including Canada

and does not replace a Social Security number or Internal Revenue

and Mexico, insert a 2 character alphabetic ISO code representing the country.

Service employer identification number. In general, a Customs Assigned

Number will only be issued to foreign businesses or individuals, provided

BLOCK 17 - PREVIOUSLY ASSIGNED CUSTOMS IMPORTER NUMBER

no IRS or Social Security number exists for the applicant. If Block 2C is

Indicate whether or not importer has previously been assigned a Customs

completed, this form must be submitted in duplicate. Customs will issue

Importer Number under the same name or a different name. If "Yes" to either

an Assigned Number and return a copy of the completed form with the

question, list name(s) and/or number(s) in Block 17c.

Assigned Number to the requester. This identification number will be used

for all future Customs 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

OFFICIAL UNITED STATES POSTAL SERVICE

assigned by Customs, the importer will continue to use the assigned

TWO-LETTER STATE AND POSSESSION ABBREVIATIONS

number unless otherwise instructed.

Alabama

MT Montana

2D -Customs-Assigned Number - Complete this block if you are assigned a

Alaska

NE Nebraska

Customs-Assigned Number but there is an Action change (Block 1).

Arizona

NV Nevada

Arkansas

NH New Hampshire

BLOCK 3 - IMPORTER NAME

American Samoa

NJ New Jersey

If the name is an individual, input the last name first, first name, and middle

California

NM New Mexico

initial. Business names should be input first name first.

Colorado

NY New York

Connecticut

NC North Carolina

BLOCK 4 - DIV/AKA/DBA

Delaware

ND North Dakota

District of Columbia

MP Northern Mariana Islands

Complete this block if an importer is a division of another company (DIV), is also

Federated States of Micronesia

OH Ohio

known under another name (AKA), or conducts business under another name

Florida

OK Oklahoma

(DBA).

Georgia

OR Oregon

Guam

PW Palau

BLOCK 5 - DIV/AKA/DBA NAME

Hawaii

PA Pennsylvania

Complete this block only if Block 4 is used.

Idaho

PR Puerto Rico

Illinois

Rhode Island

BLOCK 6 - TYPE OF COMPANY

Indiana

SC South Carolina

Iowa

SD South Dakota

Check applicable box. Please Note: Place an "X" after U.S. Gov't only for a

Kansas

TN Tennessee

U.S. federal government department, agency, bureau or office.

All federal

Kentucky

TX Texas

agencies are assigned I.R.S. numbers which should be used for any Customs

Louisiana

UT Utah

Maine

VT Vermont

transactions by that agency.

Marshall Islands

VA Virginia

Maryland

Virgin Islands

BLOCK 7 - IMPORTER MAILING ADDRESS

Massachusetts

WA Washington

This block must always be completed. It may or may not be the importer's

Michigan

WV West Virginia

business address.

Insert a post office box number, or a street number

Minnesota

WI Wisconsin

representing the first line of the importer's mailing address (up to 32 characters).

Mississippi

WY Wyoming

Missouri

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

OFFICIAL TWO-LETTER CANADIAN PROVINCE CODES

12.

Alberta

NS Nova Scotia

British Columbia

ON Ontario

BLOCK 8 - CITY

Manitoba

PE Prince Edward Island

Insert the city name of the importer's mailing address.

New Brunswick

PQ Quebec

Newfoundland (Incl. Labrador)

SK Saskatchewan

Northwest Territories

YT Yukon Territory

Customs Form 5106 (031595)(Back)

Customs Form 5106 (031595) Importer Id Input Record Page 2

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