PSD- 4500 Grain Hopper Test Report

OMB Control No. 0581-0308

U.S. DEPARTMENT OF AGRICULTURE
AGRICULTURAL MARKETING SERVICE
FAIR TRADE PRACTICES PROGRAM
PACKERS AND STOCKYARDS DIVISION
2a. Test Agency

3a. Scale Owner

b. Address

b. Physical Address of Scale

c. City

d. State e. Phone

4. Indicator Manufacturer
8. Scale Capacity
lbs.

lbs.

12. Test Date (mm/dd/yyyy)

f. E-mail

c. City

5. Serial Number

9. Scale Division

1. Page

Hopper Test Report

d. State

6. Model Number 7. Type of Indicator
Beam
Dial
11. Scale and Computer interfaced
Yes

10. Accuracy Class
Not Marked
Marked III

Digital
No

If yes, list system _____________________________________________

13. Previous Test Date (mm/dd/yyyy)
Test Data

14. SR (Sensitivity Response) or Discrimination Test – As Found

Zero Load = __________ lb.

15. Increasing Load Test
Feed
(15a)

16. Test Results

Balance Weights
(15b)

Test Weights
(15c)

Maximum Load = _______________ lb.
15. Increasing Load Test

Error Weights
(lbs.) (15d)

Feed
(15a)

Balance Weights
(15b)

Marking approved indicates that the errors indicated on this test report are within the
accuracy requirements specified in National Institute of Standards and Technology
(NIST) Handbook 44 as required in the regulations (9 CFR 201.71)

Test Weights
(15c)

Error Weights
(lbs.) (15d)

Approved
Condemned
Rejected
Other ___________

17. Remarks (If serial number has changed, please note here)

18. Receipt of Report Acknowledged (Signature):

19. Scale Inspector (Signature):

Response is required to assure that tests are made on feed scales, and to show accuracy of scales used to weigh feed when feed weight is a factor in determining payment or
settlement for livestock or live poultry. (9 CFR 201.72.) 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 .75 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 provide 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 4500

Expires 02/28/2021

Page 1 of 3

Instructions to Complete Hopper Scale Test Report Form PSD 4500
Submit the completed form to the appropriate regional office of the Packers and Stockyards Division
as listed below. The states covered by each regional office are listed below its address.
Regional Offices of the Packers and Stockyards Division
Agricultural Marketing Service, Fair Trade Practices Program
Atlanta Regional Office
Denver Regional Office
Des Moines Regional Office
75 Ted Turner Dr., SW, Suite 230 3950 Lewiston St., Suite 200
210 Walnut Street, Room 317
Atlanta, GA 30303-3308
Aurora, CO 80011-1556
Des Moines, IA 50309-2110
Telephone: (404) 562-5840
Telephone: (515) 323-2579
Telephone: (303) 375-4240
FAX: (404) 562-5848
FAX: (303) 371-4609
FAX: (515) 323-2590
e-mail:
e-mail:
e-mail:
PSDAtlantaGA@usda.gov
PSDDenverCO@usda.gov
PSDDesMoinesIA@usda.gov
States Covered
States Covered
States Covered
AL, AR, CT, DC, DE, FL, GA,
AK, AZ, CA, CO, HI, ID, KS,
IA, IL, IN, KY, MI, MO, MN, ND,
LA, MA, MD, ME, MS, NC, NH, MT, NM, NV, OK, OR, TX, UT, NE, OH, SD, WI
NJ, NY, PA, PR, RI, SC, TN, VA, WA, WY
VT, WV
If you have any questions regarding this form, please contact the appropriate regional office of the
Packers and Stockyards Division listed above. If additional forms are needed, please visit our website
at https://www.ams.usda.gov/.
Line
Number
1

2
a.
through
e.
3
a
through
e.
4

Subject
Page Number

5

Testing Agency,
Address, City,
State, Phone, and
Email
Scale Owner,
Address, City,
State, Phone, and
Email
Indicator
Manufacturer
Serial Number

6

Model Number

Form PSD 4500

Instruction
The page number is normally 1 of 1. If additional space is
needed or when testing multiple indicator/platform
installations, number pages identifying the current page
number and the total number of pages. For example, page 2
of 3.
Enter the name, address, city, state, zip code, phone number,
and e-mail address of the scale test agency

Enter the name, address, city, state, zip code, phone
number, and e-mail address of the scale owner or operator.

Enter the name of the manufacturer of the beam, dial or digital
indicator
Enter the serial number of the indicator being tested. If the
serial number has changed since the last test, show the previous
serial number in the remarks.
Enter the model number from the manufacturer’s ID plate.

Expires 02/28/2021

Page 2 of 3

Line
Number
7
8

Subject

Instruction

Type of Indicator
Scale Capacity

Check the appropriate box to indicate the type of indicator
Enter the total scale capacity (maximum nominal capacity), in
pounds.

9
10

Scale Division
Accuracy Class

Enter the minimum scale division quantity, in pounds.
Check the appropriate box to indicate the class of scale
(Marked III or Not Marked).

11

Computer
Interfaced

Indicate if the scale is interfaced with a computer. If yes,
list the computer system used.

12
13

Test Date
Last Test Date

Enter the date (month, day, and year) you tested the scale.
Enter the date (month, day, and year) the scale was last tested.

14
15
a.
through
d.

Test Data
Sensitivity
Enter the sensitivity response (SR) on beam scales or the
Response or
discrimination on dial and digital scales, in pounds, at zero
Discrimination
and maximum test loads.
Increasing load test For the increasing load test, enter, in pounds, the weight of
feed used, balance weights, test weights, weight indication,
error weights, and error.
NOTE: The weight shown on the indicator after removing
the error weights is NOT entered on the form. The amount
of the error will be the difference between column d and the
amount shown on the indicator after removing the error
weights.

16

Test Results

The State official or the scale company that conducted the
test enters the test results.

17

Remarks

18

Receipt Signature

Use the “Remarks” section to enter needed explanations,
comments, adjustments you made, recommendations
needed to correct a defective condition, etc. If the serial
The owner or responsible person must sign the form
acknowledging receipt of a copy of the test report form.

19

Inspector Signature The scale inspector or person(s) testing the scale must sign
the test report form.

Form PSD 4500

Expires 02/28/2021

Page 3 of 3