Form P&SP-1500 Expires 11-30-2017 Page 1 of 3

U.S. DEPARTMENT OF AGRICULTURE

GRAIN INSPECTION, PACKERS AND 

STOCKYARDS ADMINISTRATION

PACKERS AND STOCKYARDS PROGRAM

LIVE POULTRY DEALER INQUIRY

Section 1 - General Information 

1. Name and Address 2. Type of Organization

 Association 

 Corporation 

 Individual 

 L.L.C. 

 L.L.P. 

 Partnership 

 Other __________________ 

(Specify) 

3a. Telephone No. 

3b. Fax No. 

5. State Formed:

 ___________________ 

 Date Formed: 

 ___________________ 

3c. Cell Phone No. 

6. If firm operates on a fiscal

year, list fiscal year: 

From: ______________ 

To: _________________ 

4. E-mail Address

7a. Name and Mailing Address of Owners, Officers, 

Directors, and/or Partners 7b. 7c. Title 7d. % 

Ownership

Section 2 - Description Of Business

8. The poultry firm is a (check all that apply)

 Slaughterer  Broker (live)  Meat Dealer or Broker 

 Processor  Dealer (live) 

Section 3 - Live Poultry Purchases 

9a. Did the firm purchase live poultry for slaughter?  Yes  No 9b. FSIS Establishment No.

10. Did the firm purchase live poultry to sell to a firm that slaughters?  Yes  No 

OMB No. 0580-0015
Form P&SP-1500 Expires 11-30-2017 Page 2 of 3

11. Did the firm’s purchases originate outside the state in which it was slaughtered?  Yes  No

12. Total annual live poultry purchases $___________________________

Section 4 - Live Poultry Produced Under Growing Arrangements 

13. Did firm obtain poultry using growing arrangements for its own slaughter?  Yes  No 

14. Did firm sell or contract poultry obtained using a growing arrangement?  Yes  No 

15. Did obtained poultry originate outside the state in which it was slaughtered ?  Yes  No

16. Number of growers with growing arrangements _____________

17. Estimated yearly value of the poultry obtained under growing arrangements annually $____________________

Section 5 - Poultry Product Sales

18. Did the firm manufacture or prepare poultry products and then sell or ship those products

outside the state of slaughter?  Yes  No

19. Did the firm manufacture or prepare poultry products and then sell or ship those products

to the U.S. Government?  Yes  No

Section 6 - Poultry Product Sold 

20. Total dollar amount sales of poultry products and by-products sold on an annual basis? $_______________

Section 7 – Remarks

21. Use this space for additional information or explanation for any numbered items above, making reference to the

item number.

Section 8 - Certification 

_________________________________ 22. Signature

______________________________________ 23. Title

 ________________________________ 24. Date
Form P&SP-1500 Expires 11-30-2017 Page 3 of 3 

The Packers and Stockyards Act provides in part that “any person who shall willfully make, or cause to be made, any false entry or statement of 

fact in any report required to be made under this Act ... shall be deemed guilty of an offense against the United States, and shall be subject, upon 

conviction in any court of the United States of competent jurisdiction, to a fine of not less than $1,000 nor more than $5,000, or to imprisonment 

...” 

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 0580-0015. 

The time required to complete this collection is estimated to average 54 minutes per response, including the time to review instructions, search 

existing data resources, gather and maintain the data needed, and complete and review the information collection. 

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

age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, genetic information, political 

beliefs, 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). To file a complaint of discrimination, write to USDA, 

Director, Office of Civil Rights, 1400 Independence Avenue, S.W., Washington, D.C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-

6382 (TDD). USDA is an equal opportunity provider and employer.