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 

SUPPLEMENT TO 

ANNUAL REPORT 

OF PACKERS 

Select this box if you want to receive 

electronic notification to file your 

annual report. This will begin the next 

reporting cycle. 

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 PSD 3005 for each plant that you use for your firm's operation. The total values reported in Section 

3 of Form PSD 3005 will be combined and reported as the totals in Section 3 on Form PSD 3004. 

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? Yes No 

202 

a. Manufacturer b. Model c. Serial Number 

203 What is the basis of payment made to the entity for most livestock you purchase? Per Head Live Wt. Dressed Wt./Carcass Basis 

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

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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? Federal State Neither 

307 FSIS or state plant inspection number: ______________ 

308 Do you own or lease this plant? Own Lease 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 in 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 Expires 01/31/2025 Page 1 of 2
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 

I I 

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) 

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) Calf (hd) Hog (hd) Sheep/Goat (hd) Other (hd) 

324 From other packers 

325 Direct 

326 Through public 

markets 

327 Total 

Slaughter Adjustments: Livestock procured but not slaughtered: 

Steer/Heifer (hd) Cow/Bull (hd) Calf (hd) Hog (hd) Sheep/Goat (hd) Other (hd) 

328 Livestock sold 

329 Dead or condemned 

I 330 Total I 

Total Slaughter: Line 331 equals line 319 plus 323, plus 327, minus line 330 

Steer/Heifer (hd) Cow/Bull (hd) Calf (hd) Hog (hd) Sheep/Goat (hd) Other (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) 

332 Carcass Basis/ 

Dressed Wt. 

Submitted information is confidential (9 CFR 201.96). Failure to report may result with a complaint filed against the entity in a United States District Court 

charging the entity with violations of the Packers and Stockyards Act and seeking civil penalties as authorized by law 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: program.intake@usda.gov. 

Form PSD 3005 Expires 01/31/2025 Page 2 of 2