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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)

Mailer

Mailing

Publication Title and Owner or News Agent's Name Mailing Agent's (Printer or Consolidator) Name, Address, Telephone Number,	Entry Post Office Name, State, and ZIP+4
and Email Address if Any

CAPS Customer Ref. No.

Printer/Consolidator Imprint Permit No.

CRID

Applicable Parts Completed

Statement for bundles/

Price Category

Regular

Nonprofit

Combined Mailing

Consolidated Postage Statement

(select all that apply)

containers only

Mixed Class

B - E

(If Applicable)

Classroom

Science-of-Agriculture

Single Class

Yes

Publication No.

Edition/Code

Mailer's Mailing Date

Processing Category

No. of Addressed Pieces

Number of Addressed Supplements

Letters

Excluding Addressed

In-County

Outside-County

Flats

Supplements

Issue Date

Issue Frequency

Statement Sequence No.

Parcels

Weight of

a Single

Weight per Copy for Issue (Round off to 4 decimal

Advertising Percentage in This

Number and Type of Containers. (Enter total number of

Ride-Along piece

places if necessary)

Issue

containers)

0 . ___ ___ ___ ___ lb.

____ ____ . ____ ____ ____ ____ pounds

____ ____ . ____ ____ %

_____ Trays _____ Sacks _____ Pallets

For Automation Pieces, Enter Date

For Carrier Route Pieces, Enter Date

For Carrier Route Pieces, Enter

For pieces bearing a simplified address enter date of

of Address Matching and Coding

Date of Carrier Route Sequencing

delivery statistics file or alternative method

____ ____ / ____ ____ / ___ ___ ___ ___

____ ____ / ___ ___ / ___ ___ ___ ___

Postage

Certification

Part A InCounty Prices Total Part A (page 2) (Postmaster: Report total Part A postage in AIC 224)

Part B OutsideCounty Pound Prices	Total Part B (Page 3)

Part C OutsideCounty Piece Prices	Total Part C (Page 4)

Part D OutsideCounty Bundle Prices	Total Part D (Page 5)

Part E OutsideCounty Sack/Tray/Pallet Prices	Total Part E (Page 6 &7)

OutsideCounty Postage	Subtotal Parts B, C, D, and E

Preferred Price Discount - Nonprofit, Classroom, Limited Circulation, Limited Circulation Science of
Agriculture (Add line B19, and parts C, D, and E Totals) _____ X .05 (all others enter zero)

Subtract the Preferred Price Discount from the OutsideCounty Postage		=
Part F OutsideCounty RideAlong and Repositionable Notes (Page 8)		+

Total OutsideCounty Postage (Postmaster: Report total Outside-County postage in AIC 135)

	Add Total InCounty Postage and Total OutsideCounty Postage	Total Postage
		Total Postage
		(AIC 224 + AIC 135)

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.


Owner or Agent's Name	OnlyUseUSPS	incompletedbeTo PostalOne!sites-non	Post Office Computed Weight per Copy			Round Stamp	(Required)	Tobecompletedin	USPSUseOnly
	OnlyUseUSPS	incompletedbeTo PostalOne!sites-non	(Round off to 4 decimal places if necessary)			Payment Date	non-sitesPostalOne!	Tobecompletedin	USPSUseOnly
			(Round off to 4 decimal places if necessary)			Payment Date
			____ ____ . ____ ____ ____ ____ pounds
Owner or Agent's Signature			____ ____ . ____ ____ ____ ____ pounds
Owner or Agent's Signature
			Time	AM	PM

Name and Telephone Number of Contact			USPS Employee's Signature
Person in Publisher's Office			Print USPS Employee's Name
			Print USPS Employee's Name

Form 35411, September 2014 (Page 1 of 8) PSN 7530-07-000-6222 This form and mailing standards are available on Postal Explorer at pe.usps.com.

Periodicals One Issue or One Edition InCounty

Part A

Check box at left if prices are populated in this section.

InCounty

Pound Price

Subscriber or

Nonsubscriber or

Total

Entry

Requester

Nonrequester

Price

Copies

Pounds

Postage

Copies

DDU

$0.157

None

0.205

Total Pound Price Postage (Add lines A1 and A2)

Piece Price (Presort)

Entry / Zone

Presort Discount

Total

Addressed

Price

Total

Copies

Pieces

Postage

Nonautomation

$0.143

Basic

Automation Letters

0.066

Automation Flats

0.127

Nonautomation

0.131

3-Digit

Automation Letters

0.054

Automation Flats

0.119

A10

Nonautomation

0.117

A11

5-Digit

Automation Letters

0.052

A12

Automation Flats

0.111

A13

Basic

0.067

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

A20

Number of pieces that comply ____________ x $0.001 =

Periodicals InCounty Subtotal (Line A18 minus A19)

RideAlong Price

(Must equal the number of copies in line A16, not number of addressed pieces)

A21 Ride-Along Pieces

Repositionable Notes

(Must equal the number of copies in line A16, not number of addressed pieces)

A22 Repositionable Notes

Total	Addressed		Total
Copies	Pieces	Price	Postage

		$0.179

Total	Addressed	Price	Total
Copies	Pieces	Price	Postage

		$0.000

A23

Other Subtotal(Add lines A21 and A22)

Part A Total (Add lines A3, A20, and A23) Postmaster: Report in AIC 224

PS Form 3541, September 2014 (Page 2 of 8)

Periodicals One Issue or One Edition OutsideCounty

Part B	Check box at left if prices are populated in this section.

OutsideCounty 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

Price

Subscriber or Nonsubsc. or

Total

Advertising

Entry Zone

Requester

Nonreq.

Total Copies

Total Pounds

Reg

Sci/Ag

Copies

Pounds

Postage

DDU

$0.146

$0.110

DFSS

0.223

0.167

DSCF

0.223

0.167

DADC

0.239

0.179

1 & 2

0.262

0.197

0.287

0.353

0.452

0.555

B10

0.683

B11

0.794

B12

0.794

B13

Subtotal (Add lines B1-B12)

Nonadvertising Pound Prices

Price

Total

Advertising equals Nonadvertising

minus

Reg

Sci/Ag

Total Postage

Pounds

B14

DDU

(From B1)

$0.123

B15

DFSS

(From B2)

0.186

B16

DSCF

(From B3)

0.186

B17

DADC

(From B4)

0.198

B18

All Others

(From B5-B12)

0.220

B19

Subtotal (Add lines B14-B18)

Pound Price Postage Total (Add lines B13 and B19)

Nonadvertising Pound Prices Alternate (Nonprofit and Classroom publications with 10% or less advertising, or other publications with 0% advertising.)

						Price
		Subscriber or	Nonsubsc. or
		Subscriber or
	Entry Zone	Requester		Total Copies Total Pounds	Reg		Sci/Ag	Total Postage
	Entry Zone	Requester	Nonreq. Copies	Total Copies Total Pounds	Reg		Sci/Ag	Total Postage
		Copies	Nonreq. Copies
		Copies
B14	DDU				$0.123		$0.123

B15	DFSS				0.186		0.186

B16	DSCF				0.186		0.186

B17	DADC				0.198		0.198

B18	All Others				0.220		0.220

B19					Subtotal (Add lines B14-B18)

Part B Total Pound Price Total (Add lines B13 and B19)

PS Form 35413, September 2014 (Page 3 of 8) PSN 7530-07-000-6223

Periodicals One Issue or One Edition OutsideCounty

		Part C				Check box at left if prices are populated in this section.
		Part C				Check box at left if prices are populated in this section.
	OutsideCounty Piece Prices
	OutsideCounty Piece Prices
Machinable Flats
			Level	Price Level	Total Copies	Addressed Pieces	Price	Total
			Level	Price Level	Total Copies	Addressed Pieces	Price	Postage
								Postage
C1			Mixed ADC	Barcoded			$0.447
C2				Nonbarcoded			0.481

C3				FSS
C4			ADC	Barcoded			0.418
C5				Nonbarcoded			0.444

C6				FSS
C7			3-Digit	Barcoded			0.401
C8				Nonbarcoded			0.425

C9				FSS
C10			5-Digit	Barcoded			0.308
C11				Nonbarcoded			0.321

C12				FSS
Nonmachinable Flats
C13			Mixed ADC	Barcoded			$0.625

C14				Nonbarcoded			0.675

C15			ADC	Barcoded			0.521

C16				Nonbarcoded			0.553

C17			3-Digit	Barcoded			0.456

C18				Nonbarcoded			0.474

C19			5-Digit	Barcoded			0.335

C20				Nonbarcoded			0.336

Parcels

C21 Mixed ADC

C22 ADC

C23 3-Digit

C24 5-Digit

Letters

$0.675

0.553

0.474

0.336

C25	Mixed ADC	Barcoded		$0.348

C26		Nonbarcoded		0.481

C27	ADC	Barcoded		0.308

C28		Nonbarcoded		0.444

C29	3-Digit	Barcoded		0.286

C30		Nonbarcoded		0.425

C31	5-Digit	Barcoded		0.221

C32		Nonbarcoded		0.321

Carrier Route & Firm Bundles
C33	Basic			$0.205

C34	High-Density			0.172

C35	Saturation			0.146

C36	Firm Bundle (Use "Addressed Pieces" to			0.199
C36	calculate postage)			0.199
	calculate postage)
C37	Subtotal (Add lines C1 through C36)
C38	Nonadv. % (100 minus adv.%) _____ X # of Addressed Pieces (C37) X $0.00111


C39			Subtotal Outside County Piece Prices (Line C37 minus C38)

Full Service Intelligent Mail Option

C40

Number of pieces that comply ______ x $0.001 =

Part C Total (Line C39 minus C40)

PS Form 3541, September 2014 (Page 4 of 8)

Periodicals One Issue or One Edition OutsideCounty

	Part D				Check box at left if prices are populated in this section.
	Part D				Check box at left if prices are populated in this section.
	Outside County Bundle Prices
	Outside County Bundle Prices
		Container Level	Bundle Level	Bundles		Price	Total
		Container Level	Bundle Level	Bundles		Price	Postage
							Postage
D1			Mixed ADC			$0.086

D2			ADC			0.225

D3		Mixed ADC	3-Digit/SCF			0.299

D4			FSS Scheme			0.299

D5			5-Digit			0.310

D6			Carrier Route			0.438

D7			Firm			0.201

D8			ADC			0.125

D9			3-Digit/SCF			0.207

D10		ADC	FSS Scheme			0.207

D11			5-Digit			0.223

D12			Carrier Route			0.353

D13			Firm			0.167

D14			3-Digit/SCF			0.143

D15		SCF/ 3-Digit	FSS Scheme			0.143
		SCF/ 3-Digit
D16			5-Digit			0.163

D17			Carrier Route			0.313

D18			Firm			0.154

D19		FSS Facility	FSS Scheme			0.143

D20		FSS Scheme	FSS Scheme			0.143

D21			5-Digit			0.157

D22		CR/ 5-Digit	Carrier Route			0.165

D23			Firm			0.086

Part D Total (Add lines D1-D23)

PS Form 35415, September 2014 (Page 5 of 8) PSN 7530-10-000-0501

Periodicals One Issue or One Edition OutsideCounty

		Part E				Check box at left if prices are populated in this section.
		Part E				Check box at left if prices are populated in this section.
		OutsideCounty Sack and Tray Prices
		OutsideCounty Sack and Tray Prices

OutsideCounty Sack/Tray Prices
			Container Level	Entry	Sacks/Trays	Price	Total
			Container Level	Entry	Sacks/Trays	Price	Postage
							Postage
	E1			Origin NDC		$0.482

	E2		Mixed ADC	Origin ADC		0.482
	E3		Sack/Tray	Origin SCF		0.482

	E4			Origin Post Office/DMU		0.482

	E5			Origin NDC		2.260

	E6			Origin ADC		2.260

	E7		ADC Sack/Tray	Origin SCF		2.260

	E8			Origin Post Office/DMU		2.260

	E9			Destination NDC		1.580

	E10			Destination ADC		0.903

	E11			Origin NDC		2.371

	E12			Origin ADC		2.371

	E13		3-Digit /	Origin SCF		2.371
	E14		SCF Sack/	Origin Post Office/DMU		2.371

	E15		Tray	Destination NDC		1.694

	E16			Destination ADC		1.355

	E17			Destination SCF		0.903

	E18			Origin NDC		2.371

	E19			Origin ADC		2.371

	E20			Origin SCF		2.371

	E21		FSS Facility	Origin Post Office/DMU		2.371

	E22		Sack/Tray	Destination NDC		1.694

	E23			Destination ADC		1.355

	E24			Destination FSS
	E25			Destination SCF		0.903

	E26			Origin NDC		2.371

	E27			Origin ADC		2.371

	E28			Origin SCF		2.371

	E29		FSS Scheme	Origin Post Office/DMU		2.371

	E30		Sack/Tray	Destination NDC		1.694

	E31			Destination ADC		1.355

	E32			Destination FSS
	E33			Destination SCF		0.903

	E34			Origin NDC		3.048

	E35			Origin ADC		3.048

	E36		5-Digit/	Origin SCF		3.048
	E37		Carrier Route	Origin Post Office/DMU		3.048

	E38		Sack/Tray	Destination NDC		2.258

	E39			Destination ADC		1.919

	E40			Destination SCF		1.468

	E41			DDU		1.016

E42

Part E Sack and Tray Total (Add lines E1-E41)

PS Form 3541, September 2014 (Page 6 of 8)

Periodicals One Issue or One Edition OutsideCounty

Part E - Continued

Check box at left if prices are populated in this section.

OutsideCounty Pallet Prices

OutsideCounty Pallet Prices						Total
	Container Level	Entry	Pallets		Price	Total
	Container Level	Entry	Pallets		Price	Postage
						Postage
E43		Origin NDC		$3.825

E44	Mixed ADC Pallet	Origin ADC		3.825

E45		Origin SCF		3.825

E46		Origin Post Office/DMU		3.825

E47		Origin NDC		36.415

E48		Origin ADC		36.415

E49	ADC Pallet	Origin SCF		36.415

E50		Origin Post Office/DMU		36.415

E51		Destination NDC		25.125

E52		Destination ADC		13.908

E53		Origin NDC		43.135

E54		Origin ADC		43.135

E55	3-Digit /	Origin SCF		43.135

E56	SCF Pallet	Origin Post Office/DMU		43.135

E57		Destination NDC		26.695

E58		Destination ADC		23.218

E59		Destination SCF		12.449

E60		Origin NDC		43.135

E61		Origin ADC		43.135

E62		Origin SCF		43.135

E63	FSS Facility	Origin Post Office/DMU		43.135

E64	Pallet	Destination NDC		26.695

E65		Destination ADC		23.218

E66		Destination FSS
E67		Destination SCF		12.449

E68		Origin NDC		43.135

E69		Origin ADC		43.135

E70		Origin SCF		43.135

E71	FSS Scheme	Origin Post Office/DMU		43.135

E72	Pallet	Destination NDC		26.695

E73		Destination ADC		23.218

E74		Destination FSS		0.000

E75		Destination SCF		12.449

E76		Origin NDC		56.538

E77		Origin ADC		56.538

E78		Origin SCF		56.538

E79	5-Digit /	Origin Post Office/DMU		56.538

E80	Carrier Route Pallet	Destination NDC		35.781

E81		Destination ADC		33.872

E82		Destination SCF		22.881

E83		DDU		1.795


E84	Part E Pallet Total (Add lines E43-E83)

Part E Total (add lines E42 and E84)

PS Form 35417, September 2014 (Page 7 of 8) PSN: 7530-10-000-0502

Periodicals One Issue or One Edition OutsideCounty

	Part F
	Part F
	RideAlong Price and Repositionable Notes (Outside-County Only)		Check box at left if prices are populated in this section.
			Check box at left if prices are populated in this section.

RideAlong Price		Total	Addressed	Price	Total
(Must equal the number of copies, not number of addressed pieces)		Copies	Pieces	Price	Postage
		Copies	Pieces		Postage

F1	Ride-Along Pieces			$0.179

Repositionable Notes		Total	Addressed	Price	Total
(Must equal the number of copies, not number of addressed pieces)		Copies	Pieces	Price	Postage
		Copies	Pieces		Postage

F2	Repositionable Notes			$0.000

Part F Total (Add lines F1 and F2)

PS Form 3541, September 2014 (Page 8 of 8)

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:

Parts A - In-County piece and pound prices.

Parts B - Outside-County pound prices.

Parts C - Outside-County piece prices.

Parts D - Outside-County bundle prices.

Parts E - Outside-County sack/tray/pallet prices.

Parts F - Outside-County Ride-along and Repositionable Notes 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 Total 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 Total 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.)

Information: For more information on mailing standards, prices, and fees please go to Postal Explorer at pe.usps.com.

PS Form 3541, September 2014 (Instructions)

Question	Answer
Form Name	Ps Form 3541 1
Form Length	9 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	2 min 15 sec
Other names	usps 3541, 3541 form ps printable, 3541 postal form form, the form 3541

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