Beef--App. for Use of Non-Producer Certification Stamp A

OMB 0581-0093

APPLICATION FOR USE OF A STAMP
TO CERTIFY NON-PRODUCER STATUS

I. APPLICANT INFORMATION
A. Identification of Applicant
Name
Company
Address
City, State, Zip
Physical Location
Federal Tax ID/SS #

B. Type of Business
Applicant will use stamp as:
Order Buyer
Dealer/Trader
Market
Feedlot
Other (explain)

OFFICE USE
ONLY
STAMP NO.
ASSIGNED

C. Other Names
Applicant also conducts business under the following names:
(Name, entity relation to applicant, type of business)

II CONDITIONS
A. In making this application for a stamp to certify non-producer status, Applicant certifies that during any one month of the
preceding twelve-month period, Applicant has resold cattle in at least (20) twenty individual transactions and agrees to
the following conditions for use:

1.

2.

3.

4.

Applicant will be permitted by the Cattlemen’s Beef Promotion and Research Board to use this stamp to certify nonproducer status for cattle which Applicant sells in lieu of providing a certification of non-producer form to the
buyer or person paying Applicant in such sales transactions;
Applicant will use this stamp only on a document which provides the following information:
a. Seller’s name;
b. Buyer’s (or market agency’s) name;
c. Number of cattle sold;
d. Date of transaction.
Applicant certifies that the name under which it has submitted this application (Section 1, Paragraph A. above) is
the only name in which it will conduct business in connection with the use of this stamp to certify non-producer
status.
Applicant certifies that prior to using this stamp in any transaction, all conditions for claiming non-producer status
with regard to cattle sold in the transaction shall be met, those conditions are:
a. Applicant has collected $1.00 per head of cattle upon the purchase of the cattle; or
b. Applicant has received a certification of non-producer form from the seller of the cattle when
Applicant purchased them; or
c. Applicant purchased the cattle in a transaction in which Applicant was not responsible for collecting
$1.00-per-head assessment; and (collected by brand inspector or by the market)
d. Applicant acknowledges that upon selling these cattle in any transaction in which the Applicant uses the
stamp that Applicant is certifying that Applicant has purchased these cattle to facilitate the transfer of
ownership of these cattle to a third-party and (1) Applicant is reselling these cattle no later than 10 days
from the date Applicant purchased them, or (2) that upon transfer of these cattle Applicant shall receive
only a sales commission or a service fee which was established prior to Applicant’s purchase of the
cattle.

B. Applicant acknowledges and understands that should Applicant use the stamp to certify non-producer status on any
document in which Applicant knowingly or willfully make false statements, that Applicant may be fined up to $10,000,
imprisoned up to 5 years, or both, for the action pursuant to 18 USC §1001.

C. Applicant certifies that it will not allow any other person or business entity to utilize this stamp in any transaction in which
Applicant is not the seller of the cattle, and that only those authorized to do so by Applicant shall certify non-producer status
on a sales document.

D. Applicant certifies that only the following signature is authorized for use in connection with this stamp to certify nonproducer status.

Signature
Print or Type Name

LPS (Rev. 04/17)

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E. Applicant understands and acknowledges that the
at any time upon notification to Applicant of the revocation.

may revoke the right to utilize the stamp

F. Applicant certifies that Applicant fully understands the conditions for claiming non-producer status, and that any and all
documents relating to transactions in which Applicant has sold cattle which contain this stamp fully meet the conditions for nonproducer status, and that all such documents or copies thereof be maintained in a permanent file by the Applicant.

Signature of Applicant
Position
Date

Notary Seal

Subscribed and sworn to before me this

day of

, 20___ .

The following statements are made in accordance with the Privacy Act of 1974 (U.S.C. 522a) and the Paperwork Reduction Act of
1995, as amended. The authority for requesting this information to be supplied on this form is the Commodity Promotion, Research,
and Information Act of 1996, Pub. L. 104-127, 110 Stat.1032 (7 U.S.C. 7411-7425). Furnishing the requested information is necessary
for the administration of this program. Submission of Tax Identification Number (TIN) or Employer Identification Number (EIN) is
mandatory, and will be used to determine affiliation or entity identification.
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 0581-0093. The time required to complete this information collection is estimated to average 2 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.
In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the
USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from
discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation,
disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or
retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all
programs). Remedies and complaint filing deadlines vary by program or incident.
Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print,
audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA’s TARGET Center at (202) 720-2600
(voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be
made available in languages other than English.
To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
http://www.ascr.usda.gov/complaint_filing_cust.html and at any USDA office or write a letter addressed to USDA and provide in the
letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your
completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture, Office of the Assistant Secretary for Civil Rights,
1400 Independence Avenue, SW., Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: [email protected].
USDA is an equal opportunity provider, employer, and lender.

LPS (Rev. 04/17)

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SAMPLE of the Non Producer Stamp: 

CERTIFICATION OF NON‐PRODUCER STATUS 
FOR THE RESELLER 
Claimed on #
cattle pursuant to 
7CFR 1260.116 and 1260.314 
DO NOT DEDUCT the 
$1.00 per head Beef Promotion Assessment 
Cattlemen’s Beef Promotion & Research Board 
SC#0001 
/
Signature 
Date 

LPS (Rev. 04/17)

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