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, Email 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 224 + 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 www.usps.com. 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 3541-1, January 2018 (Page 1 of 8) PSN 7530-07-000-6222 This form and mailing standards are available on Postal Explorer at pe.usps.com.
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 0.204 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 0.066 A6 Automation Flats 0.132 A7 Nonautomation 0.143 A8 3-Digit Automation Letters 0.056 A9 Automation Flats 0.125 A10 Nonautomation 0.127 A11 5-Digit Automation Letters 0.054 A12 Automation Flats 0.116 A13 Basic 0.066 A14 Carrier Route High Density 0.049 A15 Saturation 0.034 A16 Presort Subtotal (Add lines A4 A15) A17 Number of Addressed Pieces at DDU Prices 0.008 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)
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 3541. 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 0.176 0.132 B3 DADC 0.188 0.141 B4 1 & 2 0.212 0.159 B5 3 0.230 0.230 B6 4 0.291 0.291 B7 5 0.364 0.364 B8 6 0.445 0.445 B9 7 0.539 0.539 B10 8 0.623 0.623 B11 9 0.623 0.623 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) 0.132 0.132 B15 DADC (From B3) (From B3) 0.141 0.141 B16 All Others (From B4 B11) (From B4 B11) 0.157 0.157 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 0.132 0.132 B15 DADC 0.141 0.141 B16 All Others 0.157 0.157 Postage B17 Subtotal (Add lines B13 B16) Part B Pound Price (Add lines B12 and B17) PS Form 3541-3, January 2018 (Page 3 of 8) PSN 7530-07-000-6223
Part C Outside-County Piece Prices Machinable Flats Level Price Level Copies Addressed Pieces Price Postage C1 Barcoded $0.490 Mixed ADC C2 Nonbarcoded 0.535 C3 Barcoded 0.441 ADC C4 Nonbarcoded 0.474 C5 Barcoded 0.390 3-Digit/SCF C6 Nonbarcoded 0.416 C7 Barcoded 0.314 5-Digit C8 Nonbarcoded 0.317 Nonmachinable Flats Level Price Level Copies Addressed Pieces Price Postage C9 Barcoded $0.672 Mixed ADC C10 Nonbarcoded 0.672 C11 Barcoded 0.569 ADC C12 Nonbarcoded 0.579 C13 Barcoded 0.529 3-Digit/SCF C14 Nonbarcoded 0.530 C15 Barcoded 0.397 5-Digit C16 Nonbarcoded 0.398 Parcels Level Copies Addressed Pieces Price Postage C17 Mixed ADC $0.672 C18 ADC 0.579 C19 3-Digit/SCF 0.530 C20 5-Digit 0.398 Letters Level Price Level Copies Addressed Pieces Price Postage C21 Mixed ADC Barcoded $0.341 C22 Nonbarcoded 0.535 C23 ADC Barcoded 0.304 C24 Nonbarcoded 0.474 C25 3-Digit/SCF Barcoded 0.284 C26 Nonbarcoded 0.416 C27 5-Digit Barcoded 0.216 C28 Nonbarcoded 0.317 Carrier Route & Firm Bundles Level Copies Addressed Pieces Price Postage C29 Basic $0.205 C30 High-Density 0.168 C31 Saturation 0.147 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 $0.0011 0.207 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)
Part D Outside-County Bundle Prices Container Level Bundle Level Bundles Price Postage D1 Mixed ADC $0.212 D2 ADC 0.610 D3 3-Digit/SCF 0.715 Mixed ADC D4 5-Digit 0.761 D5 Carrier Route 0.998 D6 Firm 0.396 D7 ADC 0.366 D8 3-Digit/SCF 0.459 D9 ADC 5-Digit 0.516 D10 Carrier Route 0.770 D11 Firm 0.306 D12 3-Digit/SCF 0.344 D13 5-Digit 0.387 SCF/3-Digit D14 Carrier Route 0.558 D15 Firm 0.257 D16 5-Digit 0.343 D17 CR/5-Digit Carrier Route 0.156 D18 Firm 0.106 Part D (Add lines D1 D18) PS Form 3541-5 January 2018 (Page 5 of 8) PSN 7530-10-000-0501
Part E Outside-County Sack Prices Container Level Entry Sacks Price Postage E1 Origin NDC $0.627 E2 Origin ADC 0.627 Mixed ADC Sack E3 Origin SCF 0.627 E4 Origin Post Office/DMU 0.627 E5 Origin NDC 2.415 E6 Origin ADC 2.415 E7 Origin SCF 2.415 ADC Sack E8 Origin Post Office/DMU 2.415 E9 Destination NDC 1.639 E10 Destination ADC 0.952 E11 Origin NDC 2.546 E12 Origin ADC 2.546 E13 Origin SCF 2.546 E14 3-Digit/SCF Sack Origin Post Office/DMU 2.546 E15 Destination NDC 1.781 E16 Destination ADC 1.466 E17 Destination SCF 0.957 E18 Origin NDC 3.355 E19 Origin ADC 3.355 E20 Origin SCF 3.355 E21 5-Digit/Carrier Origin Post Office/DMU 3.355 E22 Route Sack Destination NDC 2.475 E23 Destination ADC 2.077 E24 Destination SCF 1.564 E25 DDU 1.027 PS Form 3541, January 2018 (Page 6 of 8) Part E continued on next page
Part E Continued Outside-County Tray Prices Container Level Entry Trays Price Postage E26 Origin NDC $0.627 E27 Origin ADC 0.627 Mixed ADC Tray E28 Origin SCF 0.627 E29 Origin Post Office/DMU 0.627 E30 Origin NDC 2.415 E31 Origin ADC 2.415 E32 Origin SCF 2.415 ADC Tray E33 Origin Post Office/DMU 2.415 E34 Destination NDC 1.639 E35 Destination ADC 0.952 E36 Origin NDC 2.546 E37 Origin ADC 2.546 E38 Origin SCF 2.546 E39 3-Digit/SCF Tray Origin Post Office/DMU 2.546 E40 Destination NDC 1.781 E41 Destination ADC 1.466 E42 Destination SCF 0.957 E43 Origin NDC 3.355 E44 Origin ADC 3.355 E45 Origin SCF 3.355 E46 5-Digit/Carrier Origin Post Office/DMU 3.355 E47 Route Tray Destination NDC 2.475 E48 Destination ADC 2.077 E49 Destination SCF 1.564 E50 DDU 1.027 E51 Part E Sack and Tray (Add lines E1 E50) Part E continued on next page PS Form 3541-7, January 2018 (Page 7 of 8) PSN 7530-10-000-0502
Part E Continued Outside-County Pallet Prices Container Level Entry Pallets Price Postage E52 Origin NDC $8.093 E53 Origin ADC 8.093 Mixed ADC Pallet E54 Origin SCF 8.093 E55 Origin Post Office/DMU 8.093 E56 Origin NDC 64.195 E57 Origin ADC 64.195 E58 Origin SCF 64.195 ADC Pallet E59 Origin Post Office/DMU 64.195 E60 Destination NDC 44.386 E61 Destination ADC 25.475 E62 Origin NDC 66.992 E63 Origin ADC 66.992 E64 Origin SCF 66.992 E65 3-Digit/SCF Pallet Origin Post Office/DMU 66.992 E66 Destination NDC 47.187 E67 Destination ADC 42.783 E68 Destination SCF 24.849 E69 Origin NDC 82.237 E70 Origin ADC 82.237 E71 Origin SCF 82.237 E72 5-Digit Pallet Origin Post Office/DMU 82.237 E73 Destination NDC 62.404 E74 Destination ADC 58.001 E75 Destination SCF 40.066 E76 Origin NDC 64.567 E77 Origin ADC 64.567 E78 Origin SCF 64.567 E79 Origin Post Office/DMU 64.567 Carrier Route Pallet E80 Destination NDC 44.734 E81 Destination ADC 40.331 E82 Destination SCF 21.596 E83 DDU 3.046 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)
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)