DA-156 Request to Display Official Identification/Labels

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Form Approved OMB No. 0581-0126

Reproduce Locally. Include form number and edition date on all reproductions.

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 3 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 information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age, disability,
and where applicable, sex (including gender identity and expression), marital status, familial status, parental status, religion, sexual orientation, political beliefs,
genetic information, 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).

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:

Email Address:

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:

Applicant Representative Signature:

Date:

Fax:

Form DA-156 (06-12) Destroy all previous editions.

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