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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
			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
			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
			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).							19. Date Signed


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
		Check if		Application under New Launch procedure
		Applicable:		(Attach publisher’s signed business plan)
	1. Basic Annual Subscription Price
	1. Basic Annual Subscription Price						$
Distribution	2. Subscriptions Received by the Publisher at the Basic Annual
Distribution	Subscription Price From Persons to Whom Publication is Sent
	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
Paid	Publisher's Cost Per Item		Retail Value		Value Represented
	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)
Nonsub.	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
	1. Benevolent or Fraternal						Published:	 Under auspices of society or order
								 Under auspices of society or order
Institutions/Societies										Certified copy of the constitution and bylaws and
				Type:						Certified copy of the constitution and bylaws and
	2.	Society		Type:	 Literary  Professional  Historical				 Scientific	the resolution or order showing the date publica-
	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
	3. Trade Union			Published:					of trade union
				Published:					of trade union

	4. Church or Church Organization			Publication Is			 Church	 Church organization		Evidence that the publication is actually issued
	4. Church or Church Organization			Issued By:						by a church or church organization
										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		Certified copy of the charter, articles of incorpora-
	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
			institution of learning?	learning supported in whole or in				secondary institution of learning or its		amendments thereto, and, when necessary, evi-
				part by public taxation?				administrative or governing body?		amendments thereto, and, when necessary, evi-
		Learning		part by public taxation?				administrative or governing body?		dence to substantiate nonprofit status or support
		Learning
			 Yes  No	 Yes		 No		 Yes	 No
			 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)
1. If this application includes a request for
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.	 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)	 Scientific	 Labor	 Other Qualified Organizations

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
Your publication originates in another country but you
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)	PRIVACY NOTICE: See our privacy policy on www.usps.com®.

Question	Answer
Form Name	Form 3500
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	ps form 3500, form 3500 application, form 3500, form 3500 fda

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