P&SP 7001 Status of Custodial Bank Account for Shippers' Proceeds

					For P&SP Use Only									P&SP Bar Code Only
U.S. Department of Agriculture					STATUS OF CUSTODIAL BANK ACCOUNT FOR SHIPPERS' PROCEEDS SPECIAL REPORT
Grain Inspection,
Packers and Stockyards
Administration
Packers and					Instructions: If an item's value is zero, enter "0". If an item does not apply, enter "NA". Upon completion please verify that all items have been answered. Return completed form to the appropriate P&SP regional office. See separate instructions for complete information about this report.
Stockyards
Program
										GENERAL INFORMATION - SECTION 1
101			Date of Report (mm/dd/yy)
102			Legal Business Name
103			Business Name (dba)
104			Mailing Address
105			City, State, Zip
106			Physical Address
107			City, State, Zip
108			Contact Name
109			Telephone Number
110			Fax Number
									CUSTODIAL ACCOUNT INFORMATION - SECTION 2
201			Name of Bank
202			Mailing Address
203			City, State, Zip
204			Telephone Number
205			Bank Contact Name
									CUSTODIAL ACCOUNT DESIGNATION - SECTION 3
301			Designation or Title of Custodial Account on Bank Statement
302			Designation or Title of Custodial Account on Checks Issued
							ANALYSIS OF CUSTODIAL BANK ACCOUNT FOR SHIPPERS' PROCEEDS - SECTION 4
			Bank statement balance:										401	$
			Deposits in transit (in mail or bank, but not on statement)										402	$
			CD's and savings accounts designated as custodial funds										403	$
			Proceeds on hand										404	$
			Proceeds receivables (show details in Section 5 of this report)										405	$
			Total debits															406	$
			Outstanding checks and drafts that have not cleared bank										407	$
			Proceeds due consignors of livestock for which no checks were issued										408	$
			Expense items related to sales remaining in account										409	$
			Total credits															410	$
			Overage in account (debits exceed credits)															411	$
			Shortage in account (credits exceed debits)															412	$
									PROCEEDS RECEIVABLE - SECTION 5
			“Proceeds Receivables” vary based on the livestock buyer. For most buyers when conducting the custodial analysis any uncollected funds during the time period including the analysis date and the 6 days before the analysis are proceeds receivables. For livestock purchases made by the market, its owner, officers, employers, and credit buyers the time period is limited to include only the analysis date and the previous business day.
			Date of Sale				Name of Buyer												Amount of Proceeds Receivable
501																			$
502																			$
503																			$
504																			$
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506																			$
507																			$
508																			$
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517																			$
518																			$
519																			$
520																			$
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522																			$
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524																			$
525																			$
526																			$
527																			$
528																			$
529																			$
530																			$
531																			$
532																			$
533							Total from Additional Pages (enter 0 if no other pages used)												$
534							Total Proceeds Receivable (enter on line 405)												$
										CERTIFICATION - SECTION 6
Under the Packers and Stockyards Act any person who willfully makes, or causes any false entry or statement of fact in this report shall be deemed guilty of offense against the United States, and be subject to a fine of $1,000 to $5,000, or to imprisonment for a term of not more than 3 years, or to both fine and imprisonment.
I certify that this report has been prepared by me or under my direction, and to the best of my knowledge and belief correctly reflects reporting entity operations.
701 Print Name												702 Signature (Must be signed by a person listed on 201-205)
703 Phone Number								704 Date				705 Title
Submitted information is confidential (9 CFR 201.96). Failure to report will result in forfeiture to the United States $110 per day until report receipt 7 (U.S.C. 222). Response is required in order to determine establishment, maintenance and status of custodial account (9 CFR 201.97). 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 control number. The valid OMB control number for this information is 0580-0015. The time required to complete this information collection is estimated to average 1 hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political beliefs, reprisal, or because all or part of an individual’s income is derived from any public assistance program. (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 USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination, write to USDA, Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.