Cbp Form 350 - Harbor Maintenance Fee Amended Quarterly Summary Report - 2018

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Approved OMB No. 1651-0055

Exp. 07/31/2018

1. Identifying Number

DEPARTMENT OF HOMELAND SECURITY

EIN or IRS

CBP

SSN

U.S. Customs and Border Protection

Number

HARBOR MAINTENANCE FEE

2. Name of Company or Individual

AMENDED QUARTERLY SUMMARY REPORT

19 CFR 24.24

4. Identifying Number on Original Report

3. Complete Mailing Address

EIN or IRS Number

CBP Number

SSN

5. Reporting Period of Original Report

Year

(One Quarter Only)

Reason for Amended Report

Remit a Supplement Payment, because:

Correction of Items 1-4

Request for a Refund, because:

(1)

Calculation/Clerical Error

(2)

Duplication of Payment

(2)

Omission of Shipments

(3)

Misinterpretation of Exemptions

(4)

Overvaluation of Shipments

(4)

Overvaluation of Shipments

(5)

Other (Please Specify)

(5)

Other (Please Specify)

AMENDED PAYMENT CALCULATIONS

10.

11.

Value of Shipments

Type of Shipment

Value of Exemptions

Net Value

HMF Due

(column 8 less column 9) (multiply the amounts in

With

(from corresponding

columns A-D of line 20)

Class Code

col. 10 by appropriate rate)

A. Domestic Movements

503

B. FTZ Admissions

505

C. Passengers

504

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

D. Total Values (Total Column 8, 9, & 10)

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12. Total HMF Due (Total of Lines 11A through 11C)

13. Previous HMF Paid for this Reporting Period for this type Movement

. . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . .

Supplemental Payment, If line 12 is greater than line 13, enter difference

14. A.

Remit Payment to: CBP, Office of Finance, Revenue Division, 6650 Telecom Drive, Indianapolis, IN 46278

Refund Due. If line 13 is greater than line 12, enter difference.

. . . .

Mail refund request to: CBP, HMF

Refunds, 6650 Telecom Drive, Suite 100, Indianapolis, IN 46278

ITEMIZATION OF EXEMPTIONS

A. Domestics

B. FTZ(s)

C. Passengers

D. Total

15. Exempt Port

16. Inland Waterway Fuel Tax

17. Intraport

18. U.S. Mainland/State/Possession/

Territory

19. Other

20. TOTALS (Also enter amounts in

19A thru 15C in 9A thru 9C above.)

21. CERTIFICATION

I hereby certify under penalties provided by law that the above information regarding the Harbor Maintenance Fee is complete and accurate to the best

of my knowledge.

Please Sign Here

Date

22. Type or print name of person who prepared this report (if same as block 2,

23. Telephone Number

write "SAME".)

PRIVACY ACT NOTICE: The following information is given pursuant of the Privacy Act of 1974 (Pub. L. 93-579). The disclosure of the social security number is mandatory when

an Internal Revenue Service number is not disclosed whenever an identification number is requested. Identification numbers are solicited under the authority of Excecutive Order

9397 and Pub. L. 99-662. The identification number provides unique identification of the party liable for the payment of the Harbor Maintenance Fee. The number will be used to

compare on this form with information submitted to the Government on other forms required in the course of shipping, exporting, or importing merchandise, which contain the

identification number, e.g., the SED, Vessel Operation Report, to verify that the information submitted is accurate and current.

Failure to disclose an identification number may

cause a penalty pursuant to 19 CFR 24.24(h).

PAPERWORK REDUCTION ACT NOTICE: This request is in accordance with the Paperwork Reduction Act. We ask for the information in order to carry out the Harbor

Maintenance Revenue provisions of the Water Resources Development Act of 1988. We need it to ensure that the trade community is complying with this Act, and to allow CBP to

determine if the correct amount of Harbor Maintenance Fee (HMF) is collected. It is mandatory. The estimated average burden associated with this collection of information is 30

minutes per respondent plus 10 minutes recordkeeping depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for

reducing this burden should be directed to U.S. Customs and Border Protection, Asset Management, Washington, DC 20229, and to the Office of Management and Budget,

Paperwork Reduction Project (1651-0055), Washington, DC 20503.

CBP Form 350 (03/09)