P&SP 7003 Special Report For Review of Dealer, Market Agency and P

Instructions to Complete
Special Report for Review of Dealer,
Market Agency and Packer Bonds.
Form P&SP-7003
As a business regulated by the Packers and Stockyards Act, you are required to file a special
report with the U.S. Department of Agriculture’s Packers and Stockyards Program (P&SP) on
Form P&SP-7003, Special Report for Review of Dealer, Market Agency and Packer Bonds.
Provide information for each line on the form that applies to the period specified in the cover
letter. If space provided for any item is not sufficient, attach additional pages containing the
information and make reference to the line number on the form
You must file the form by the date shown in the letter notifying you to file the special report.
You may be fined $110 for each day the report remains delinquent. All information must be
completed on this form in its entirety. Failure to do so will result in the form being
returned incomplete.
For questions about Form P&SP-7003, or additional copies of the form, please contact the PSP
Central Reporting Unit at 303-375-4264 or PSP-CRU.GIPSA@usda.gov. Forms and instructions
are also on GIPSA’s website at www.gipsa.usda.gov. Please fax the completed form to the
Central Reporting Unit at 314-457-4421, email to PSP-CRU.GIPSA@usda.govor mail to:

USDA PSP
P.O. Box 110639
Aurora, CO 80042

SECTION-BY-SECTION INSTRUCTIONS
GENERAL INFORMATION - SECTION 1
Enter information identifying the firm and contact information for the firm in the spaces
provided.
BOND INFORMATION – SECTION 2

Line 201: Enter number of public sale days held during the reporting period.
Line 202: Enter gross value of all livestock sold on commission.
Line 203: Enter total cost of livestock purchased on a dealer basis for registrant’s account
including clearees’ accounts if applicable.
Line 204: Enter total cost of livestock purchased for the accounts of others including clearees’
accounts if applicable.
Line 205: Enter the sum of lines 203 and 204.
Line 206: Enter total cost of livestock purchased for feeding.
Line 207: Enter total cost of livestock purchased for slaughter.
Line 208: Enter the sum of lines 206 and 207.
CERTIFICATION - SECTION 3
An owner, partner, officer of a corporation or a managing member in control of the entity must
sign the report. Any owner, officer, partner, or officer must sign the report. If the report is

P&SP Form 7003-i

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signed by a power of attorney, a copy of the power of attorney must be submitted with the
report.
Line 701-705: Enter the date the report was signed, the title or authority of the person signing the
report, phone number and signature as explained above.

P&SP Form 7003-i

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Business Entity ID Only

For P&SP Use Only

U.S. Department of Agriculture
Grain Inspection,
Packers and Stockyards

SPECIAL REPORT FOR REVIEW OF DEALER,
MARKET AGENCY AND PACKER BONDS

Administration

Packers and
Stockyards
Program

P&SP Bar Code Only

OMB No. 0580-0015
Expires: xx/xx/20xx

Instructions: If an item's value is zero, enter "0". If an item does not apply, enter "NA". Upon completion please verify that all items have been
answered. Return completed form to the appropriate P&SP regional office. See separate instructions for complete information about this report.

GENERAL INFORMATION - SECTION 1

101

Reporting Period
(mm/dd/yy)

a. from

b. to

102 Legal Business Name
103 Business Name (dba)
104 Mailing Address
105 City, State, Zip
106 Telephone Number
107 Fax Number
108 Contact Name
109 Contact Number
BOND INFORMATION - SECTION 2

Livestock Sold by a Market Agency:
201 Number of Public Sale Days that were held during this reporting period:
202 Gross Value of all Livestock Sold on Commission:

$

Livestock Purchased as a Dealer for their own account and on Commission for the accounts of others:
203 Total Cost of Livestock Purchased on a Dealer Basis for Registrant's Account - Include Clearees if Applicable:

$

204 Total Cost of Livestock Purchased for the Accounts of Others - Include clearees if Applicable:

$

205 Total Cost of Livestock Purchased:

$

Livestock Purchased as a Packer:
206 Total Cost of Livestock Purchased for Feeding:

$

207 Total Cost of Livestock Purchased for Slaughter:

$

208 Total Livestock Purchased:

$
CERTIFICATION - SECTION 3

Under the Packers and Stockyards Act any person who willfully makes, or causes any false entry or statement of fact in this report shall be deemed guilty of offense against the
United States, and be subject to a fine of $1,000 to $5,000, or to imprisonment for a term of not more than 3 years, or to both fine and imprisonment.
I certify that this report has been prepared by me or under my direction, and to the best of my knowledge and belief correctly reflects reporting entity operations.
701 Print Name
703 Phone Number

702 Signature (Must be signed by a person listed on 201-205)

704 Date

705 Title

Submitted information is confidential (9 CFR 201.96). Failure to report will result in forfeiture to the United States $110 per day until report receipt 7 (U.S.C. 222). This is a special
report to determine adequacy of bond requirements under the Packers and Stockyards Act. 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 0580-0015. The time required to complete this information collection is estimated to average 1 hour 30 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.
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.
Form 7003

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