Form P&SP 1100 P&SP 1100 Application for Registration - Packer Buyer

Instructions to Complete
Application for Registration
Packer Buyer
Form P&SP – 1100
Applicants employed by a packer on salary or other compensation and buying livestock for such packer use form P&SP-1100 to
register as a packer buyer. If any information is missing or incorrect, the Packers and Stockyards Program will return the
application form to the principal for completion or correction.
Operating without proper registration and bond may subject the principal to penalties including a fine of $550 for each violation and
$27.50 for each day it continues.
After completing the application for registration, the applicant should retain a copy for their files and mail the completed form with
original signature to the regional office of the Packers and Stockyards Program as listed below. The states covered by each regional
office are listed below the regional office’s address.
Regional Offices of the Packers and Stockyards Program
Grain Inspection, Packers and Stockyards Administration
Eastern Regional Office
Western Regional Office
Midwestern Regional Office
Suite 230
3950 Lewiston St., Suite 200
Room 317
75 Spring Street
Aurora, CO 80011-1556
210 Walnut Street
Atlanta, GA 30303-3308
Telephone: (303) 375-4240
Des Moines, IA 50309-2110
Telephone: (404) 562-5840
FAX: (303) 371-4609
Telephone: (515) 323-2579
FAX: (404) 562-5848
e-mail:
FAX: (515) 323-2590
e-mail:
[email protected] e-mail:
[email protected]
[email protected]
States Covered
States Covered
States Covered
AL, AR, CT, DC, DE, FL, GA, LA, AK, AZ, CA, CO, HI, ID, KS, MT, IA, IL, IN, KY, OH, MI, MO, MN,
MA, MD, ME, MS, NC, NH, NJ,
NM, NV, OK, OR, TX, UT, WA,
ND, NE, SD, WI
NY, PA, RI, SC, TN, VA, VT, WV
WY
Packer-buyer must complete Items No. 1 through 14 and sign and complete Item No. 15.
The Packer must complete Item 16.
Line No.
1
2
3a
through
3d

Subject
Name of Applicant to be
Registered

Instruction
Enter the name of the individual or firm to be registered.

Mailing Address

Enter your mailing address, including street, city, state, and 9-digit zip code. This is
the address where all correspondence from the Packers and Stockyards Program will
be sent. If you conduct your business services at another location, enter that address
in lines 4a through 4d.
Enter the street, city, state, and zip code of the physical location where you operate.
This is the address where you conduct your business services. If there is a separate
mailing address for correspondence to be sent, enter that address on lines 3a through
3d.
Enter the county and country where you conduct your operation.

4a
through
4d

Operating Address

5a
through
5b
6

County, Country

7
8
9

Cell No.
Fax No.
E-Mail Address

P&SP-1100-i

Telephone No.

Enter the telephone number including area code where you can be reached during the
hours of 8:00 a.m. to 5:00 p.m. local time.
Enter your cellular phone number.
Enter the firm’s fax number.
Enter the firm’s e-mail address or that of one of the owners.

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Line No.
10
11

12
13

14a

14b
through
14d
15a
through
15c
16 (a)
16 (b)
16 (c)
16 (d)

P&SP-1100-i

Subject
Livestock to be Purchased
Names and Locations of
Posted Stockyards,
Feedlots, or Websites…
If You Operate a Buying
Station
If Previously Registered,
List Registered Name and
Address
Do You Own An Interest In
Other

Instruction
Check the appropriate box to indicate each category of livestock you will be
purchasing.
Enter the name and address of each of the posted stockyards, feedlots, or web sites.
Include city and state where you will purchase livestock.

Name, Location, Percent
Control

Enter the name and address, including city and state, where you operate a buying
station.
If you or your business was previously registered with the Packers and Stockyards
Program, list each of the name(s) under which you or your business was previously
registered, and the address(s) of the prior business(s).
If you currently operate as, or own any interest in, any dealer organization(s), market
agency(s), stockyard company(s), or packing company(s), check “Yes” and provide
details in the next section, otherwise, check “No.”
Enter the name(s), location, including city, state, and zip, and the percentage of
control or ownership that you maintain in any of the businesses.

Signature of Applicant,
Title, Date

The applicant must sign the application, enter relevant title, if any, and enter the date
the form was signed.

THIS SECTION IS TO BE COMPLETED BY THE PACKER-EMPLOYER.
Signature
An authorized officer of the packer-employer must sign the form.
Official title
Enter the official title of the officer signing the application.
Name of Firm-Address
Enter the full name, address, and telephone number of the employing packer firm.
Date
Enter the date the application is signed by the packer-employer.

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U.S. DEPARTMENT OF AGRICULTURE
GRAIN INSPECTION, PACKERS AND
STOCKYARDS ADMINISTRATION
PACKERS AND STOCKYARDS PROGRAM

OMB Control No. 0580-0015
Expires: xx/xx/20xx

APPLICATION FOR REGISTRATION
PACKER BUYER
Buying Only for Slaughter as an Employee of a Meat Packer
(Under the Packers and Stockyards Act, 1921, as Amended and Supplemented)

Please Print or Type
(1) Name of Applicant to Be Registered (Individual or Firm)

(2)

(3a) Mailing Address
(3b) City

(3c) State

(3d) Zip Code

(4c) State

(4d) Zip Code

(4a) Operating Address (if different from mailing address listed above)
(4b) City
(5a) County
(6) Telephone No.

(5b) Country
(7) Cell No.

(8) Fax No.

(9) E-mail Address
(10) Livestock to Be Purchased (check all that apply)
‰ Feeder Cattle
‰ Cows and Bulls
‰ Fed Cattle
‰ Calves
‰ Steers and Heifers
‰ Swine

‰ Sheep and Goats
‰ Horses and Mules

(11) Names and locations of posted stockyards, feedlots, or web sites where you will purchase livestock

(12) If you operate a buying station for your employer, list name and location

(13) If previously registered, list all registered name(s) and address(es)

(14a) Do you own an interest in other dealer organization(s), market agency(s), stockyard company(s), or
packing company(s)?
‰ Yes (complete table below)
‰ No (go to item 15 in the form)
(14b) Name of other
Organization

Form P&SP-1100

(14c) Location (City, State, Zip Code)

(14d) Percent of
Control by
Applicant

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Certification: To the best of my knowledge and belief, the foregoing statements are true and correct.
(15a) Signature of Applicant

(15b) Title (if any)

(15c) Date

For Completion By Packer-Employer
The above applicant is employed by our firm to buy the livestock identified in item no. 10 for slaughter
purposes only.
(16a) Signature

(16b) Official Title

(16c) Name of Firm

(16f) Date

(16d) Address

(16e) Telephone No.

Do Not Complete: For Official Use Only
Registration No.

Registered As

Dealer

Remarks

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.
Registration is required in order to operate as a market agency or dealer as defined in Section 301 (7 U.S.C. 201) of the Packers and
Stockyards Act, 1921, as amended and supplemented and 9 CFR 201.10 (a). Information held confidential (9 CFR 201.96).
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 0580-0015. The time
required to complete this information collection is estimated to average 1 hour 30 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.

Form P&SP-1100

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