Poultry Grading Volume Report

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
POULTRY PROGRAMS

1. NAME AND ADDRESS OF WORK LOCATION (Include Zip Code):

2 (a). Plant No.

2 (b). Fee Request No.

OMB APPROVED - NO. 0581-0128
Page ________ of _________

POULTRY
GRADING VOLUME REPORT

3. REPORTING PERIOD

Daily

4. From

Weekly

5. To

Billing Period

ADMINISTRATIVE VOLUME
6. Live Received (a)

8. Total Volume Received (a+b)

7. Ready to Cook Received (b)
ACCEPTANCE SERVICE VOLUME

9.
KIND

1
0
CLASS
.

11.
TYPE

12.
STYLE

13.
SUBSTYLE

1
14.
5
ACCEPTANCE
EXPORT
SERVICE CODE COUNTRY
CODE
.

16.
GRADED

17.
CONSUMER
LABELED

18.
LBS
ACCEPTED

19.
LBS
RETAINED

CERTIFICATION STATEMENTS

I certify that the volumes stated above are the volumes of products processed and received.
____________________________________________________________________
Signature of Plant Manager

I certify that the volumes of products processed and received, as stated above, are correct to the best
of my knowledge and the product officially identified as marked.
_______________________________________________________________________
Signature of Grader

The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a). The authority for requesting the information to be supplied on thi s form and by supplements to this form is the Agricultural Marketing Act of 194 6, as amended (7 U.S.C.
162-1627) to provide voluntary grading programs. Response is required to obtain volume of poultry (7 CFR 70.77(a)(4)) to determine the administrative volume charge per billing period.
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 0581-0128. The time required to complete this information collec tion is estimated to average 45 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, 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.
PY-240P (11-07) (Previous edition dated (05-05) may be used.)