PSD- 1400 Packer Inquiry

OMB No. 0581-0308

U.S. Department of Agriculture
Agricultural Marketing Service
Fair Trade Practices Program
Packers and Stockyards Division

PACKER INQUIRY

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 appropriate Regional Office.
See separate instructions for complete information about this report.

GENERAL INFORMATION - SECTION 1
101

Reporting Period
(mm/dd/yyyy)

a. FROM

b. TO

102 Legal Business Name
103 Trade Name/DBA
104 Mailing Address
105 City, State, Zip+4
106 Physical Address
107 City, State, Zip+4
108 Contact Name
109 Contact Telephone

111 E-Mail Address

110 Fax

112 Web Address

ORGANIZATIONAL STRUCTURE - SECTION 2
201 Type of organization:

Individual

Partnership

Corporation

202 List State Incorporated/Registered/Formed

L.L.C.

L.L.P.

Co-op

Association

Other

203 Date Incorporated/Registered/Formed

List owners, officers, partners, and members in control of this business
a. Name

b. Title

c. % Ownership

204
205
206
207
208

COST OF LIVESTOCK PURCHASED - SECTION 3
301 Total cost of all livestock purchased for your account during the reporting period

$

OPERATION - SECTION 4
401 Number of days livestock was purchased during the reporting period .
402 Does the firm purchase livestock for slaughter?

Yes

No

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

Yes

No

Yes

No

Yes

No

Yes

No

Does the firm sell or ship any meat or meat food products outside the State where such meat or meat food products are processed
404
or prepared by it?
Does the firm sell or ship meat or meat food products processed or prepared by it to the U.S. Government agencies (i.e. military
405
installations, hospitals, etc.)?
Do you operate as a wholesale broker, dealer, or distributor in commerce to market meat, meat food products, or livestock
406
products in an unmanufactured form?

Form PSD 1400

Expires 02/28/2021

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OMB No. 0581-0308

LIVESTOCK SLAUGHTERED - SECTION 5

Number of Head
Cattle

Calves

Hogs

Sheep/Goats

501 Livestock slaughtered by the firm for its own account.
Livestock slaughtered by others for the firm's account. (i.e. Custom
Killed for the firm at other locations.
Livestock slaughtered by the firm for the accounts of others. (i.e.
503
Custom Killed)
502

504 FSIS or State Establishment Number of Firm where livestock is processed.
Note: Under Remarks (Section 6), list name and address of each person or firm for or by whom at least 100 head were slaughtered during the reporting
period. List the State or Federal Establishment number(s) of each firm, as applies.
REMARKS - SECTION 6

601 Use this space for additional information or explanation for lines 502 and 503, making reference to item number. Continue on addition page if necessary.

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.
Section 10 of the FTC Act, made applicable by Section 402 of the Act (7 U.S.C. 222).
With my signature, I certify the information provided on this form is true and correct to the best of my knowledge and belief, I am an owner, officer, or have
been authorized by responsible management to certify this report.
701 Print Name
703 Phone Number

702 Signature
704 Date

705 Title

In accordance with Federal law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, this institution is prohibited from discriminating on the basis of
race, color, national origin, sex, age, disability, and reprisal or retaliation for prior civil rights activity. (Not all prohibited bases apply to all programs.) 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
State or local Agency that administers the program 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 is also available in languages other than English.
To file a complaint alleging discrimination, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at
http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office or write a letter addressed to USDA and provided 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: (a) mail: U.S. Department of Agriculture, Office of the
Assistant Secretary for Civil Rights, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410; (b) fax: (202) 690-7442; or (c) email: [email protected].

Form PSD 1400

Expires 02/28/2021

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Instructions to Complete
Packer Inquiry
Form PSD 1400
This form is used by any entity engaged in business as a packer and is required by Section
201.94 of the regulations under the Packers and Stockyards Act, 1921 (Act), as amended and
supplemented, to provide the information required by Form PSD 1400.
Penalties for willfully making, or causing to be made, any false entry or statement of fact in any
report required to be made under the Act include a fine between $1,000 to $5,000 or
imprisonment. Section 10 of the FTC Act, made applicable by Section 402 of the Act (7 U.S.C.
222).
Submit the completed form to the appropriate regional office of the Packers and Stockyards
Division (PSD) as listed below. The states, territories, and provinces covered by each regional
office are listed below its address.
Regional Offices of the Packers and Stockyards Division
Agricultural Marketing Service, Fair Trade Practices Program
Atlanta Regional Office
Denver Regional Office
Des Moines Regional Office
75 Ted Turner Drive SW, Ste 230 3950 Lewiston St., Suite 200
210 Walnut Street, Room 317
Atlanta, GA 30303-3308
Aurora, CO 80011-1556
Des Moines, IA 50309-2110
Telephone: (303) 375-4240
Telephone: (404) 562-5840
Telephone: (515) 323-2579
FAX: (404) 562-5848
FAX: (303) 371-4609
FAX: (515) 323-2590
e-mail:
e-mail:
e-mail:
[email protected]
[email protected]
[email protected]
States Covered
States Covered
States Covered
AL, AR, CT, DC, DE, FL, GA,
AB, AK, AZ, BC, CA, CO, HI, IA, IL, IN, KY, MB, MI, MN,
LA, MA, MD, ME, MS, NC,
ID, KS, MT, NM, NV, OK,
MO, ND, NE, OH, ON, SD, WI
NH, NL, NJ, NY, PA, PR, QC,
OR, SK, TX, UT, WA, WY
RI, SC, TN, VA, VT, WV
Additional copies of the report may be obtained from the regional office covering your state, or
on our website located at www.ams.usda.gov. All inquiries concerning any section or part of a
section contained in the report can also be addressed to that regional office.
Line No.
101
102
103
104
and
105

Subject
Instructions
GENERAL INFORMATION – SECTION 1
Reporting Period
Report covers the time from the start of your reporting period
(a. From) to the end of your reporting period (b. To)
Entity Name
Enter the name under which you are registered with PSD.
Trade Name/d.b.a.
Enter the trade name under which you operate. This is the
name the business uses, if applicable. If you do not operate
with a “Trade Name”, enter “N/A”.
Mailing Address
Enter your mailing address. Enter street, city, county, state,
and zip+4. This is the address where all correspondence,
regular and certified from the Packers and Stockyards Division
should be sent.

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Line No.
Subject
106
Operating Address
and
107
108
Contact Name
109
110
111
112

Instructions
Enter the physical location of your operating address. Enter
street, city, state, and zip+4. This is the address where you
conduct your business services.
Enter the name of the person to be contacted regarding
questions on the report.
Contact Telephone
Enter the telephone where the contact person may be reached.
Fax
Enter the Fax used by the entity.
E-Mail Address
Enter the entity’s e-mail address.
Web Site Address (if Enter the complete Web site address the business operates.
applicable)
For example: [email protected]

ORGANIZATIONAL STRUCTURE – SECTION 2
201
Type of Organization Check the appropriate box to indicate the type of organization
as it applies to the business’ operation.
202
State Incorporated/
If appropriate, enter the state where the Corporation, LLC, or
Registered/Formed
LLP was formed.
203
Date Incorporated/
If appropriate, enter the date the Corporation, LLC, or LLP
Registered/Formed
was formed.
204a
Owners, Members,
For each owner, officer, member, and every partner, enter
Through Partners, Or Officers, their name, title, and respective percentage of ownership.
208c
(Name and Title),
Provide this information for every individual with any
Percent Ownership
ownership interest, 10% or greater, in the applicant’s
operation. The person signing this report on line 702, must be
listed in this section.
COST OF LIVESTOCK PURCHASED – SECTION 3
301
Livestock Purchased Enter the total cost of livestock purchased for your account
during the reporting period.
OPERATION – SECTION 4
401
Number of Days
Indicate the number of days’ livestock was purchased during
the reporting year.
402
Livestock for
Check the appropriate box to indicate if the firm purchases
Slaughter
livestock for slaughter at terminal stockyards, auction markets
or other sources.
403
Livestock for
Check the appropriate box to indicate if the firm purchases
Slaughter Outside
livestock for slaughter from outside the State in which it is
the State
slaughtered.
404
Selling Meat
Check the appropriate box to indicate if the firm sells or ships
Outside the State
any meat or meat food products outside the State where the
Meat is
meat or meat food products are manufactured.
Manufactured
405
Selling Meat to
Check the appropriate box to indicate if the firm sells or ships
U.S. Government
meat or meat food products manufactured or prepared by it to
Agencies
U.S. Government agencies.

Form PSD 1400

Expires 02/28/2021

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Line No.
Subject
406
Wholesale Broker,
Dealer, or
Distributor

501
502
503
504
601

701
702
703
704
705

Instructions
Check the appropriate box to indicate if the firm operates as a
wholesale broker, dealer, or distributor in commerce to market
meat, meat food products, or livestock products in an
unmanufactured form.

LIVESTOCK SLAUGHTERED – SECTION 5
Slaughtered on
Enter the number of head of livestock that was slaughtered by
Firm’s Account
the firm for its own account by each category of livestock.
Slaughtered by
Enter the number of head of livestock that was slaughtered by
Others For the Firm others for the firm’s account by each category of livestock.
Enter additional comments on line 601.
Slaughtered For
Enter the number of head of livestock slaughtered for others by
Others
each category of livestock. Enter additional comments on line
601
Establishment
Enter the FSIS or State Establishment number of the firm where
Number
livestock is slaughtered.
REMARKS – SECTION 6
Remarks
Use line 601 for additional information or explanation for lines
502 and 503, making reference to the line number. Continue on
additional page if necessary.
CERTIFICATION – SECTION 7
Print Name
Print the name of the owner, officer, partner, or member
responsible for this report. The signor must be listed on lines
204-208
Signature
The report must be signed by a responsible person, listed on
lines 204-208.
Phone
Enter the phone of the person who signed the report.
Date
Enter the date the form is signed.
Title
Enter the title of the person signing the form.

Form PSD 1400

Expires 02/28/2021

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