P&SP 3005 Supplement to Annual Report of Packers

For P&SP Use Only

P&SP Bar Code Only

U.S. Department of Agriculture

SUPPLEMENT TO ANNUAL REPORT OF PACKERS

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 P&SP Central Reporting Unit. See separate instructions for complete information about this report. You must complete a separate Form 3005 for each plant you operate and enter total values for all plants on Form 3004.

Stockyards

Program

GENERAL INFORMATION - SECTION 1

101

Reporting Period (mm/dd/yy-mm/dd/yy)

a. from

b. to

102

Legal Name of Reporting Packer

103

Business Name (dba)

104

Mailing Address

105

City, State, Zip

LIVESTOCK FEEDING OPERATIONS, PROCUREMENT, AND SLAUGHTER - SECTION 2

Plant Information.

Report the plant used for your slaughter operations below. Enter total firm values on Form 3004.

201

Plant Name

202

Plant Mailing Address

203

City, State, Zip

204

Plant Physical Address (if different from 202)

205

Is this plant federally or state inspected?

Federal

State

Neither

206. FSIS or state plant inspection number:

207

Do you own or lease this plant?

Own

Lease

Neither

Custom Slaughter: If you custom slaughter for other businesses in the plant listed in line 201, complete lines 209-217, otherwise skip to line 218.

List the names and addresses of the four largest entities you slaughter at this plant for in lines 208-211. List only entities for which you slaughter at least 100 head. Add total slaughter for entities not in your largest four and less than 100 head together and list on line 216. Total all values on line 217.

Entity Name

Entity Address

208

1st Entity

209

2nd Entity

210

3rd Entity

211

4th Entity

Your response to this form is required under the Packers and Stockyards Act of 1921 (9 CFR 201.97 and 7 U.S.C. 181-229). 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 3 hour per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection.

Custom Slaughter continued.

Enter the number of head slaughtered for each entity listed in lines 209-212

Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Lamb (hd)

Other (hd)

212

1st Entity

213

2nd Entity

214

3rd Entity

215

4th Entity

216

All others

217

Total

Committed Procurement: Livestock procured more than 14 days before slaughter.

Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Lamb (hd)

Other (hd)

218

Packer owned

219

From other packers

220

All other committed sources

221

Total

Non-Committed Procurement: Livestock procured 14 days or fewer before slaughter.

Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Lamb (hd)

Other (hd)

222

From other packers

223

Direct

224

Through public markets

225

Total

Slaughter Adjustments: Livestock procured but not slaughtered.

Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Lamb (hd)

Other (hd)

226

Livestock sold

227

Dead or condemned

228

Total

Total Slaughter.

Line 229 equals line 217 plus line 221 plus line 225 minus line 228

Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Lamb (hd)

Other (hd)

229

Total slaughter

Number of Livestock Paid for Based on Carcass Basis and Dressed Weight (i.e., not liveweight).

Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Lamb (hd)

Other (hd)

230

Carcass and Dressed

231

Do you use an electronic instrument to determine payment for carcasses or livestock?

Yes

No

232

If you answered yes in item 231, list the manufacturer and the type of instrument.

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). Enclose this form and all completed 3005 forms required with Form 3004, Annual Report of Packers.

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.