PY-33 Application for Specification Approval

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OMB APPROVED - NO.

REPRODUCE LOCALLY. Include form number and date on all reproductions.
U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
POULTRY PROGRAMS

APPLICATION FOR
SPECIFICATION APPROVAL

Response is required in order to obtain specification approval applicable to grading service specification (CFR 56.4
and 70.10).
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB
control number for this information collection is 0581-0127. The time required to complete this information collection
is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
The United States Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the
basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital
or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative
means for communication of program information (Braille, large print, audiotape, etc.) should contact the USDA's
TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint, write USDA, Director, Office of Civil
Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, DC, 20250-9410 or call
(202) 720-5964 (voice and TDD ). USDA is an equal opportunity provider and employer.

I hereby apply for Acceptance Service certification of the product(s) checked below. It is understood that:
The applicant will provide an approved copy of the specifications to plant management and the U.S. Department of
Agriculture (USDA) representative at each plant packing to these specifications.
Any graded or inspected product subject to these specifications which does not meet the terms of the
specifications will be placed under USDA retention. Retained product will be released only when reworked to meet
specification requirements, or when verbal or written authority is granted by the applicant to waive specific
requirements.
The applicant will provide waivers to specific requirements directly to plant management and the USDA
representative at the packing location.
When applicable, the applicant is to verify that all products procured under the Acceptance Service certification
program are properly identified and accompanied by the required certification documents when received at
destination.
Any product bearing any USDA identification shall at all times comply with USDA requirements and regulations.
PRODUCT

APPLICABLE REGULATIONS
Regulations Governing the Voluntary Grading of Shell Eggs (7 CFR 56)

SHELL EGGS

United States Standards, Grades, and Weight Classes for Shell Eggs (AMS 56)
Regulations Governing the Voluntary Grading of Poultry Products and Rabbit (7 CFR 70)

POULTRY

United States Classes, Standards, and Grades for Poultry (AMS 70.200 et. seq.)

TITLES OF PERSONS AUTHORIZED TO GRANT SPECIFICATION WAIVERS

NAME OF APPLICANT*

TELEPHONE NUMBERS (Include Area Code)

ADDRESS OF APPLICANT (Street and No., City, State, and Zip Code)

E-Mail Address:
DATE OF APPLICATION

SIGNATURE OF APPLICANT

FOR USE BY AGRICULTURAL MARKETING SERVICE
DATE APPLICATION APPROVED

DATE SPECIFICATIONS APPROVED

TITLE

SIGNATURE OF USDA OFFICIAL

*No member of or delegate to Congress, or Resident Commissioner, shall be admitted to any benefit that may arise from this service unless derived
through service rendered a corporation for its general benefit.
PY-33 (12-03) (Destroy previous editions.)

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