7-3 Estimated Indemnity Worksheet for the Acfelerated Pseudo

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of Information unless it displays a valid
OMB number. The valid OMB number for this information collection is 0579-0137. The time required to complete this collection of
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gathering and maintaining the data needed, and completing and reviewing the form.

FORM APPROVED
OMB NUMBER 0579-0137

ESTIMATED INDEMNITY WORKSHEET FOR THE
ACCELERATED PSEUDORABIES ERADICATION PROGRAM
PRODUCER NAME
ADDRESS, CITY, STATE, ZIP
TELEPHONE NUMBER
CONTACT DATE
ESTIMATE DATE

ENROLLMENT DATE

DELIVERY DATE

ACCEPTANCE DATE

MARKET PRICE ON CONTACT DATE

MARKET PRICE ON DELIVERY DATE

WEIGHT RANGE
(pounds)

MID POINT WEIGHT
(pounds)
(a)

NUMBER OF SWINE IN CATEGOR
(d)

MARKET VALUE PER POUND DURING
CONTACT WEEK
(c)

TOTAL OF SUBTOTAL BY WEIGHT RANGE (f)

SWINE CATEGORY

NUMBER OF SWINE IN CATEGORY
(b)

DOLLAR COST OFFSET AS PER CONTACT DATE
(e)

$

DOLLAR COST OFFSET SUBTOTAL BY CATEGORY
(d*e)

TOTAL OF DOLLAR COST OFFSET SUBTOTAL (g)

TOTAL ESTIMATE: (f+g)

SUBTOTAL BY WEIGHT RANGE
(a*b*c)

$

$

SIGNATURE OF STATE OR FEDERAL ESTIMATOR

DATE

Depopulation Proposal (as per the herd plan):
I hereby agree that this worksheet is only an estimate of the compensation that I am to receive and that the actual indemnity will be based on the total weight of my
animals and the number of swine in each category on the Date of Delivery. The Dollar Cost Offset per Contact Date of this form will be used to calculate the final
Dollar Cost Offset. The value per pound compensation paid will the greater of the value per pound on the Contact Date or on the Delivery Date.

SIGNATURE OF PRODUCER

VS FORM 7-3
FEB 2002

DATE