Regulations and Related Reporting and Recording Requirements - Packers and Stockyards Programs-Business

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U.S. Department of Agriculture

STATUS OF CUSTODIAL BANK ACCOUNT FOR SHIPPERS' PROCEEDS
SPECIAL REPORT

Grain Inspection,
Packers and Stockyards
Administration
Packers and
Stockyards
Program

P&SP Bar Code Only

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.

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

$

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 debits

406

$

Total credits

410

$

Overage in account (debits exceed credits)

411

$

Shortage in account (credits exceed debits)

412

$

Form 7001

10/14/2026

Page 1 of 2

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

$

505

$

506

$

507

$

508

$

509

$

510

$

511

$

512

$

513

$

514

$

515

$

516

$

517

$

518

$

519

$

520

$

521

$

522

$

523

$

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

703 Phone Number

702 Signature (Must be signed by a person listed on 201-205)

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.

Form 7001

10/14/2026

Page 2 of 2