Reproduce Locally. Include form number and edition date on all reproductions. Form Approved OMB No. 0581-0126

U. S. DEPARTMENT OF AGRICULTURE

AGRICULTURAL MARKETING SERVICE

DAIRY PROGRAMS

REQUEST TO DISPLAY OFFICIAL IDENTIFICATION OR GRADE LABELS

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 control number for this information is 0581-0126. The time required to complete this information collection 

is estimated to average 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data 

needed, and completing and reviewing the collection information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age, disability, 

 and where applicable, sex (including gender identity and expression), marital status, familial status, parental status, religion, sexual orientation, political beliefs, 

 genetic information, 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).

 USDA official identification or grade labels may not be used unless a completed application has been received and approved.

Application is hereby made, in accordance with the provisions of the appropriate sections of the Regulations 

Governing the Inspection and Grading of Manufactured or Processed Dairy Products (7 CFR, Ch. I, Part 58, 

Subpart A), or the Regulations Governing the Certification of Sanitary Design and Fabrication of Equipment Used in 

the Slaughter, Processing, and Packaging of Livestock and Poultry Products (7 CFR, Ch. I, Part 54, Subpart C), for 

the privilege of displaying official identification or grade labels on the following product packaging materials, 

equipment, utensils, or descriptive or promotional materials. The applicant (listed below) affirms compliance to the 

aforesaid regulations and such instructions as may be issued by the Administrator, Agricultural Marketing Service 

covering inspection, grading and evaluation of products, packaging materials, equipment, utensils, or descriptive or 

promotional materials, and attests that an approved Application To Use Official Identification or Grade Labels, Form 

DA-155 is on file with Dairy Programs.

Three copies of the product packaging materials, or descriptive or promotional materials displaying the official 

identification or grade label are attached or, if this request has been faxed for review, are being mailed under 

separate cover.

Product packaging materials, equipment, utensils, or descriptive or promotional materials to 

display official identification or grade label (Brand name, item description, etc.):

 Distributor if different from Applicant:

1.

2.

3.

4.

5.

Name, Address and Plant No. (if applicable) of Applicant:

Email Address:

Send this form and attached materials to:

Grade Label Coordinator

USDA/AMS/Dairy Programs

Dairy Grading Branch

Room 2746-S MS 0230

1400 Independence Ave. SW 

Washington, DC 20250-0230

Tel: 202-720-3171

Fax: 202-720-2643

Name and Title of Applicant Representative (Print or Type): Telephone: Fax:

Applicant Representative Signature: Date:

Form DA-156 (06-12) Destroy all previous editions.