OMB Control No. 0581-0308 

U.S. Department of Agriculture 

Agricultural Marketing Service 

Fair Trade Practices Program 

Packers and Stockyards Division 

APPLICATION FOR REGISTRATION 

PACKER BUYER 

Buying only for Slaughter as an Employee of a Meat Packer 

(Under the Packers and Stockyards Act, 1921, as Amended and Supplemented) 

1. Name of Applicant to Be Registered (Individual or Firm) 

2a. Mailing Address 

2b. City 2c. County 2d. State 2e. Zip+4 

3a. Operating Address (If different from mailing address listed above) 

3b. City 3c. County 3d. State 3e. Zip+4 

4. Telephone 5. Cell Phone 6. Fax 

7. E-Mail Address 

8. Type of Livestock To Be Purchased for Slaughter (Check all that Apply) 

Steers and Heifer 

□ Cows and Bulls 

□ 

□ 

□ 

□ 

Calves □ 

Swine 

Sheep and Goats 

Horses and Mules 

9. Names and Locations of Posted Stockyards, Feedlots, or Web Sites where you will purchase livestock 

10. If you operate a buying station for your employer, list name, city, state and zip +4 

11. If previously registered list all registered name(s) and address(es) 

12. Do you own an interest in other dealer organization(s), market agency(s), stockyard company(s), or packing company(s)? If yes, complete the table below. If not, 

go to item no. 13 in the form. 

Yes No 

12a. Name of other Organization 12b. Location (City, State, Zip+4 Code) 12c. % Control by 

Applicant 

Form PSD 1100 Expires 01/31/2025 Page 2 of 2 
 

 

OMB Control No. 0581-0308 

CERTIFICATION: With my signature, I certify the information provided on this form is true and correct to the best of my knowledge and 

belief I am an owner, officer, or have been authorized by responsible management to certify this report. 

13a. Signature of Applicant: 13b. Print name of Applicant: 13c. Date: 

PACKER EMPLOYER 

CERTIFICATION: The above applicant is employed by our firm to buy the livestock identified on line 8 for slaughter purposes only. 

14a. Signature of Employer: 14b. Print name: 14c. Date: 

15. Official Title: 

16. Name of Firm: 

17. Address: 18. Telephone: 

19. Email Address: 20. Website, if applicable: 

Do Not Complete: Completed by Packers & Stockyards Division 

Registration No. 

Date of Acceptance 

Remarks: 

Registration is required in order to operate as a market agency or dealer subject to the Packers and Stockyards Act, 1921, as amended and supplemented, and 9 CFR 

201.10 (a). Information held confidential (9 CFR 201.96) 

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 1.50 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 1100 Expires 01/31/2025 Page 2 of 2