Beef Promotion and Research Board

OMB 0581-0093

A program designed to increase demand for beef

Funded by the Beef Checkoff. 

 MONTHLY REPORT AND REMITTANCE FOR ALL CATTLE PURCHASED OR MARKETED IN THE MONTH OF:

______________________/___________________________

I.D. No. : _____________________________________________________________________________________________________

Company: _____________________________________________________________________________________________________

Address: _____________________________________________________________________________________________________

City: _________________________________________________ State: __________ Zip Code: _________________________

Business Phone No.: ___________________________________________________________________________________________________

This report and assessments must be remitted by the 15th day of the month following the month in which

the cattle were marketed. Late payments are subject to a 2-percent per month late payment charge.

Instructions: Please provide the following information on all cattle you or your company marketed by completing the following table:

CATTLE AND CALVES

State of Origin Total Number of Head Marketed Number of Heat NOT Assessed Number of Head per State Assessed

- =

- =

- =

- =

- =

- =

- =

TOTAL TOTAL TOTAL

Send this report and a check payable to:

Find remittance addresses for individual states under 

the “State Beef Council” tab on this Web site. Amount Due

X $1.00/Head

$ 

_______________________________________________________________________________________________________________________________________ 

I declare under the penalties provided by law, that this report has been examined by me and to the best

of my knowledge is a true, correct, and complete report. I also certify that I am authorized to sign this report.

 

DATE RESPONDING OFFICIAL’S NAME (PRINT)

 

TITLE (PRINT) SIGNATURE

 

 CHECK TO ORDER FORMS

Forward original with remittance. Retain copy for your records.

 

(Rev. 04/17) See reverse for burden/non-discrimination statement 

Information is required by (7 CFR 1260.201). Failure to report can result in a fine. Information is held in confidential (7 CFR 1260.201).
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 1 hour 

per response, including the time for reviewing instructions, searching existing data sources, gathering and maintain the data 

needed, and completing and review 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: program.intake@usda.gov. USDA is an equal opportunity provider, employer, and lender.