P&SP 1400 Packer Inquiry

for P&SP Stamp Only

Business Entity ID Number

U.S. Department of Agriculture
Grain Inspection,
Packers and Stockyards
Administration

P&SP Bar Code Only

Indicate your preference to submit forms
electronically, or by paper copy

PACKER INQUIRY

Electronic Filing
Manual Filing

Packers and
Stockyards
Program

Instructions: If an item's value is zero, enter "0". If an item does not apply, enter "NA". Upon completion please verify that all items have been answered.
Return completed form to the P&SP Central Reporting Unit. See separate instructions for complete information about this report.

GENERAL INFORMATION - SECTION 1

101

Reporting Period
(mm/dd/yy)

a. from

b. to

102 Legal Business Name
103 Business Name (dba)
104 Mailing Address
105 City, State, Zip
106 Physical Address
107 City, State, Zip
108 Contact Name
109 Telephone Number

110

Fax Number

111 E-Mail Address

112

Web Address

ORGANIZATIONAL STRUCTURE - SECTION 2
List owners, officers, partners, and members in control of this business
a. Name

b. Title

c. Percentage Ownership

201
202
203
204
205
206 Type of organization:

Individual

Partnership

Corporation

207 Did any change in organization take place during the year?

Yes

L.L.C.

L.L.P.

Co-op

Association

Other

No

208 If line 207 is "Yes", give details
210

209 List State Incorporated/Registered/Formed

Date Incorporated/Registered/Formed

COST OF LIVESTOCK PURCHASED - SECTION 3
301 Total cost of all livestock purchases for your account

$
JURISDICTION - SECTION 4

401 Number of days livestock was purchased during the reporting year
402 Total sales value of all meat and meat food products handled by the firm.

$

403 Does the firm purchase livestock for slaughter at terminal stockyards or auction markets?

Yes

No

404 Does the firm purchase livestock for slaughter from outside the State in which slaughtered?

Yes

No

Yes

No

Yes

No

Yes

No

405 Does the firm sell or ship any meat or meat food products outside the State where such meat or meat food products are manufactured or
prepared by it?
406 Does the firm sell or ship meat or meat food products manufactured or prepared by it to the U.S. Government agencies (i.e. military
installations, hospitals, etc.)?
Does the firm operate as a wholesale broker, dealer, or distributor in commerce to market meat, meat food products, or livestock products in
407
an unmanufactured form?

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

Form 1400

Page 1 of 2

LIVESTOCK SLAUGHTERED - SECTION 5

Number of Head
Cattle

Calves

Hogs

Sheep/Goats

501 By the firm for its own account.
502 By the firm for the accounts of others (i.e. Custom Killed)
503

By others for the firm's account. (i.e. Custom Killed for the firm at other
locations).

Note: Under Remarks (Section 6), list name and address of each person or firm for or by whom at least 1,000 head were slaughtered and indicate whether it
applies to lines 502 or 503.
REMARKS - SECTION 6

601 Use this space for additional information or explanation, making reference to item number.

CERTIFICATION - SECTION 7

Under the Packers and Stockyards Act any person who willfully makes, or causes any false entry or statement of fact in this report shall be deemed guilty of offense against the
United States, and be subject to a fine of $1,000 to $5,000, or to imprisonment for a term of not more than 3 years, or to both fine and imprisonment.
I certify that this report has been prepared by me or under my direction, and to the best of my knowledge and belief correctly reflects reporting entity operations.

701 Print Name

703 Phone Number

702 Signature (Must be signed by a person listed on 201-205)

704 Date

705 Title

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 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.
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.

Form 1400

Page 2 of 2