Work Schedule Request Voluntary Grading Service

REPRODUCE LOCALLY. Include form number and edition date on all reproductions.
U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
POULTRY PROGRAMS

WORK SCHEDULE REQUEST
VOLUNTARY GRADING SERVICE

FORM OMB APPROVED - NO. 0581-0128

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 0581-0218. The time required
to complete this information collection is estimated to average .25 hours 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, 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.

PLANT NO.

NAME AND ADDRESS OF FIRM (Include Zip Code)

In compliance with the applicable Agreement and regulations (7 CFR Parts 56 or 70), it is requested that the days and number of hours shown below be
established as the normal work schedule(s) for this plant.
It is understood that:
1. The scheduled number of hours assigned below for Voluntary Grading Service will be the number of hours of work for which the plant will
be rendered service at the regular rate charge for Voluntary Grading Service for shell eggs, rabbits, and poultry. The plant is responsible
for payment of all contracted hours whether work is available or not.
2. The hours worked in excess of those scheduled each day or on a nonscheduled workday are to be considered overtime and will be charged
to the plant at the overtime rate.
3. Graders are to be notified by plant management not later than the preceding workday of any changes in the start of a grader's tour.
4. The hours requested below are effective no earlier than the beginning of the biweekly pay period following concurrence.
5. The number of Holiday hours assigned below will be charged to the plant at the respective regular rate for each Federal Holiday.
These hours are based on the number of hours per work schedule requested by the plant.
HOURS SCHEDULED FOR GRADER "A"
EFFECTIVE DATE

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

FRIDAY

SATURDAY

TOTAL

FRIDAY

SATURDAY

TOTAL

FRIDAY

SATURDAY

TOTAL

FRIDAY

SATURDAY

TOTAL

NO. HOURS
HOURS SCHEDULED FOR GRADER "B"
EFFECTIVE DATE

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

NO. HOURS
HOURS SCHEDULED FOR GRADER "C"
EFFECTIVE DATE

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

NO. HOURS
HOURS SCHEDULED FOR GRADER "D"
EFFECTIVE DATE

SUNDAY

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

NO. HOURS
HOLIDAY HOURS
DATE

REGULAR ________

NIGHT DIFFERENTIAL ________

TITLE OF FIRM REPRESENTATIVE

SIGNATURE OF FIRM REPRESENTATIVE

CONCURRENCE
DATE

SIGNATURE OF REGIONAL DIRECTOR

This program or activity will be conducted on a nondiscriminatory basis without regard to race, color, religion, national origin, age, sex, marital status, or disability.
PY-100 (01-07) (Destroy previous edition dated (01-05.)

*U.S. GPO: 1996-716-950/8330.3