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U.S. DEPARTMENT OF AGRICULTURE AGRICULTURAL MARKETING SERVICE LIVESTOCK AND POULTRY PROGRAM REGISTRATION OF SHELL EGG HANDLER RETURN THIS REPORT TO: Email: ses@usda.gov Livestock and Poultry Program, AMS U.S. Department of Agriculture 1400 Independence Ave., SW; MAIL STOP 0258 Washington D.C. 20250-0258 No shell egg handler (except a producer - packer with a flock of 3,000 hens or less) who grades and packs eggs for the ultimate consumer may start operations until a registration form has been properly completed and submitted (7 CFR 57.690).

Instructions: Complete and return the original copy to the address shown in the upper middle section. Keep one copy for your records (optional). If more space is needed, use the reverse of the form. Please print or type. FOR USDA USE ONLY

HANDLER NAME: REGISTRATION NUMBER DATE OF REGISTRATION

EMAIL: STATE COUNTY HANDLER

PHONE NUMBER:

STREET ADDRESS: SIGNATURE AND TITLE OF USDA OFFICIAL:

CITY, STATE, ZIP CODE: REMARKS:

COUNTY IN WHICH BUSINESS IS LOCATED:

PLEASE LIST BELOW IF MAILING ADDRESS DIFFERS FROM STREET ADDRESS:

MAILING ADDRESS:

CITY, STATE, ZIP CODE:

NATURE OF BUSINESS: (Check as appropriate) PRODUCER/PACKER with more than 3,000 birds [F2] [F8] GRADING STATION

OTHER (Specify) ____________________

Do you pack shell eggs in consumer size containers? ____________________ Do you sell eggs directly to consumers on retail egg routes? ____________________

Do you sell eggs in consumer size containers to retailers or brokers who in turn sell them to retail distributors? ____________________

Do you sell eggs directly to institutional type users (i.e., restaurants, schools, hospitals, etc.)? ____________________

CERTIFICATION OF INDUSTRY PERSONNEL PREPARING REPORT

DATE: TITLE: TYPED OR PRINTED NAME: SIGNATURE:

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 0581-0113. The time required to complete this information collection is estimated to average 20 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, 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, employer, and lender.

Public Law 91-597 enacted by the 91st Congress of the United States referred to as the “Egg Products Inspection Act” places restrictions upon the disposition of certain qualities of shell eggs effective July 1, 1972.

Producers having 3,000 or less hens and producers who do not pack eggs for sale to the ultimate consumer exclusive of sales direct to consumers on the producer's premises are exempt.

To carry out the provisions of this Act, it is necessary that all persons who pack eggs for consumer outlets, including producer-packers that have more than 3,000 hens, persons who operate grading stations, and persons who have hatcheries are to complete the attached registration form and return it to the address shown in the upper middle section of the form. Keep one copy of this form for your records. You will receive a copy of this form showing your registration number after it has been assigned.

The Act and the regulations issued pursuant thereto require specific labeling and handling for restricted eggs and the maintenance of records of production, bills of sale, inventories (by class and quantities of product), receipts, shipments, dates of shipment and receipt, carrier names, and shippers and receivers names.