HOURS OF OPERATION

USDA, FSIS, OIEA, ELD

1400 Independence Avenue, SW

Stop Code 3753, PP3, Cubicle 8-235A

Washington, D.C. 20250-3700

EPBCorrespondence@fsis.usda.gov

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 0583-0128. The time required to complete this information collection

is estimated to average 15 minutes 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.

U.S. DEPARTMENT OF AGRICULTURE

FOOD SAFETY AND INSPECTION SERVICE

OFFICE OF INVESTIGATION, ENFORCEMENT AND AUDIT

REGISTRATION OF

MEAT AND POULTRY HANDLERS

DISTRIBUTION: RETAIN ONE COPY FOR YOUR FILES, AND RETURN

ONE COPY OF THIS FORM TO:

NOTICE TO MEAT AND POULTRY HANDLERS

2. NAME AND MAILING ADDRESS OF REGISTRANT (Include Zip Code)

4. NATURE OF BUSINESS (Check all that apply)

MEAT OR MEAT 

PRODUCTS 

POULTRY OR POULTRY 

PRODUCTS

5. CHECK EACH TYPE OF BUSINESS YOU ARE ENGAGED IN 

DOMESTIC BROKER RENDERER ANIMAL FOOD 

MANUFACTURER

PUBLIC WAREHOUSEMAN WHOLESALER

Buying, selling, transporting, or importing any dead, dying, disabled, or diseased amendable species or parts of the carcasses

of any such amenable species that died otherwise than by slaughter. (4D operator)

6. Address(es) of subsidiaries, branches, or divisions of your organization which engage in business of the type identified in Item 4. 

Include trade or other names if different from your organization's. (If none, state none)

CHANGES: If you make any changes in the names, including trade names, or addresses of the place or places where you do business, report

such changes within 15 days to address in upper right corner.

CERTIFICATION BY FIRM OFFICIAL

7. TYPED OR PRINTED NAME 8. TITLE 9. SIGNATURE 10. DATE

FSIS FORM 5020-1 (05/11/2015) REPLACES FSIS FORM 5020-1 (2/2/2007), WHICH IS OBSOLETE

PAGE 1 OF 2

PHONE: E-MAIL:

IMPORT BROKER

SILURIFORMES FISH OR 

SILURIFORMES FISH 

PRODUCTS

a. REGISTRATION NO.

NOTICE OF REGISTRATION BY USDA (COMPLETED BY USDA OFFICIAL)

b. DATE OF REGISTRATION c. TITLE OF USDA OFFICIAL d. SIGNATURE OF USDA OFFICIAL

ORIGINAL UPDATE REGISTRATION NO.

2a. PHYSICAL ADDRESS OF REGISTRANT (Include Zip Code) (if different from # 2.) 

PHONE: E-MAIL:

(Check or specify)

INDIVIDUALLY OWNED

INCORPORATED PARTNERSHIP

 COOPERATIVE 

ASSOCIATION

OTHER Specify

LIMITED LIABILITY 

CORPORATION

3. FORM OF ORGANIZATION 

SILURIFORMES FISH 

FARM/POND

SILURIFORMES FISH 

TRANSPORTER

Unless you operate under Federal Inspection, you are required by law to register with the U.S. Department of Agriculture if you deal in meat or poultry products or Siluriformes in 

or for commerce. (The term "commerce" means commerce between any State, any territory, or the District of Columbia, and any place outside thereof; or within any territory not 

organized with a legislative body, or the District of Columbia, or within a State or Territory that has been designated for 21 U.S.C. 643 and/or 21 U.S.C. 460 because such State 

or Territory does not operate a program of its own.) 

 

INSTRUCTIONS: Complete items 1 through 10 and send 2 copies to the address in the upper right corner. USDA will return one copy of the completed registration to the 

registrant in item 2.

1. Check the "original" box to indicate first time registration or check the "update" box for any changes to original form and highlight the changed information. 

 (When submitting an update, please specify the registration number.) 

 
INSTRUCTIONS FOR FSIS FORM 5020-1,

REGISTRATION OF MEAT AND POULTRY HANDLERS

PAGE 2 OF 2

OFFICIAL OF THE "MEAT AND POULTRY HANDLING" FIRM REQUIRED TO REGISTER: COMPLETE

BLOCKS 1-10 BEFORE SUBMITTING THE FORM TO FSIS.

Enter the entire name and mailing address of the registering firm, include the phone number and an

e-mail address.

Check the box that describes the "Form of Organization" of the registering firm's organization.

Check the box that best describes the nature of the registrant's business. 

Print or type the name of the registering official.

Print or type the title of the registering official.

Signature of the registering official (can be signed electronically or printed and signed).

Enter the date when the registering official signs the form.

Block 2.

Block 3.

Block 4.

Block 6. 

Block 7.

Block 8.

Block 9.

Block 10.

Block 1. Check the box that best describes the nature of the application (original for first time registrations), or 

update to request changes (specify the registration number and highlight the changes). 

Block 2a. Enter the physical address of the registering firm (if different from #2).

Enter the address or addresses of subsidiaries, branches, or divisions of the registrants as names, trade 

names, or names that are different than the name entered in block 1. Include the phone number, an 

e-mail address, and the hours of operation for each subsidiary, branch, or division. Attach additional 

sheets if necessary.

Check all the boxes that describe the "Type of Business" that the registrant is engaged in. 

Note: Only those Siluriformes farms/ponds and transporters sending fish to FSIS inspected 

establishments are to register. If your farm/pond or your transportation does not supply to an FSIS 

inspected establishment, you do not need to register those farms/ponds or transporters.

Block 5.