OMB NO. 0581-0093 

ALTERNATIVE FORM: To be used by first time purchasers with computerized recordkeeping systems that cannot supply information required on primary 

remittance form. Columns A, B, C, and D must be completed in detail. 

UNITED STATES DEPARTMENT OF AGRICULTURE 

AGRICULTURAL MARKETING SERVICE 

SOYBEAN PROMOTION, 

RESEARCH, AND CONSUMER 

INFORMATION PROGRAM 

(SPARC) 

A program of promotion, research, and consumer information 

designed to strengthen, expand and develop new foreign and 

domestic markets for soybeans and soybean products. 

Note: Information is required by 7 CFR 1220.223. Failure to report can result in 

a fine. Information is held confidential (7 CFR 1220.243). 

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 

maintaining the data needed, and completing and reviewing the collection of 

information. 

REPORT AND REMITTANCE OF AMOUNT COLLECTED AND DUE ON SOYBEANS PURCHASED 

NAME AND ADDRESS (include P.O. Box or Street, City, State, and ZIP) Federal Identification Number 

State Grain Dealer License Number (if applicable) 

County 

Business Telephone (include area code) 

The report and assessments must be remitted (postmarked) by the last day of the 

month following the end of the collection period. Late Payments are subject to a 

2 percent per month late payment charge. Must be remitted by . 

The following report is a report on soybeans purchased and the net market value 

paid for such purchases for the period commencing and 

ending . 

“Net market value” (quoted price plus or minus premiums 

or discounts such as moisture and quality factors) is the 

total dollars paid for assessed soybeans during the 

reporting period. 

(A) (B) 

STATE OF ORIGIN 

(C) 

NET MARKET VALUE OF ASSESSED BU. 

(D) 

RATE TOTAL 

NUMBER OF BUSHELS 

PURCHASED (ALL STATES) 

BUSHELS 

X.005 = $ 

X.005 = $ 

X.005 = $ 

NET MARKET VALUE OF 

ALL BUSHELS PURCHASED 

(ALL STATES) 

$ 

X.005 = $ 

X.005 = $ 

* NOTE: If remitting assessments past due date, 

calculate the 2 percent mandatory late payment 

(compounded monthly). 

Total Assessments x.02 = Late Payment 

TOTAL ASSESSMENTS = 

* LATE PAYMENT = 

SEND THIS REPORT AND A CHECK IN THE TOTAL AMOUNT SHOWN ABOVE TO: 

CERTIFICATION STATEME

TOTAL REMITTANCE = 

OFFICE USE ONLY 

PENALTIES: You may, by law, be fined up to $10,000, 

imprisoned up to 5 years, or both for knowingly or willfully 

making false statements within this document (18 U.S.C. 

§1001). 

NT 

I declare, under the penalties provided by law, that this report has been examined by me; and to the best of my knowledge and believe is a true, correct and complete report. 

NAME/TITLE (Print or type) SIGNATURE DATE 

LP-46-1 (Expiration Date 11/30/2024) See reverse for burden/non-discrimination statement 
 

 

 

 

 

 

 

 

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. 

LP-46-1 (Expiration Date 11/30/2024)