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Form PSD 7003

Expires 02/28/2021

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Page 1 of 5

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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.

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Section 10 of the FTC Act, made applicable by Section 402 of the Act 7 86&
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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 is 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 1.5 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 Englis
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 7003

Expires 02/28/2021

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Instructions to Complete Special Report for Review of
Dealer, Market Agency and Packer Bonds
Form PSD 7003
As an entity 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 Division (PSD) on Form PSD 7003 Special
Report for Review of Dealer, Market Agency and Packer Bonds.
Provide information for each line on the form that that applies to the period specified in the request 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
Submit the completed form by the date showing in the letter notifying you to file the special report, to the
regional office of the Packers and Stockyards Division as listed below. You may be fined $569 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.
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 Drive 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: (303) 375-4240
Telephone: (515) 323-2579
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,
AB, AK, AZ, BC, CA, CO, HI, IA, IL, IN, KY, MB, MI, MN, MO,
LA, MA, MD, ME, MS, NC, NJ, ID, KS, MT, NM, NV, OK, OR, ND, NE, OH, ON, SD, WI
NL, NH, NY, PA, PR, QC, RI,
SK, TX, UT, WA, WY
SC, TN, VA, VT, WV
If you have any questions about the form or completing the form, please contact the appropriate regional
office of the Packers and Stockyards Division as listed above.
SECTION-BY-SECTION INSTRUCTIONS
FORM HEADER – BUSINESS ENTITY ID
Business Entity ID should be completed using information on request letter. You may also contact the
appropriate regional office as listed above to obtain this information

Form PSD 7003

Expires 02/28/2021

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Line No.
101
a and b
102
103
104
and
105
106
and
107
108
109
110
111
112
201
202
203
a
through
e
204
a
through
e

Subject

Instruction
GENERAL INFORMATION - SECTION
The reporting period covers the period of time specified in the
Reporting Period
request letter (FROM) [date], (TO) [date]. Please use the date
format MM/DD/YYYY
Enter the name under which you are registered with PSD.
Entity Name
Enter the trade name under which you operate. This is the
Trade Name/d.b.a.
name the business uses, if applicable. If you do not operate
with a “Trade Name/d.b.a,”, enter N/A.
Mailing Address
Enter your mailing address (street, city, state, and zip+4). This
is the address where all correspondence from PSD should be
sent.
Operating Address
Enter the physical location of your operating address (street,
city, state, and zip+4). This is the address where you conduct
your business services.
Contact Name
Enter the name of the person to be contacted regarding
questions on the annual report.
Contact Telephone
Enter the telephone where the contact person may be reached.
Fax
Enter the Fax used by the entity.
E-Mail Address
Enter the entity’s e-mail address.
Web Site Address (if
Enter the complete Web site address the business operates.
applicable)
For example: www.WebSiteName@domain.com
BOND INFORMATION – SECTION 2
Number of Public Sale
Enter the number of day’s livestock sales were conducted by
Days
the market.
Gross Value of Livestock
Enter the gross value of livestock sold on commission, for
each category of livestock, during the reporting period.
Cost of livestock
Enter the cost for each category of livestock, and the total cost
purchased as a dealer
of livestock purchased on a dealer basis during the reporting
period.
Cost of livestock bought
on commission

205

Combined cost of
livestock, per quarter

206

Type of Livestock
Purchased

207

Livestock Purchased for
Feeding

Form PSD 7003

Enter the cost for each category of livestock and the total cost
of livestock purchased as an order buyer during the reporting
period. You must include all livestock that you bought on
commission regardless whether you or another entity paid for
it.
Enter the combined cost of livestock purchased as a dealer,
and bought on commission, per quarter, during the reporting
period.
Check the appropriate box to indicate the type of livestock the
entity purchased for slaughter and/or feeding, during the
reporting period.
Enter the gross dollar amount of all livestock purchased for
feeding, during the reporting period.

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Line No.
208
209
301
302
303
304
305

Subject
Instruction
Livestock Purchased for
Enter the gross dollar amount of all livestock purchased for
Slaughter
slaughter, during the reporting period.
Total Livestock Purchased Enter the sum total of lines 208 and 209.
CERTIFICATION – SECTION 3
Print Name
Print the name of the owner, officer, partner, or member
responsible for this report.
Signature
The report must be signed by a responsible person.
Phone Number
Enter the phone number of the person signing the report.
Date
Enter the date the report is signed.
Title
Enter the title of the person signing the report.

Form PSD 7003

Expires 02/28/2021

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