Form 3500 PDF Details

Navigating the intricacies of postal regulations and filing procedures, the 3500 form emerges as a fundamental document for entities seeking Periodicals Mailing Privileges. Integral to this pursuit are the detailed instructions spanning pages 3 and 4, guiding applicants through a meticulously structured process tailored to various publication categories. Each category, from General to Requester Publications, and from State Department of Agriculture Publications to Foreign Publications, demands specific parts of the form to be completed. This comprehensiveness ensures that the diverse nature of periodical publications is accommodated, whether they involve institutional advertising or news agents. Essential information such as publication title, frequency, ownership details, and distribution specifics are solicited to gauge eligibility under the Postal Service’s criteria. Moreover, the form reflects a broader commitment to transparency and accountability, mandating disclosures about financial interests that might influence content or circulation. The procedural aspects extend to audits of circulation, underscoring the USPS’s vigilant oversight. Also noteworthy is the provision for special rates under Part F, catering to publications from nonprofit organizations meeting certain criteria. In sum, the 3500 form stands as a critical conduit for accessing Periodicals Mailing Privileges, encapsulating a range of requirements and facilitating a comprehensive review process to uphold the standards and integrity of periodical mailing.

QuestionAnswer
Form NameForm 3500
Form Length4 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min
Other namesps form 3500, form 3500 application, form 3500, form 3500 fda

Form Preview Example

See instructions on pages 3 and 4

Application for Periodicals Mailing Privileges

Filing Status

Type of Publication—See DMM® 207.6 (Check only one):

General Publication—Complete Parts A and B Requester Publication—Complete Parts A and C

Publication of State Department of Agriculture—Complete Parts A and D

News Agents—Complete Part A and attach a separate sheet listing the publications you handle and where they are published.

Foreign Publication—Complete Parts A and B

Publication of Institutions and Societies With Publisher’s Advertising Only—Complete Parts A and D

Publication of Institutions and Societies With General Advertising— Complete Parts A, D, and E

Request for Permission to Mail at Special Periodicals Rates— Complete Part F and all other applicable parts

Publication Information

Postmaster

Part A

1. Title of Publication as Shown on Publication

 

 

2. Name of Publisher ( Agent for Foreign

3. ISSN (If already assigned)

 

 

 

 

 

Publication)

 

 

 

 

 

 

 

 

4. Frequency of Issue (Be specific. For example, "weekly," "monthly except June")

 

5. Number of Issues Published Annually

6. Basic Annual Subscription Price

 

 

 

 

 

 

 

 

7. Full Name of Owner (Individual, partnership, or corporation)

 

 

8. Complete address of Known Office of Publication, Including County. For foreign

 

 

publications, agent’s address (not a Post Office™ box address)

 

 

 

 

 

 

 

 

 

 

 

9. If owned by a corporation, list the names of all stockholders owning or holding

 

 

 

 

1 percent or more of the total stock. (Attach a separate sheet if necessary)

 

 

 

 

 

 

 

 

 

 

 

 

10. Are any of the owners or stockholders interested financially in any

Yes

 

If response is "Yes," explain the interest.

 

 

business or trade represented by the publication? (Check one)

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11. Do any of the persons or concerns that advertise in the publication

Yes

 

If response is "Yes," explain the interest.

 

 

have any interest therein? (Check one)

No

 

 

 

 

 

 

 

 

 

 

 

12. Is more than one copy of each issue furnished to any one advertiser

Yes

 

If response is "Yes," how many copies are furnished and what are the reasons.

therein? (Check one)

 

 

No

 

 

 

 

 

 

 

 

 

 

 

13. Date of issue on which application is based. (Usually issue published closest to

 

14. Total Number of Copies Printed (For foreign publications, number

date of filing)

 

 

 

 

of copies imported into United States)

 

 

 

 

 

 

 

 

 

15. Contact's Name

 

16. Contact's Address

 

17. Contact's Telephone Number

 

 

 

 

 

 

I hereby certify that all information

furnished on this form is in support of this application, including the Business Plan

 

18. Signature of Publisher (or Agent for

supporting an application under the New Launch procedure (if applicable), and other supporting documentation, is

 

Foreign Publication)

 

 

accurate, truthful, and complete. I understand that anyone who furnishes false or misleading information or who omits

 

 

material information requested on this form may be subject to criminal sanctions (including fines and imprisonment)

 

19. Date Signed

and/or civil actions (including multiple damages and civil penalties).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20. Date of First Mailing Under Deposits After Application Was Filed

 

21. Amount of Application Fee Paid

 

22. Date Fee Paid

 

 

 

 

 

23. Name of Postal Employee to Contact With Any Questions About

 

24. Signature of Postmaster

 

25. Date Signed

This Application (Print)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26. Post Office Address

 

 

 

 

 

 

27. Area Code/Telephone Number

Check if Centralized Acceptance Post Office

 

Part B

Check if

Application under New Launch procedure

 

 

 

 

Applicable:

(Attach publisher’s signed business plan)

 

1. Basic Annual Subscription Price

 

 

 

 

 

$

Distribution

2. Subscriptions Received by the Publisher at the Basic Annual

 

Subscription Price From Persons to Whom Publication is Sent

 

 

 

 

3. Subscriptions Received Under Offer of a Premium or Other

 

 

Reduction Arrangement (Attach a separate sheet if necessary)

 

 

Description of Premium or Reduction Arrangement

 

 

Paid

 

 

 

 

 

 

 

Publisher's Cost Per Item

Retail Value

Value Represented

 

 

 

 

 

 

 

 

 

 

4. Subscriptions Paid for With Dues or Contributions

(Attach

 

Nonsub.

printed copies of forms used for taking these subscriptions)

 

11. Single or Bulk Copies for Free Distribution (Samples/comps)

 

 

 

 

12. Expired Subscriptions

 

 

 

 

Percentage

16. Unsold Newsstand and Vending Copies on Hand, Inventory for

 

 

 

 

Future Orders, Copies Destroyed, etc. (Attach documentation)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PS Form 3500, December 2014 (Page 1 of 4) PSN: 7510-05-000-4625

Initial Audit of circulation by

Electronic Copies — Initial Audit of circulation

Authorized Audit Bureau Requested

by Authorized Audit Bureau Required

5.Copies Purchased by Others (Attach a separate sheet showing who purchased, for what price, and for what purposes)

6.All Single Copies Sold (Newsstand, vendor, street sales)

7.Copies Furnished to Actual Advertisers in This Issue to Prove Insertion of Ads (One copy per advertiser)

8.Copies Exchanged With Other Publications (One copy for another)

9.Other Paid Circulation (Describe)

10.Total Paid Distribution (Add items 2 through 9)

13.Nominal Rate Subscriptions (DMM 207.6.1.2)

14.Total Nonsubscriber Distribution (Add items 11 through 13)

15.Total Copies Distributed (Add items 10 and 14)

17.Total Copies Printed (Add items 15 and 16. Should match total on press run/order or number imported. Attach press run or print order)

18.Percentage of Qualified Subscribers (Divide item 10 by item 15)

This form is on the Internet at www.usps.com®.

Application for Periodicals Mailing Privileges (Continued)

Percentage Nonreq. Requester Copies

Part C

Check if

Application under New Launch procedure

Applicable:

(Attach publisher’s signed business plan)

 

1.Requests Received by the Publisher From the Persons to Whom the Publication Is Sent (Not paid subscription copies)

2.Subscription Copies Paid for or Promised to be Paid for Including Those Below Nominal Rate

3.Copies Furnished to Actual Advertisers in This Issue to Prove Insertion of Ads (One copy per advertiser)

4.Copies Exchanged With Other Publications (One copy for another)

5.Copies Requested by Employers for Employees by Name or Position (Attach samples of these requests)

9.Requests More Than 3 Years Old

10.Requests Induced by a Premium Offer or Material Consideration

14.Unsold Newsstand and Vending Copies on Hand, Inventory for Future Orders, Copies Destroyed, etc. (Attach documentation)

Initial Audit of circulation by

Electronic Copies — Initial Audit of circulation by

Authorized Audit Bureau Requested

Authorized Audit Bureau Required

6.All Single Copies Sold (Newsstand, vendor, street sales)

7.Copies Sent in Fulfillment of Requests in a Manner Not Covered in Items 1 through 6 (Explain)

8.Total Requested Distribution (Add items 1 through 7)

11.Total Sample Copies Distributed (In the mails or otherwise)

12.Total Nonrequester Distribution (Add items 9 through 11)

13.Total Copies Distributed (Add items 8 and 12)

15.Total Copies Printed (Add items 13 and 14. Should match total on order or number imported. Attach press run or print order)

16.Percentage of Qualified Requesters (Divide item 8 by item 13)

Part D

 

 

 

Type of Organization (Complete one row)

 

 

Attach to Application

 

 

 

 

 

 

 

 

 

 

1. Benevolent or Fraternal

No. of Members

 

Publication is

By society or order

 

 

 

 

 

Published:

Under auspices of society or order

 

 

 

 

 

 

 

 

 

 

Institutions/Societies

 

 

 

 

 

 

 

 

 

Certified copy of the constitution and bylaws and

 

 

 

Type:

 

 

 

 

 

2.

Society

 

Literary Professional Historical

Scientific

the resolution or order showing the date publica-

 

 

 

 

 

 

 

 

 

 

 

 

tion was adopted by the organization

 

3. Trade Union

 

Publication Is

 

By trade union

Under auspices

 

 

 

Published:

 

 

 

 

of trade union

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4. Church or Church Organization

Publication Is

 

Church

Church organization

Evidence that the publication is actually issued

 

Issued By:

 

 

 

 

 

by a church or church organization

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is publication issued by

Is publication issued by a regularly

Is publication issued by a public or

Certified copy of the charter, articles of incorpora-

 

 

 

a regularly incorporated

established state institution of

nonprofit private elementary school or

 

5.

Institution of

institution of learning?

learning supported in whole or in

secondary institution of learning or its

tion, legislative act creating the institution and

 

amendments thereto, and, when necessary, evi-

 

 

part by public taxation?

administrative or governing body?

 

 

Learning

 

dence to substantiate nonprofit status or support

 

 

 

 

 

 

 

 

 

 

 

 

Yes No

Yes

No

Yes

No

 

 

 

by public taxation

 

 

 

 

 

 

 

 

6.

State Agency of Health, Public Charities, Corrections, Agriculture,

Agency Issuing Publication

Evidence that authorized agency issues the

 

 

Conservation, Fish and Game, or Industrial Development

 

 

 

 

publication

 

7. Educational Radio or Television Agency of a State or Political Subdivision

Category Under Which Applying

Evidence that authorized station issues the

 

 

of a State, or a Nonprofit Educational Radio or Television Station

 

 

publication

Institutions/Societies w/Adv.

Part E

1.Subscriptions From Members Who Received the Publication Paid for by Dues or Assessments, Contributions, or Otherwise (Attach a certified copy of the resolution or arrangement used for taking these subscriptions)

2.Copies Sent to Other Subscribers

3.Copies Exchanged With Other Publications (One copy for another)

4.Subscriptions Obtained in a Manner Not Covered Above (Explain in block 9)

5.Copies Furnished to Actual Advertisers in This Issue to Prove Insertion of Ads (One copy per advertiser)

6.Total Subscriptions (Add items 1 through 5)

7.Total Sample Copies Distributed (In the mails or otherwise)

8.Disposition and Number of Remaining Copies (Explain)

9.Explanation From Item 4

Part F

Special Rates

1. If this application includes a request for

A. Nonprofit Category (Check one box only)

B. Price (Check one box only)

 

 

 

 

special Periodicals privileges, submit doc-

Religious

Philanthropic

Veterans

Science-of-Agriculture (DMM 207.11.2)

umentation that shows your organization

Educational

Agricultural

Fraternal

Classroom (DMM 207.10.4)

meets the requirements in DMM 207.10.

Scientific

Labor

Other Qualified Organizations

 

(Check one box in either A or B)

 

 

 

 

 

 

2. Was organization formed for profit or does any net income inure to the benefit of any private stockholder or individual?

Yes No

PS Form 3500, December 2014 (Page 2 of 4)

INSTRUCTIONS FOR COMPLETING PS FORM 3500, APPLICATION FOR PERIODICALS MAILING PRIVILEGES

APPLICANT

Complete PS Form 3500 when applying for any category of Periodicals mailing privilege.

Information about Periodicals mail is published in the Domestic Mail Manual (DMM®). You can access the DMM on the Internet at http://pe.usps.gov.

If you're looking for...

Then turn to...

 

 

 

 

General eligibility for Periodicals rates

DMM 207.4

 

 

 

 

Standards for physical construction and mailpiece components

DMM 207.3

 

 

 

 

Postage rates for Periodicals

DMM 207.1

 

 

 

 

If you have questions about Periodicals mailing, check the DMM first. If you still need help:

Call the manager of Business Mail Entry at the district office that serves your ZIP Code™. This information is listed in DMM 608.8.4.1

Call the USPS® help line at 800-ASK-USPS®.

All publications must first meet these basic standards to qualify for Periodicals rates:

1.You must show intent to publish issues indefinitely with continuity from issue to issue. Your purpose must be to transmit information of a general or specific nature.

2.You must publish issues at a regular frequency of at least four times a year.

3.You must maintain a known office of publication where normal business is conducted during posted hours.

4.Your publication must be formed of printed sheets.

Completing the Application

There are several eligibility categories. Consult the DMM for full requirements, including advertising restrictions.

If...

Then your publication may be

And you can

To apply,

 

eligible as a...

read more in...

complete...

At least 50 percent of your total distribution goes to

General Publication

DMM 207.6.1

Parts A and B

individuals who have paid above a nominal rate

 

 

 

At least 50 percent of your total distribution goes to

Requester Publication

DMM 207.6.4

Parts A and C

qualified requesters, whether or not they have paid for

 

 

 

the subscription

 

 

 

 

 

 

 

Your publication is issued by a state department of

Publication of a State Department

DMM 207.6.3

Parts A and D

agriculture

of Agriculture

 

 

Your publication originates in another country but you

Foreign Publication

DMM 207.6.6

Parts A and B

 

 

 

have a known office of publication through an agent

 

 

 

or broker in the United States

 

 

 

 

 

 

 

Your publication is issued by an institution or society

Publication of an Institution

DMM 207.6.2

Parts A and D

and contains the institution's or society's advertising

or Society With Publisher's

 

 

only

Advertising Only

 

 

Your publication is issued by an institution or society

Publication of an Institution or

DMM 207.6.2

Parts A, D, and E

and contains general advertising

Society With General Advertising

 

 

 

 

 

 

In addition, if your publication is issued by a nonprofit organization, you may qualify for discounted rates. Read DMM 207.10 and complete Part F.

If you are a person or business selling two or more publications from different publishers, you are considered a News Agent. Read DMM 207.6.7 and complete Part A. Attach a separate sheet listing the publications you handle and where they are published.

PS Form 3500, December 2014 (Page 3 of 4)

INSTRUCTIONS FOR COMPLETING PS FORM 3500 (Continued)

Filing the Application

Submit your application to the Post Office that serves your known office of publication. Bring all of the following:

1.A completed PS Form 3500.

2.For an application filed under the “General” or “Requester” category, the publisher must check the appropriate space in Part B or Part C, as applicable, if the application is being submitted under the New Launch procedure.

3.The publisher must check the applicable space in Part B or Part C, as applicable, if requesting or if required to have the initial audit of circulation be performed by an authorized audit bureau.

4.Two copies of the issue of the publication described in this application marked to show the advertising content. Indicate on the cover both the total units (e.g., column inches, square inches, pages) and the percentage of advertising and nonadvertising. If the publication is in a foreign language, provide a brief translation of its contents.

5.The application fee. This fee is nonrefundable and may be paid by cash, check (payable to “Postmaster”), or credit card.

6.If you intend to mail at a Post Office other than the Post Office that serves your known office of publication, you must submit a completed PS Form 3510-M, Application for Additional Mailing Office for Periodicals Publication.

Publisher's Records

You must make adequate records available to the Postal Service™ to permit verification of the figures on your application. The Postal Service will contact you to schedule this review. (Not applicable for an application filed under the “General” or “Requester” category if the initial verification of circulation will be performed by an authorized audit bureau.)

POSTMASTER

Process PS Form 3500 as follows:

1.Review the application for completeness.

2.Complete items 20 through 27 on page 1. Round-date the application in this area.

3.Forward the application and one marked copy of the publication to the manager of the Pricing and Classification Service Center (PCSC).

PRICING AND CLASSIFICATION SERVICE CENTER

90 CHURCH STREET, STE 3100

NEW YORK NY 10007-2951

PRICING AND CLASSIFICATION SERVICE CENTER

1.Review the application to determine if the basic Periodicals criteria are met.

2.If the criteria are met, the PCSC manager sends a memo to the postmaster or BME manager giving instructions on how to audit the publication, with a list of the specific records to be reviewed. These records may include the following, as applicable:

a.Print order and printer's invoice.

b.Mailing labels or a mailing list.

c.Subscription/requester list.

d.Records of newsstand and over-the-counter sales and returns.

e.Stubs or copies of receipts issued.

f.Records of vending machine sales and returns.

g.Records of membership dues paid (if they include a subscription fee).

h.Assignment and collection records for carriers other than USPS.

i.Cash receipts, cashbook, or similar source records that show subscription payments.

j.Records showing the number of copies destroyed.

k.Records of gift subscriptions.

l.Records of bulk orders.

3.Once the audit is completed and returned, the PCSC manager rules on the application.

PS Form 3500,

December 2014 (Page 4 of 4)

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