LPS-155 Registration of Shell Egg Handler

FORM APPROVED OMB NO. 0581-0113
RETURN THIS REPORT TO:

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
PROGRAMS
LIVESTOCK,POULTRY
POULTRY,
AND SEED PROGRAM

Quality Assessment Division

Grading Branch, Poultry Programs, AMS,
Livestock,
Poultry,ofand
Seed Program, AMS
U.S.
Department
Agriculture
U.S. Department
of Agriculture
1400
Independence
Ave., SW MAIL STOP 0258
1400 Independence
Ave., SW, Mail Stop 0258
D.C. 20250-0258
Washington

REGISTRATION OF SHELL EGG HANDLER

Washington, D.C. 20250-0258

Instructions: Complete and return the original copy to the address shown
in the upper middle section. Keep one copy for your records (optional). If
more space is needed, use the reverse of the form. Please print or type.

No shell egg handler (except a producer packer with a flock of 3,000 hens or less)
who grades and packs eggs for the
ultimate consumer may start operations
until a registration form has been properly
completed and submitted (7 CFR 57.690)

FOR USDA USE ONLY

HANDLER NAME:

REGISTRATION NUMBER
STATE

COUNTY

DATE OF REGISTRATION

HANDLER

STREET ADDRESS:

CITY, STATE, ZIP CODE:

SIGNATURE AND TITLE OF USDA OFFICIAL
REMARKS:

COUNTY IN WHICH BUSINESS IS LOCATED:

PLEASE LIST BELOW IF MAILING ADDRESS DIFFERS FROM STREET ADDRESS:

MAILING ADDRESS:

CITY, STATE, ZIP CODE:
NATURE OF BUSINESS (Check as appropriate)
PRODUCER/PACKER with more than 3,000 birds

HATCHERY

COOKED EGG

GRADING STATION

INEDIBLE COLLECTION/PROCESSING

EXEMPT BREAKER

OTHER (Specify)

YES

NO

Do you pack shell eggs in consumer size containers? ....................................................................................................
Do you sell eggs directly to consumers on retail egg routes? .........................................................................................
Do you sell eggs in consumer size containers to retailers or brokers who in turn sell them to retail distributors? .............
Do you sell eggs directly to institutional type users (i.e., restaurants, schools, hospitals, etc.)? ........................................

DATE:

TITLE:

CERTIFICATION OF INDUSTRY PERSONNEL PREPARING REPORT
TYPED OR PRINTED NAME:
SIGNATURE:

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 0581-0113. The time required to complete this information collection is estimated to
average 20 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.
(Revised 8/2010)
Previous
destroyed.
PY-155 (08-10)
Previous
editioneditions
dated must
04-08bemay
be used.
LPS-155
(01-2015)

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
1400 INDEPENDENCE AVENUE, SW MAIL STOP 0258
WASHINGTON, DC 20250-0258

NOTICE TO SHELL EGG HANDLERS
Public Law 91-597 enacted by the 91st Congress of the United States referred to as the
''Egg Products Inspection Act" places restrictions upon the disposition of certain
qualities of shell eggs effective July 1, 1972.
Producers having 3,000 or less hens and producers who do not pack eggs for sale to the
ultimate consumer exclusive of sales direct to consumers on the producers premises are
exempt.
To carry out the provisions of this Act, it is necessary that all persons who pack eggs for
consumer outlets, including producer-packers that have more than 3,000 hens, persons
who operate grading stations, and persons who have hatcheries are to complete the
attached registration form and return it to the address shown in the upper middle section
of the form. Keep one copy of this form for your records. You will receive a copy of
this form showing your registration number after it has been assigned.
The Act and the regulations issued pursuant thereto require specific labeling and
handling for restricted eggs and the maintenance of records of production, bills of sale,
inventories (by class and quantities of product), receipts, shipments, dates of shipment

and receipt, carrier names, and shippers and receivers names.

PY-155 (04-08)
Previous edition dated 01-04 may be used.
LPS-155
(01-2015)