PY-33 Application for Specification Approval

REPRODUCE LOCALLY.

OMB APPROVED - NO. 0581-0128

Include form number and edition date on all reproductions.

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

Response is required in order to obtain specification approval applicable to grading service specification (CFR
56.4 and 70.10).

APPLICATION FOR
SPECIFICATION APPROVAL

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.

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 collection is estimated to average 2 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.

I hereby apply for Acceptance Service certification of the product(s) checked below. It is understood that:

•

The applicant will provide an approved copy of the specifications to plant management and the U.S. Department of
Agriculture (USDA) representative at each plant packing to these specifications.

•

Any graded or inspected product subject to these specifications which does not meet the terms of the specifications will be
placed under USDA retention. Retained product will be released only when reworked to meet specification requirements, or
when verbal or written authority is granted by the applicant to waive specific requirements.

•

The applicant will provide waivers to specific requirements directly to plant management and the USDA representative at the
packing location.

•

When applicable, the applicant is to verify that all products procured under the Acceptance Service certification program are
properly identified and accompanied by the required certification documents when received at destination.

•

Any product bearing any USDA identification shall at all times comply with USDA requirements and regulations.
PRODUCT

APPLICABLE REGULATIONS

SHELL EGG

Regulations Governing the Voluntary Grading of Shell Eggs (7 CFR 56)
United States Standards, Grades, and Weight Classes for Shell Eggs (AMS 56)

POULTRY

Regulations Governing the Voluntary Grading of Poultry Products and Rabbit (7 CFR 70)
United States Classes, Standards, and Grades for Poultry (AMS 70.200 et. seq.)

TITLES OF PERSONS AUTHORIZED TO GRANT SPECIFICATION WAIVERS

TELEPHONE NUMBERS (Include Area Code)

ADDRESS OF APPLICANT (Street and No., city, State, and ZIP Code)

NAME OF APPLICANT*

E-MAIL ADDRESS:
DATE OF APPLICATION

SIGNATURE OF APPLICANT

FOR USE BY AGRICULTURAL MARKETING SERVICE
DATE APPLICATION APPROVED

DATE SPECIFICATIONS APPROVED

TITLE

SIGNATURE OF USDA OFFICIAL

*No member of or delegate to Congress, or Resident Commissioner, shall be admitted to any benefit that may arise from this service unless
derived through service rendered a corporation for its general benefit.
PY-33 (03-14) (Previous edition 03/10 may be used.)