LS-315 Application for commitment Grading or Certification Serv

Reproduce Locally. Include form number and edition date on all reproductions.

FORM APPROVED – OMB NO. 0581-0124

United States Department of Agriculture

For Official Use Only
Effective Date

Marketing and Regulatory Programs 
Agricultural Marketing Service
Livestock and Seed Program
Grading and Verification Division

Application Number

APPLICATION FOR COMMITMENT GRADING OR VERIFICATION SERVICE
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 0581-0124. The time to complete this information collection is estimated to average 12 minutes 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 U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and
activities on the basis of race, color, national origin, sex, religion, age, disability, political beliefs, sexual orientation, or 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 USDA’s TARGET Center at (202) 720-2600 (voice and TDD). To file a complaint of discrimination,
write USDA Director, Office of Civil Rights, Room 326–W, Whitten Building, 14th and Independence Avenue, SW, Washington D.C. 20250-9410 or call (202) 720-5964 (voice and TDD). USDA is an equal employment
opportunity provider and employer.
Information provided in this application is needed to authorize USDA employees to perform the requested service (7 CFR 54, 6, & 7 CFR 62). You may by law, be fined up to $10,000, imprisoned up to 5 years, or both for
knowingly or willfully making false statements within this document (18 U.S.C. Section 1001).

Agreement Terms:
1.
2.

3.
4.
5.

The provisions of the “Regulations of the Department of Agriculture governing the grading and certification of meats, prepared meats, and meat products” (7CFR
Part 54, Subpart A, as amended), shall be applicable to this application and the signers thereof.
The applicant shall pay for the following:
a.
For 8 hours per day, Monday through Friday, of the grader’s time excluding 8 hours on Federal legal holidays on which no work is performed, at the hourly
rate prescribed in Section 54.27, “Fees and other charges for service,” as amended (or portion thereof, if more than one applicant). At any time that the services
of the official grader are not required by the applicant(s), he/she maybe utilized elsewhere for the performance of Federal grading and certification service.
Credits for service so performed elsewhere (Monday through Friday) will be allowed to the applicant(s) (or prorated to the applicant(s) to cover their unused
hours) so long as allowable credit hours plus hours actually worked for the applicant(s) do not exceed 8 hours per day, Monday through Friday, excluding
Federal legal holidays.
b. For hours worked in excess of 8 hours per day Monday through Friday (or portions of 8 hours if more than one applicant) and all hours worked on Saturday or
Sunday, except Federal legal holidays, at the rate prescribed in Section 54.27, as amended.
c.
For work performed on Federal legal holidays at the rate prescribed in Section 54.27, as amended.
d. The costs for transportation, mileage and per diem incurred by the grader in performing grading or certification at the applicant’s request in accordance with
Section 54.27, as amended.
e.
To the Agricultural Marketing Service, within 7 days after the receipt of the billing covering any period, the sums due in accordance with paragraphs a, b, c and
d.
The United States Department of Agriculture shall not be responsible for damages accruing to the applicant(s) through any acts of commission or omission on the part
of any of its official graders.
The services to be rendered under this commitment may be denied or withdrawn at any time in accordance with Section 54.11, “Denial or withdrawal of service,” as
amended.
(Any of) the applicant(s) may terminate the application at his/her (their) discretion, effective at close of business on any Saturday, by giving written notice thereof to the
Grading and Verification Division, 13952 Denver West Parkway, Building. 53, Suite 350, Lakewood, CO 80401, at least 7 days prior to such Saturday.

Account Number

Name of Applicant

Email Address:
Address of Facility

Commitment Hours
Hours Per Day
Hours Per Week

(If known)

Signature of Responsible Official

Type or Print Name and Title

Name of Applicant

Date

Account Number

Miles (if
applicable)

Address of Facility

Commitment Hours

Miles (if
applicable)

(If known)

Hours Per Day

Signature of Responsible Official

Hours Per Week

Type or Print Name and Title

Date

Account Number

Name of Applicant

Address of Facility

Commitment Hours

Miles (if
applicable)

(If known)

Hours Per Day

Signature of Responsible Official

Hours Per Week

Type or Print Name and Title

Date

For Official Use Only

Signature of Approving Official and Title

Date Signed

LS-315 (05-08)

Previous editions must be destroyed

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Continuation Sheet – Application for Commitment Grading or Verification Service
Account Number

Name of Applicant

Address of Facility

Commitment Hours
Hours Per Day
Hours Per Week

(If known)

Signature of Responsible Official

Type or Print Name and Title

Name of Applicant

Date

Account Number

Miles (if
applicable)

Address of Facility

Commitment Hours

Miles (if
applicable)

(If known)

Hours Per Day

Signature of Responsible Official

Hours Per Week

Type or Print Name and Title

Date

Account Number

Name of Applicant

Address of Facility

Commitment Hours

Miles (if
applicable)

(If known)

Hours Per Day

Signature of Responsible Official

Hours Per Week

Type or Print Name and Title

Date

General Comments or Special Provisions

LS-315 (05-08)

Previous editions must be destroyed

Page 2 of 2