LS-46-1 Soybean Report & Remittance--Amount Collected and Due on

REPRODUCE LOCALLY. Include form number and edition date on all reproductions

FORM APPROVED – OMB NO. 0581-0093

ALTERNATIVE FORM: To be used by first time purchasers with computerized recordkeeping systems that cannot supply information required on primary
remittance form. Columns A, B, C, and D must be completed in detail.
Note: Information is required by 7 CFR 1220.223. Failure to report can result in a fine. Information is held
confidential (7 CFR 1220.243).
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 0581-0093. The time required to complete
this information collection is estimated to average 1 hour 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.

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

SOYBEAN PROMOTION,
RESEARCH, AND CONSUMER
INFORMATION PROGRAM
(SPARC)

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.

A program of promotion, research, and consumer information
designed to strengthen, expand and develop new foreign and
domestic markets for soybeans and soybean products.

REPORT AND REMITTANCE OF AMOUNT COLLECTED AND DUE ON SOYBEANS PURCHASED
NAME AND ADDRESS (include P.O. Box or Street, City, State, and ZIP)

Federal Identification Number
State Grain Dealer License Number (if applicable)
County
Business Telephone (include area code)

The report and assessments must be remitted (postmarked) by the last day of the

“Net market value” (quoted price plus or minus premiums

month following the end of the collection period. Late Payments are subject to a 2%
per month late payment charge. Must be remitted by _____________________.
The following report is a report on soybeans purchased and the net market value
paid for such purchases for the period commencing _________________and

or discounts such as moisture and quality factors) is the
total dollars paid for assessed soybeans during the
reporting period.

ending ______________________.
(A)

(B)
STATE OF ORIGIN

(D)

(C)
NET MARKET VALUE OF ASSESSED BU.

RATE

TOTAL

NUMBER OF BUSHELS

X.005 =

$

PURCHASED (ALL STATES)

X.005 =

$

X.005 =

$

NET MARKET VALUE OF

X.005 =

$

ALL BUSHELS PURCHASED

X.005 =

$

BUSHELS ______________

(ALL STATES)
$___________________

* NOTE: If remitting assessments past due date,
calculate the 2% mandatory late payment
(compounded monthly).
Total Assessments x.02 = Late Payment

TOTAL ASSESSMENTS =
* LATE PAYMENT =
TOTAL REMITTANCE =

SEND THIS REPORT AND A CHECK IN THE TOTAL AMOUNT SHOWN ABOVE TO:

OFFICE USE ONLY

PENALTIES: You may, by law, be fined up to $10,000,
imprisoned up to five years or both for knowingly or willfully
making false statements within this document
(18 U.S.C., Section 1001).

CERTIFICATION STATEMENT
I declare, under the penalties provided by law, that this report has been examined by me; and to the best of my knowledge and believe is a true, correct and complete report.

NAME/TITLE (Print or type)

LS-46-1

SIGNATURE

DATE

“The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a)
and the Paperwork Reduction Act of 1995, as amended. The authority for requesting this
information to be supplied on this form is the Commodity Promotion, Research, and Information
Act of 1996, Pub. L. 104-127, 110 Stat.1032 (7 U.S.C. 7411-7425). Furnishing the requested
information is necessary for the administration of this program. Submission of Tax Identification
Number (TIN) or Employer Identification Number (EIN) is mandatory, and will be used to
determine affiliation or entity identification”.

LS-46-1 (02-2011)

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