LPS-155 Registration of Shell Egg Handler

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
LIVESTOCK AND POULTRY PROGRAM

REGISTRATION OF SHELL EGG HANDLER

RETURN THIS REPORT TO:
Email: [email protected]

Livestock and Poultry Program, AMS
U.S. Department of Agriculture
1400 Independence Ave., SW; MAIL STOP 0258
Washington D.C. 20250-0258

Instructions: Complete and return the original copy to the address
shown in the upper middle section. Keep one copy for your records
(optional). If more space is needed, use the reverse of the form. Please
print or type.

OMB APPROVED: NO. 0581-0113
No shell egg handler (except a producer packer with a flock of 3,000 hens or less)
who grades and packs eggs for the ultimate
consumer may start operations until a
registration form has been properly
completed and submitted (7 CFR 57.690).

FOR USDA USE ONLY

HANDLER NAME:

REGISTRATION NUMBER
STATE

COUNTY

HANDLER

DATE OF
REGISTRATION

SIGNATURE AND TITLE OF USDA OFFICIAL:

EMAIL:
PHONE NUMBER:
STREET ADDRESS:

CITY, STATE, ZIP CODE:
REMARKS:
COUNTY IN WHICH BUSINESS IS LOCATED:
PLEASE LIST BELOW IF MAILING ADDRESS DIFFERS FROM STREET ADDRESS:

MAILING ADDRESS:

CITY, STATE, ZIP CODE:

NATURE OF BUSINESS: (Check as appropriate)
PRODUCER/PACKER with more than 3,000 birds

HATCHERY

COOKED EGG

GRADING STATION

INEDIBLE COLLECTION/PROCESSING

EXEMPT BREAKER

OTHER (Specify)__________________________________________________________________________________
Do you pack shell eggs in consumer size containers? ……………………………………………………………………

YES

NO

Do you sell eggs directly to consumers on retail egg routes? …………………………………………………………….
Do you sell eggs in consumer size containers to retailers or brokers who in turn sell them to retail distributors? ………
Do you sell eggs directly to institutional type users (i.e., restaurants, schools, hospitals, etc.)? …………………………

DATE:

TITLE:

CERTIFICATION OF INDUSTRY PERSONNEL PREPARING REPORT
TYPED OR PRINTED NAME:
SIGNATURE:

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 0581-0113. The time required to complete this information collection is estimated to average 20
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.
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, employer, and lender.
LP-155 (XX/20XX) Supersedes LPS-155
EXP. DATE: XX/XX/XXXX

UNITED STATES DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
1400 INDEPENDENCE AVENUE, SW; MAIL STOP 0258
WASHINGTON, DC 20250-0258

NOTICE TO SHELL EGG HANDLERS

Public Law 91-597 enacted by the 91st Congress of the United States referred to as the “'Egg
Products Inspection Act” places restrictions upon the disposition of certain qualities of shell
eggs effective July 1, 1972.
Producers having 3,000 or less hens and producers who do not pack eggs for sale to the
ultimate consumer exclusive of sales direct to consumers on the producer’s premises are
exempt.
To carry out the provisions of this Act, it is necessary that all persons who pack eggs for
consumer outlets, including producer-packers that have more than 3,000 hens, persons who
operate grading stations, and persons who have hatcheries are to complete the attached
registration form and return it to the address shown in the upper middle section of the form.
Keep one copy of this form for your records. You will receive a copy of this form showing
your registration number after it has been assigned.
The Act and the regulations issued pursuant thereto require specific labeling and handling for
restricted eggs and the maintenance of records of production, bills of sale, inventories (by
class and quantities of product), receipts, shipments, dates of shipment and receipt, carrier
names, and shippers and receivers names.

LP-155 (XX/20XX) Reverse