Form PSD- 1100 PSD- 1100 Application for Registration - Packer Buyer

OMB Control No. 0581-0308

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

APPLICATION FOR REGISTRATION
PACKER BUYER

Buying only for Slaughter as an Employee of a Meat Packer

(Under the Packers and Stockyards Act, 1921, as Amended and Supplemented)

1.

Name of Applicant to Be Registered (Individual or Firm)

2a.

Mailing Address

2b. City
3a.

2c.

County

2d. State

Zip+4

3e.

Zip+4

Operating Address (If different from mailing address listed above)

3b. City

3c.

County

4.

Telephone

5.

Cell Phone

7.

E-Mail Address

8.

Type of Livestock To Be Purchased for Slaughter (Check all that Apply)

9.

2e.

3d.

State
6.

Fax

Swine

□ Steers and Heifer

□

□ Cows and Bulls

□ Sheep and Goats

□ Calves

□ Horses and Mules

Names and Locations of Posted Stockyards, Feedlots, or Web Sites where you will purchase livestock

10. If you operate a buying station for your employer, list name, city, state and zip +4

11. If previously registered list all registered name(s) and address(es)

12. Do you own an interest in other dealer organization(s), market agency(s), stockyard company(s), or packing company(s)? If yes, complete the table below. If not,
go to item no. 13 in the form.

□ Yes
12a. Name of other Organization

PSD 1100

□

No
12b. Location (City, State, Zip+4 Code)

Expires XX/XX/XXXX

12c. % Control by
Applicant

Page 1 of 4

OMB Control No. 0581-0308

CERTIFICATION:

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.

13a. Signature of Applicant:

13b. Print name of Applicant:

13c.

Date:

PACKER EMPLOYER
CERTIFICATION: The above applicant is employed by our firm to buy the livestock identified on line 8 for slaughter purposes only.
14a. Signature of Employer:

14b. Print name:

14c.

Date:

15. Official Title:
16. Name of Firm:
17. Address:

18. Telephone:

19. Email Address:

20. Website, if applicable:
Do Not Complete: Completed by Packers & Stockyards Division

Registration No.
Date of Acceptance

Remarks:

Registration is required in order to operate as a market agency or dealer subject to the Packers and Stockyards Act, 1921, as amended and supplemented, and 9 CFR
201.10 (a). Information held confidential (9 CFR 201.96)
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 1.5 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].

PSD 1100

Expires XX/XX/XXXX

Page 2 of 4

Instructions to Complete
Application for Registration
Packer Buyer
Form PSD 1100
Applicants employed by a packer on salary or other compensation and buying livestock for such
packer use form PSD 1100 to register as a packer buyer. If any information is missing or
incorrect, the Packers and Stockyards Division (PSD) will return the application form to the
principal for completion or correction.
Operating without proper registration and bond may subject the principal to severe civil penalties
as authorized by law for each violation, and additional penalties for each day the violation
continues (7 U.S.C § 203).
Submit the completed form to the PSD regional office where the PACKER is bonded. The
Areas covered by each regional office are listed below the regional office's address.
Regional Offices of the Packers and Stockyards Division
Agricultural Marketing Service, Fair Trade Practices Program
Eastern Regional Office
Midwestern Regional Office
Western Regional Office
75 Ted Turner Drive SW, Ste 230 210 Walnut Street, Room 317
3950 Lewiston St., Suite 200
Atlanta, GA 30303-3308
Des Moines, IA 50309-2110
Aurora, CO 80011-1556
Telephone: (404) 562-5840
Telephone: (515) 323-2579
Telephone: (303) 375-4240
FAX: (404) 562-5848
FAX: (515) 323-2590
FAX: (303) 371-4609
e-mail:
E-mail:
E-mail:
[email protected]
[email protected] [email protected]
Areas Covered
Areas Covered
Areas Covered
AL, AR, CT, DC, DE, FL, GA,
IA, IL, IN, KY, MB, MI, MN,
AB, AK, AZ, BC, CA, CO, HI,
LA, MA, MD, ME, MS, NC,
MO, ND, NE, OH, ON, SD, WI
ID, KS, MT, NM, NV, OK, OR,
NH, NJ, NL, NY, PA, PR, QC,
SI, SK, TX, UT, WA, WY
RI, SC, TN, VA, VT, WV
If you have any questions about the form or completing the form, please contact the PSD
Regional Office that covers your area, as listed above.
Packer-buyer must complete Lines No. 1 through 12 and sign and complete Line No. 13.
The Packer must complete Line 14 through 20.

1
2a
through
2e

PSD 1100

Subject

Instruction

Name of
Applicant to be
Registered
Mailing Address

Enter the name of the individual to be registered.
Enter your mailing address, including street, city, county,
state, and zip+4. This is the address where all correspondence
from the Packers and Stockyards Division will be sent.

Expires XX/XX/XXXX

Page 3 of 4

3a
through
3e
4
5
6
7
8
9

10
11

12

12a
through
12c
13a
through
13c

Subject

Instruction

Operating Address
(if different from

Enter the operating address and/or physical location. Enter
street, city, county, state, and zip+4. This is the address where
you conduct your business services.
Enter the phone number where you can be reached.
Enter your cellphone number.
Enter your fax number.
Enter your e-mail address.
Check the appropriate box to indicate each class of livestock
you will be purchasing for slaughter.

Phone
Cell
Fax
E-Mail Address
Livestock to be
Purchased
for Slaughter
Names and
locations of posted
stockyards,
feedlots, or
websites…
If you operate a
buying station…
If previously
registered, list
registered name
and address.
Do you own an
interest in other
operations….
Name, Location,
Percentage of
Control
Signature of
Applicant, Print
Name, and Date

Enter the name and address, including city and state, of each
of the posted stockyards, feedlots, or web sites where you will
purchase livestock for slaughter.
Enter the name and address, including city, state, and zip+4
where you operate a buying station.
If you were previously registered with the Packers and
Stockyards Division list each of the name(s) under which you
were previously registered, and the address(es) of the prior
business(s).
If you currently operate as, or own any interest in, any dealer
organization(s), market agency(s), stockyard company(s), or
packing company(s), check “Yes” and provide details in the
next section, otherwise, check “No.”
Enter the name(s), location, including city, state, and zip+4,
and the percentage of control or ownership that you maintain
in any of the businesses.
The applicant must sign the application and print the name of
the person signing. Enter the date the form was signed.

THIS SECTION IS TO BE COMPLETED BY THE PACKER-EMPLOYER.
14a
Signature of
An authorized officer of the packer-employer must sign the
through Employer, Print
form, print their name, and enter the date the form was signed.
14c
Officer’s name,
Date
15
Official title
Enter the official title of the officer signing the application.
16
Name of Firm
Enter the full name of the employing packer firm.
17
Address
Enter the address, including city, state and zip+4 of the packer
firm.
18
Telephone
Enter the telephone number of the packer firm.
19
Email Address
Enter the email address of the packer firm.
20
Website Address, Enter the website address of the packer firm, if applicable.
if applicable

PSD 1100

Expires XX/XX/XXXX

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