Form PSD- 3005 PSD- 3005 Supplement to Annual Report of Packers

OMB Control No. 0580-0015
Business Entity ID Number

For PSD Stamp Only

PSD Bar Code Only

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

Select this box if you want to receive
electronic notification to file your
annual report. This will begin the next
reporting cycle.

SUPPLEMENT TO
ANNUAL REPORT
OF PACKERS

Electronic Filing

Instructions: If a line's value is zero, enter "0". If a line does not apply, enter "N/A". Return completed form to
the PSD Central Reporting Unit. If all lines are not completed when the form is received, the form will be
returned. See separate instructions for complete information about this report.
You must complete form PSD3005 for each plant that you use for your firm's operation. The total values reported in Section 3
of Form PSD3005 will be combined and reported as the totals in Section 3 on Form PSD3004.
GENERAL INFORMATION - SECTION 1
101

Reporting Period
(mm/dd/yyyy)

a. FROM:

b. TO:

102 Entity Name
103 Trade Name/d.b.a.
104 Mailing Address
105 City, State, Zip+4
ORGANIZATIONAL STRUCTURE - SECTION 2
201 Does the entity own or operate scales on which payment to sellers is determined?
202

a. Manufacturer

Yes

b. Model

No

c. Serial Number

203 What is the basis of payment made to the entity for most livestock you purchase?

Per Head

Live Wt.

204 Do you use an electronic instrument to measure carcass characteristics to determine payment to sellers?

Dressed Wt./Carcass Basis
Yes

No

205 If line 204 is Yes, list the manufacturer and the type of instrument.
LIVESTOCK FEEDING OPERATIONS, PROCUREMENT, SLAUGHTER,
AND MEAT PROCESSING - SECTION 3
Plant Information
301 Plant Name
302 Mailing Address
303 City, State, Zip + 4
304 Operating Address
305 City, State, Zip+ 4
306 Is this plant federally or state inspected?
307 FSIS or state plant inspection number:
308 Do you own or lease this plant?

Federal
State
______________
Own

Lease

Neither
Neither

Custom Slaughter: If you custom slaughter for other businesses, at the plant listed in line 301, complete lines 309-319,
otherwise continue to line 320.
List the names and addresses of the entities for which you provided custom slaughter services at this plant on lines 309-312. List only entities for
which you custom slaughtered at least 100 head or more. Add additional pages as necessary.
Entity Name

Entity Address

Telephone

309 1st Entity
310 2nd Entity
311 3rd Entity
312 4th Entity

Form PSD 3005

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OMB Control No. 0580-0015

Custom Slaughter: continued
For each entity listed on lines 309-312 enter the number of head slaughtered on lines 313-316. Combine number of head slaughtered for additional entities
reported on separate pages, and enter on line 317; for those entities you slaughter less than 100 head, enter number of head on line 318. Total all values on
line 319.
Steer/Heifer (hd)
Cow/Bull (hd)
Calf (hd)
Hog (hd)
Sheep/Goat (hd)
Other (hd)
313 1st Entity
314 2nd Entity
315 3rd Entity
316 4th Entity
317 Total additional pgs.
318 Total < 100 hd.
319 Total
Committed Procurement: Livestock procured more than 14 days before slaughter:
Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

Calf (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

Calf (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

Calf (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

320 Packer owned
321 From other packers
322 All other sources
323 Total
Non-Committed Procurement: Livestock procured 14 days or fewer before slaughter:
Steer/Heifer (hd)

Cow/Bull (hd)

324 From other packers
325 Direct
Through public
326
markets
327 Total
Slaughter Adjustments: Livestock procured but not slaughtered:
Steer/Heifer (hd)

Cow/Bull (hd)

328 Livestock sold
329 Dead or condemned
330 Total
Total Slaughter:

Line 331 equals line 319 plus 323, plus 327, minus line 330
Steer/Heifer (hd)

Cow/Bull (hd)

331 Total Slaughter
Number of Livestock Paid for Based on Carcass Grade; Carcass Weight or Carcass Grade and Weight (i.e., not liveweight):
Steer/Heifer (hd)

Cow/Bull (hd)

Calf (hd)

Hog (hd)

Sheep/Goat (hd)

Other (hd)

Carcass Basis/
332
Dressed Wt.

Submitted information is confidential (9 CFR 201.96). Failure to report will result in forfeiture to the United States $559
per day until report receipt, Section 10 of the FTC Act, made applicable by Section 402 of the Act (7 U.S.C. 222).
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 is 0581-0308. The time required to complete this information
collection is estimated to average 3 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.
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 3005

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Instructions to Complete
Supplement to Annual Report of Packers
Form PSD 3005
As a packer, if you slaughter at more than one plant, you must submit a separate Form PSD 3005
for each plant, in addition to Form PSD 3004. The total values reported in Section 3 of each form
PSD 3005 will be combined and reported as the totals in Section 3 of Form PSD 3004
All items must be completed on this form, in its entirety, before submitting the form. Failure
to do so will result in the form being returned as incomplete.
For questions about Form PSD 3005, or additional copies of the form, please contact the PSD
Central Reporting Unit at 303-375-4264 or [email protected]. Forms and instructions are
also on PSD’s website at www.ams.usda.gov. Please fax the completed form to the Central
Reporting Unit at either 314-457-4421/844-303-0332, email to [email protected] or mail to:
USDA PSD
P.O. Box 110639
Aurora, CO 80042
SECTION-BY-SECTION INSTRUCTIONS
FORM HEADER – BUSINESS ENTITY ID
Business Entity ID should be completed using information on the attached annual report letter.

Line No.
101
a and b

102
103
104
and
105
201

Form PSD 3005

Subject

Instruction
GENERAL INFORMATION - SECTION
Reporting Period
The reporting year covers the period of time operated the
previous year, either calendar year or fiscal year. (FROM:
should be the beginning of your reporting year; TO: should
be the end of your reporting year, i.e., 01/01/20YY to
12/31/20YY)
If you recently registered, please enter the date you started
operating (FROM) and the end of your reporting year (TO).
If you cease operations and go inactive, the end of your
reporting year (TO) will be the last date of operation.
Entity Name
Enter the name under which you are registered with PSD.
Trade Name
Enter the trade name under which you operate. This is the
name the business uses, if applicable.
Mailing Address
Enter your mailing address. Enter street, city, state, and zip
+4 code. This is the address where all correspondence from
the Packers and Stockyards Division should be sent.
ORGANIZATIONAL STRUCTURE – SECTION 2
Own or Operate a Scale Check the appropriate box to indicate if this entity owns or
operates a livestock scale.

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Line No.
202a.
through
202c.
203

Subject
Manufacturer, Model,
Serial Number

Instruction
If 201 is yes, list the a. manufacturer, b. model, and c. serial
number of each scale the entity operates.

Payment

204

Electronic Evaluation
Device

Check the appropriate box to indicate the basis of payment
for the majority of livestock sold.
Check the appropriate box to indicate whether or not you use
any type of electronic evaluation device (other than scale)
for payment determination. If yes, enter the type of
equipment and the manufacturer on line 205.

205

Manufacturer of
Electronic Device

301
302
and
303
304
And
305
306

List the manufacturer and type of instrument used to
measure carcass characteristics to determine payment to
sellers.
LIVESTOCK FEEDING OPERATIONS, PROCUREMENT, SLAUGHTER,
AND MEAT PROCESSING – SECTION 3
Plant Name
Enter the name of plant used for your slaughter operation.
Mailing Address
Enter the mailing address of the plant. Enter street, city,
(number and name), and state, and zip +4 code. This is the address where all
city, state and zip +4
correspondence to the plant from Packers and Stockyards
Division will be sent. .
Operating Address
Enter the physical address of the plant if it is different from
the mailing address. Enter street, city, state, and zip + 4.
Federal or State
Inspection
FSIS or State Inspection
Number
Own or Lease

Select the highest level of inspection provided at the plant.

309
through
312

Custom Slaughter
Entities

313
through
319

Number of head of
livestock custom
slaughtered

Enter name and address (street, city, state, and zip +4), for
each entity for which you slaughtered on a custom basis at
this plant during the reporting period. Add additional pages,
as necessary.
For each of the entities listed on lines 309-312, enter total
number of head of each category of livestock slaughtered by
you on a custom basis during the reporting period. Add
additional pages, as necessary. Enter custom slaughter
numbers of head for all others that were listed on separate
pages on line 317. Enter the total number of head for those
entities for whom you slaughter less than 100 head on line
318. Enter sum totals of lines 313 through 318 on line 319,
for each category livestock reported.

307
308

Form PSD 3005

Enter the inspection number assigned to the plant.
Check the ownership status. “Neither” indicates the plant
performs custom slaughter.

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Line No. Subject
Instruction
For lines 320 through 323 committed supply arrangements include marketing agreements, forward
contracts, and formula contracts agreed on more than 14 days before slaughter. The term “formula
contract” means the commitment of livestock for slaughter by any means other than through a
negotiated purchase or a forward contract, using a method for calculating price in which the price
is determined at a future date. Committed supply arrangements also include written and verbal
agreements on delivery volume and pricing terms in some combination agreed on more than 14 days
before slaughter, or to those commitments that only specify number of livestock delivered or
commitments that only specify how price will be settled if livestock are delivered.
320

Packer Owned

321

From other packers

322

All other committed
sources

323
324

Total Committed
Procurement
From Other Packers

325

Direct

326

Through Public Markets

327
328

Total Non-Committed
Procurement
Livestock Sold

329

Dead or Condemned

330
331

Total Adjustments
Total Slaughter

332

Number Paid on
Carcass Basis/Dressed
Weight

Form PSD 3005

Enter all livestock slaughtered that were owned, in whole or
in part, more than 14 days by your firm or its subsidiaries,
your firm’s parent or ultimate parent firm, or another firm
owned, in whole or in part, by your firm’s parent or ultimate
parent firm.
Enter all livestock slaughtered that were procured from other
packers through committed supply arrangements more than
14 days before slaughter.
Enter all other livestock slaughtered that were procured
through committed supply arrangements more than 14 days
before slaughter, not entered in lines 320 or 321.
Enter column totals of lines 320 through 322.
Enter all livestock slaughtered that were procured from other
packers through non-committed supply arrangements, which
procure 14 days or less before slaughter.
Enter the number of head procured directly at the packing
plant, buying stations, feedlots, etc., from non-committed
supply arrangements, which procure 14 days or less before
slaughter.
Enter the number of head procured through public markets
from non-committed supply arrangements, which were
procured 14 days or less before slaughter.
Enter column totals of lines 324 through 326.
For each category of livestock procured but not slaughtered,
enter the number of head sold during the reporting period.
For each category of livestock procured but not slaughtered,
enter the number of head that died or were condemned
during the reporting period.
Enter column totals of lines 328 and 329.
For each category of livestock, add lines, 319, 323, and 327,
then subtract line 330; enter as Total Slaughter.
For each category of livestock, enter total number of
livestock slaughtered that were purchases and paid for on a
dressed weight or a carcass merit basis (i.e., other than liveweight purchases)

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