DA-156 Request to Display Official Identification/Labels

Reproduce Locally. Include form number and edition date on all reproductions. Form Approved OMB No. 0581-0126

U. S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE DAIRY PROGRAMS REQUEST TO DISPLAY OFFICIAL IDENTIFICATION OR GRADE LABELS
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 control number for this information is 0581-0126. The time required to complete this information collection is estimated to average 1 minute per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection information. 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 for all programs.) Persons with disabilities who require alternative means for communications 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. USDA official identification or grade labels may not be used unless a completed application has been received and approved.
Application is hereby made, in accordance with the provisions of the appropriate sections of the Regulations Governing the Inspection and Grading of Manufactured or Processed Dairy Products (7 CFR, Ch. I, Part 58, Subpart A), or the Regulations Governing the Certification of Sanitary Design and Fabrication of Equipment Used in the Slaughter, Processing, and Packaging of Livestock and Poultry Products (7 CFR, Ch. I, Part 54, Subpart C), for the privilege of displaying official identification or grade labels on the following product packaging materials, equipment, utensils, or descriptive or promotional materials. The applicant (listed below) affirms compliance to the aforesaid regulations and such instructions as may be issued by the Administrator, Agricultural Marketing Service covering inspection, grading and evaluation of products, packaging materials, equipment, utensils, or descriptive or promotional materials, and attests that an approved Application To Use Official Identification or Grade Labels, Form DA-155 is on file with Dairy Programs. Three copies of the product packaging materials, or descriptive or promotional materials displaying the official identification or grade label are attached or, if this request has been faxed for review, are being mailed under separate cover.
Product packaging materials, equipment, utensils, or descriptive or promotional materials to display official identification or grade label (Brand name, item description, etc.):			Distributor if different from Applicant:
1.
2.
3.
4.
5.
Name, Address and Plant No. (if applicable) of Applicant:	Send this form and attached materials to: Grade Label Coordinator USDA/AMS/Dairy Programs Dairy Grading Branch Room 2746-S MS 0230 1400 Independence Ave. SW Washington, DC 20250-0230 Tel: 202-720-3171 Fax: 202-720-2643
Name and Title of Applicant Representative (Print or Type):	Telephone:				Fax:
Applicant Representative Signature:	Date:

Form DA-156 (01-09) Destroy all previous editions.