Postage Statement Periodicals One Issue or One Edition Unless Used as a Consolidated Statement
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1 United States Postal Service Postage Statement Periodicals One Issue or One Edition Unless Used as a Consolidated Statement Post Office: Note Mail Arrival Date & Time (Do Not Round-Stamp) Publication Title and Owner or News Agent Name Mailing Agent (Printer or Consolidator) Name, Address, Telephone, Entry Post Office Name, State, and ZIP+4 Mailer CAPS Cust. Ref. No. Printer/Consolidator Imprint Permit No. CRID CRID Mailing Publication No. Edition/Code Mailer s Mailing Date Statement Seq. No. For Automation Pieces, Enter Date of Address Matching and Coding Issue Date Issue Frequency Price Category Regular Nonprofit Classroom Science-of-Agriculture Weight per Copy for Issue (Round off to 4 decimal places if necessary). pounds Advertising Percentage in This Issue. % Weight of a Single Ride-Along Piece. pounds Statement for bundles/containers only (if applicable) Number of Addressed Pieces Excluding Addressed Supplements Combined Mailing Mixed Class Single Class Processing Category Letters Flats Parcels Number of Addressed Supplements In-County Outside- County / / For Carrier Route Pieces, Enter Date of Address Matching and Coding / / For Carrier Route Pieces, Enter Date of Carrier Route Sequencing / / For Pieces Bearing a Simplified Address Enter Date of Delivery Statistics File or Alternative Method / / No. and type of Containers (Enter total number of containers.) Trays Sacks Pallets Consolidated Postage Statement Yes No Applicable Parts Completed (Select all that apply): A B E F Part A In-County Prices Part A (page 2) (Postmaster: Report total Part A postage in AIC 224) Part B Outside-County Pound Prices Part B (page 3) Part C Outside-County Piece Prices Part C (page 4) Part D Outside-County Bundle Prices Part D (page 5) Postage Part E Outside-County Sack/Tray/Pallet Prices Part E (pages 6 & 7) Outside-County Postage Subtotal Parts B, C, D & E Preferred Price Discount Nonprofit, Classroom, Limited Circulation, Limited Circulation Science of Agriculture (Add line B17, and parts C, D, and E s) X.05 (all others enter zero) - Subtract the Preferred Price Discount from the Outside-County Postage = Part F Outside-County Ride-Along (page 8) + Outside-County Postage (Postmaster: Report total Outside-County postage in AIC 135) Add In-County Postage and Outside-County Postage Postage (AIC AIC 135) Certification The signature of the owner of the publication certifies acceptance of liability for and agreement to pay any revenue deficiencies assessed on this mailing, subject to appeal. If an agent signs this form, the agent certifies that he or she is authorized to sign on behalf of the owner of the publication and that the owner of the publication is bound by the certification and agrees to pay any deficiencies. In addition, agents may be liable for any deficiencies resulting from matters within their responsibility, knowledge, or control. The owner of the publication hereby certifies that all information furnished on this form is accurate, truthful, and complete; that the mail and the supporting documentation comply with all postal standards and that the mailing qualifies for the prices and fees claimed; and that the mailing does not contain any matter prohibited by law or postal regulation. I understand that anyone who furnishes false or misleading information on this form or who omits information requested on this form, may be subject to criminal and/or civil penalties, including fines and imprisonment. Privacy Notice: For information regarding our Privacy Policy visit Signature of Owner or Agent Printed Name of Owner or Agent Name and Telephone of Contact Person in Publisher s Office USPS Use Only To be completed in non-postalone! sites Post Office Computed Weight per Copy (Round off to 4 decimal places if necessary). pounds USPS Employee s Signature Print USPS Employee s Name Time AM PM Round Stamp (Required) Payment Date PS Form , January 2018 (Page 1 of 8) PSN This form and mailing standards are available on Postal Explorer at pe.usps.com.
2 Part A In County Pound Price Entry Subscriber or Requester Copies Nonsubscriber or Nonrequester Copies Copies Pounds Price Postage A1 DDU $0.156 A2 None A3 Pound Price Postage (add lines A1 and A2) Piece Price (Presort) A4 Entry/Zone Presort Discount Copies Addressed Pieces Price Postage Nonautomation $0.164 A5 Basic Automation Letters A6 Automation Flats A7 Nonautomation A8 3-Digit Automation Letters A9 Automation Flats A10 Nonautomation A11 5-Digit Automation Letters A12 Automation Flats A13 Basic A14 Carrier Route High Density A15 Saturation A16 Presort Subtotal (Add lines A4 A15) A17 Number of Addressed Pieces at DDU Prices A18 Piece Price Subtotal (A16 minus A17) Full Service Intelligent Mail Option A19 Number of Pieces that Comply x $0.001 = A20 Periodicals In-County Subtotal (A18 minus A19) Ride-Along Price (Must equal the number of copies in line A16, not number of addressed pieces) Copies Addressed Pieces Price Postage A21 Ride-Along Pieces $0.176 Part A (Add lines A3, A20 and A21). Postmaster: Report in AIC 224 PS Form 3541, January 2018 (Page 2 of 8)
3 Part B Outside-County Pound Prices For Nonprofit & Classroom: All commingled nonsubscriber or nonrequester copies over the 10% limit must pay regular prices & use a separate PS Form Advertising Pound Prices Entry Zone Subscriber or Requester Copies Nonsubscriber or Nonrequester Copies Copies Pounds Advertising Pounds Reg Price Sci/Ag B1 DDU $0.120 $0.090 B2 DSCF B3 DADC B4 1 & B B B B B B B Postage B12 Subtotal (Add lines B1 B11) Nonadvertising Pound Prices Price Pounds minus Advertising Pounds equals Nonadvertising Pounds x Reg Sci/Ag B13 DDU (From B1) (From B1) $0.088 $0.088 B14 DSCF (From B2) (From B2) B15 DADC (From B3) (From B3) B16 All Others (From B4 B11) (From B4 B11) Postage B17 Subtotal (Add lines B13 B16) Pound Price Postage (Add lines B12 and B17) Nonadvertising Pound Prices Alternate (Nonprofit and Classroom publications with 10% or less advertising, or other publications with 0% advertising.) Entry Zone Subscriber or Requester Copies Nonsubscriber or Nonrequester Copies Copies Pounds Reg Price Sci/Ag B13 DDU $0.088 $0.088 B14 DSCF B15 DADC B16 All Others Postage B17 Subtotal (Add lines B13 B16) Part B Pound Price (Add lines B12 and B17) PS Form , January 2018 (Page 3 of 8) PSN
4 Part C Outside-County Piece Prices Machinable Flats Level Price Level Copies Addressed Pieces Price Postage C1 Barcoded $0.490 Mixed ADC C2 Nonbarcoded C3 Barcoded ADC C4 Nonbarcoded C5 Barcoded Digit/SCF C6 Nonbarcoded C7 Barcoded Digit C8 Nonbarcoded Nonmachinable Flats Level Price Level Copies Addressed Pieces Price Postage C9 Barcoded $0.672 Mixed ADC C10 Nonbarcoded C11 Barcoded ADC C12 Nonbarcoded C13 Barcoded Digit/SCF C14 Nonbarcoded C15 Barcoded Digit C16 Nonbarcoded Parcels Level Copies Addressed Pieces Price Postage C17 Mixed ADC $0.672 C18 ADC C19 3-Digit/SCF C20 5-Digit Letters Level Price Level Copies Addressed Pieces Price Postage C21 Mixed ADC Barcoded $0.341 C22 Nonbarcoded C23 ADC Barcoded C24 Nonbarcoded C25 3-Digit/SCF Barcoded C26 Nonbarcoded C27 5-Digit Barcoded C28 Nonbarcoded Carrier Route & Firm Bundles Level Copies Addressed Pieces Price Postage C29 Basic $0.205 C30 High-Density C31 Saturation C32 Firm Bundle (Use Addressed Pieces to calculate postage.) C33 Subtotal (Add lines C1 C32) C34 Nonadv. % (100 minus adv. %) x # of addressed pieces (C33) x $ C35 Subtotal Outside-County Piece Prices (Line C33 minus C34) Full Service Intelligent Mail Option C36 Number of Pieces that Comply x $0.001 = Part C (Line C35 minus C36) PS Form 3541, January 2018 (Page 4 of 8)
5 Part D Outside-County Bundle Prices Container Level Bundle Level Bundles Price Postage D1 Mixed ADC $0.212 D2 ADC D3 3-Digit/SCF Mixed ADC D4 5-Digit D5 Carrier Route D6 Firm D7 ADC D8 3-Digit/SCF D9 ADC 5-Digit D10 Carrier Route D11 Firm D12 3-Digit/SCF D13 5-Digit SCF/3-Digit D14 Carrier Route D15 Firm D16 5-Digit D17 CR/5-Digit Carrier Route D18 Firm Part D (Add lines D1 D18) PS Form January 2018 (Page 5 of 8) PSN
6 Part E Outside-County Sack Prices Container Level Entry Sacks Price Postage E1 Origin NDC $0.627 E2 Origin ADC Mixed ADC Sack E3 Origin SCF E4 Origin Post Office/DMU E5 Origin NDC E6 Origin ADC E7 Origin SCF ADC Sack E8 Origin Post Office/DMU E9 Destination NDC E10 Destination ADC E11 Origin NDC E12 Origin ADC E13 Origin SCF E14 3-Digit/SCF Sack Origin Post Office/DMU E15 Destination NDC E16 Destination ADC E17 Destination SCF E18 Origin NDC E19 Origin ADC E20 Origin SCF E21 5-Digit/Carrier Origin Post Office/DMU E22 Route Sack Destination NDC E23 Destination ADC E24 Destination SCF E25 DDU PS Form 3541, January 2018 (Page 6 of 8) Part E continued on next page
7 Part E Continued Outside-County Tray Prices Container Level Entry Trays Price Postage E26 Origin NDC $0.627 E27 Origin ADC Mixed ADC Tray E28 Origin SCF E29 Origin Post Office/DMU E30 Origin NDC E31 Origin ADC E32 Origin SCF ADC Tray E33 Origin Post Office/DMU E34 Destination NDC E35 Destination ADC E36 Origin NDC E37 Origin ADC E38 Origin SCF E39 3-Digit/SCF Tray Origin Post Office/DMU E40 Destination NDC E41 Destination ADC E42 Destination SCF E43 Origin NDC E44 Origin ADC E45 Origin SCF E46 5-Digit/Carrier Origin Post Office/DMU E47 Route Tray Destination NDC E48 Destination ADC E49 Destination SCF E50 DDU E51 Part E Sack and Tray (Add lines E1 E50) Part E continued on next page PS Form , January 2018 (Page 7 of 8) PSN
8 Part E Continued Outside-County Pallet Prices Container Level Entry Pallets Price Postage E52 Origin NDC $8.093 E53 Origin ADC Mixed ADC Pallet E54 Origin SCF E55 Origin Post Office/DMU E56 Origin NDC E57 Origin ADC E58 Origin SCF ADC Pallet E59 Origin Post Office/DMU E60 Destination NDC E61 Destination ADC E62 Origin NDC E63 Origin ADC E64 Origin SCF E65 3-Digit/SCF Pallet Origin Post Office/DMU E66 Destination NDC E67 Destination ADC E68 Destination SCF E69 Origin NDC E70 Origin ADC E71 Origin SCF E72 5-Digit Pallet Origin Post Office/DMU E73 Destination NDC E74 Destination ADC E75 Destination SCF E76 Origin NDC E77 Origin ADC E78 Origin SCF E79 Origin Post Office/DMU Carrier Route Pallet E80 Destination NDC E81 Destination ADC E82 Destination SCF E83 DDU E84 Part E Pallet (Add lines E52 E83) Part E (Add lines E51 and E84) Part F Ride-Along Price (Outside-County Only) Ride-Along Price (Must equal the number of copies, not number of addressed pieces) Copies Addressed Pieces Price Postage F1 Ride-Along Pieces $0.176 Part F (Line F1) PS Form 3541, January 2018 (Page 8 of 8)
9 Periodicals Instructions Use this form for Periodicals mailings. Step 1: Complete Mailer and Mailing sections on page 1. List all containers in the Number and Type of Containers field. You must select either Yes or No under Consolidated Postage Statement. Step 2: Before you complete the Postage section, go to parts A through E and complete the part(s) that pertain to your mailing. Pieces that comply with the Full-Service Intelligent Mail option requirements are additionally reported on the line provided. The following information will help you determine which parts to complete: Part A: In-County piece and pound prices. Part B: Outside-County pound prices. Part C: Outside-County piece prices. Part D: Outside-County bundle prices. Part E: Outside-County sack/tray/pallet prices. Part F: Outside-County Ride-along prices. Step 3: Complete only applicable part(s), as follows: 1. For In-County mailings, complete only part A. 2. For Outside-County mailings, complete applicable parts B through F. Step 4: Go to the Postage Section on page 1. Add postage from Part box for each completed part. Bring these totals forward to front page and insert in appropriate box. For outside-county sack/tray/pallet prices, complete distribution section in order to determine Part E total. Add all parts together to get Postage. Step 5: Read and sign the Certification section, including your telephone number. Attach all completed pages together to submit with the mailing. (Do not include blank pages.) For more information on mailing standards, prices, and fees please go to Postal Explorer at pe.usps.com. PS Form 3541, January 2018 (Instructions)
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