LS-120 Weekly Noncarcass Merit Premium Swine Reporting

FORM APPROVED. - OMB NO. 0581-0186
UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE

WEEKLY NONCARCASS MERIT PREMIUM SWINE REPORTING

NOTE: 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
0581-0186. The time required to complete this information collection is estimated to average
15 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.

1. IDENTIFICATION NUMBER
2. COMPANY NAME
3. PLANT STREET ADDRESS
4. PLANT CITY

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.

5. PLANT STATE
6. PLANT ZIP CODE
7. CONTACT NAME
8. PHONE NUMBER (include area code)
9. REPORTING DATE (mm/dd/yyyy)
10. REPORTING TIME (1 = 10:00 a.m.; 2 = 2:00 p.m.)

(NOT APPLICABLE)

11a. NONCARCASS MERIT - Volume - Low Range

17a. NONCARCASS MERIT - Other Description

11b. NONCARCASS MERIT - Volume - High Range

17b. NONCARCASS MERIT - Other Value - Low Range

12a. NONCARCASS MERIT - Transportation - Low Range

17c. NONCARCASS MERIT - Other Value - High Range

12b. NONCARCASS MERIT - Transportation - High Range

18a. NONCARCASS MERIT - Other Description

13a. NONCARCASS MERIT - Delivery Timing - Low Range

18b. NONCARCASS MERIT - Other Value - Low Range

13b. NONCARCASS MERIT - Delivery Timing - High Range

18c. NONCARCASS MERIT - Other Value - High Range

14a. NONCARCASS MERIT - Breed - Low Range

19a. NONCARCASS MERIT - Other Description

14b. NONCARCASS MERIT - Breed - High Range

19b. NONCARCASS MERIT - Other Value - Low Range

15a. NONCARCASS MERIT - Pork Quality Assurance
Low Range

19c. NONCARCASS MERIT - Other Value - High Range

15b. NONCARCASS MERIT - Pork Quality Assurance
High Range

20a. NONCARCASS MERIT - Other Description

16a. NONCARCASS MERIT - Other Description

20b. NONCARCASS MERIT - Other Value - Low Range

16b. NONCARCASS MERIT - Other Value - Low Range

20c. NONCARCASS MERIT - Other Value - High Range

16c. NONCARCASS MERIT - Other Value - High Range

LS-120 (05/13) Destroy previous edition